Economics Health Care Essay

Many skilled nursing facilities have used a modified functional nursing structure, with a registered nurse leading in care planning and supervision, a licensed vocational nurse giving medication and some treatments, and nursing assistants performing hygienic and activities-of-daily-living tasks. With a new emphasis on rehabilitation of their changing and ever more acutely client population, they have developed new roles for the nursing assistants. One such role is that of the restorative aide. These individuals receive additional supervision and training related to range of motion, transfers, and other activities and may work in team with physical and occupational therapists. In some states, nursing assistants in long-term care or residential facilities receive additional training to administer oral medications under the supervision of a registered nurse, who evaluates the medication regimen and determines whether the medications should be administered as planned. This function is carefully regulated. Conversations with state board of nursing officials in several states reveal that this practice has been quite effective to date and reflects a trend. Some extended facilities that use many nursing assistants have developed the role of team leaded. These experienced, skilled assistants have exhibited additional leadership potential and are able to help the registered nurse train, mentor and evaluate the tasks completed by orientees. Since this group of assistants often exhibits a fair amount of turnover, the creation of this position has also become a means to develop and recognize highly competent, tenured employees (Hansten, 2004). Recent Labor Market Conditions Shifts or changes in the supply and demand for the labor of any occupational or professional group can have a significant impact on both the short-term employment opportunities and long-term career paths of workers over time. A general level, when the supply of new entrants (measured in actual numbers of graduates and numbers of new licenses or registrations) is maintained at moderate levels while labor demand is high, workers who meet the skill requirements of employers can reap substantial benefits. In such labor market situations, unemployment will be low, and workers will be in a strong position to demand higher levels of compensation and benefits of all forms. Conversely, when the demand for labor is reduced, due to economic downturn, system restructuring, or other factors, while the labor pool or supply continues to grow or remain stable, severe problems of unemployment and underemployment can develop. As with any other professional or occupational group, the nursing profession has been affected by significant changes in the supply and demand forces in the labor market. In particular, the nursing profession has been vulnerable to the dramatic shifts in demand for nursing personnel in the recent years (Hiscott, 1998). Nursing Assistants in the Heath Care Team While the job of nursing aide has existed almost since the beginning of the modern hospital, the position is becoming more formalized as a certified part of the health care hierarchy. This formalization is co-emergent with the growth of nursing homes, which already account for the majority of jobs in this rapidly growing field. Currently, nearly 1. 5 million nursing assistants work in the United States, and the Occupational Outlook Handbooks (1980-81) predicts 94,000 annual openings at least through the next decade, almost all of which will be in nursing homes. One trend in this development is the requirements for certification prior to work. In order to do this work, one must first be certified through a state approved training program as a certified nursing assistant (a title now replaces nursing aides). In classified newspaper columns throughout the country, there are advertisements for vocational schools that offer such training. The schools get many applicants, mostly poor women, who are attracted to the relatively good prospects for employment, the caring-oriented duties of the job, and the possibility – however remote – of moving in the ranks of the nursing profession. Unless one is formally trained in nursing (many foreign-trained nurses work as nurses aides), this certification procedure is required (Abel & Nelson, 1990). Long-Term Care There are currently 12 million people living in long-term care facilities in the United States, and the demand for such care is increasing. The $96.2 billion a year nursing home industry, providing long-term care for people who need medical as well as personal assistance, is expanding particularly rapidly, in part because the population is aging and in part because hospitals increasingly are discharging patients before they can care for themselves at home. But the ranks of nurse aides- most of them women, often immigrant or minority women, who typically provide some 80 to 90 percent of the direct care in these facilities – are thinning. More than forty states report critical shortages of nurse aides and other paraprofessional nursing-home workers. One major reason is money. The average starting wage for nurse aides in nursing homes is $6. 70 per hour, yielding an annual income of $14,000 for full-time workers, most often without benefits. The average wage for all nurse aides working in nursing homes is $10. 12, suggesting relatively small increases for seniority. A study of job leavers by the National Network for Career Nursing Assistants found that even those who like their work often leave because they cannot support their families on these wages. Exact rates of staff turnover at nursing homes are difficult to determine because method of calculation differ, but most sources place the annual rate for certified nurse assistants (CNAs) at between 80 and 100 percent. Such high rates of turnover, combined with cost cutting, mean that most nursing homes are understaffed most of the time. A recently released report of the Centers for Medicare and Medicaid Services found that more than 90 percent of the nation’s nursing homes are seriously understaffed. Indeed, the total amount of direct care given per resident per day in nursing homes averages only 3. 2 hours, well below the recommendations of professional organizations. And time studies conducted by the National Network of Career Nursing Assistants show that in an eight-hour shift it is impossible for CNAs to perform their five main responsibilities – bathing, feeding, toileting, dressing and walking patients – for caseload of twenty patients, not an uncommon assignment (Fitzgerald, 2006). Major Factors Influencing Health Care A range of influences, both external and internal, are greatly affecting the future of the profession for both pharmacists and technicians. External influences such as structural change in the health care economy, the growth of managed care, changes in health care financing, telecommunication and automated technologies, and breakthroughs in drug research and biotechnology are only a few of the forces that will undoubtedly shape the environment of pharmacy practice. Research into the molecular basis of disease and its treatment, multiple disease morbidity and chronicity in an aging population, and the critical nature of interdisciplinary health care relationships and collaboration will impose major challenges that will change our sense of purpose as professionals. Another influence on the profession may well be the heightened expectations of an increasingly informed and demanding public. Many of these external influences may be beyond our control. On the other hand, certain factors may have even more influence over our destiny. These factors include internal forces such as competency expectations and assessments, continuous education, training and retraining, the differentiated nature of pharmacy practice and growth of specialization, and the achievement of the mission and vision of pharmaceutical care (Durgin & Hanan, 1999). Economic Influences A wide array of economic and market influences continue to shape the direction and nature of the health care delivery sector. Market – driven Reforms Glacial yet profoundly fundamental changes have been occurring in health care since the mid-1980s. The Executive Summary of Third Report of the Pew Health Professions Commission poignantly describes the fact that, since 1990, the financial, organizational, and legal framework of American health care has been undergoing a transformation to systems of integrated care combining primary, specialty, and hospital services. The failure of the federal government and political system to successfully enact comprehensive health care reform legislation has given way to de fact of market-driven reforms energized by consumer and employer demands for more services and more intense technology. This problem is further compounded by a growing market trend of health care payers (public and private) refusing to pay the true and full economic costs of health care. Cost Containment A continuing focus on cost containment in health care delivery has led to a fiercely competitive marketplace. In some instances, the vision of success through providing care at the lowest possible cost may well be outpacing the quest for quality outcomes in health care. The continued market penetration of managed care and consolidation and integration of health care provider systems may well result in a survival of the fittest scenario in which only those systems that can produce the expected stakeholder results will survive. Public Demand for Health Care Services Heightened public demand for a broader and improved spectrum of health care continues unabatedly as a result of availability of consumer-focused education and the virtually instantaneous world of information access through telecommunications and the personal computer. As more information about health-related issues, breakthroughs in science and technology, and disease treatment advance, public demand spirals upward. Although health care’s future will ultimately be defined by public expectations, it will at the same time mandate the health care providers continually and systematically assess, ensure, and improve the quality and effectiveness of services provided. Hospital Reorganization The 1990s have ushered in a frenetic pace of price-driven competition among hospitals for the business of third-party payers, managed care organizations, and large employers for the services of physicians, and other hospital services. Hospitals must now compete on the basis of providing levels of care and services at predetermined prices. Financial risk continues to be shifted providers of health care as opposed to those that pay for such care. Much of this shift is a result of the growth of managed care and its impact on exposing excess hospital capacity. As a result of such trends, some hospitals that have not planned effectively or failed to recognize impending change have been forced to close. Hospital closures and consolidations are expected to continue into the next century. Unquestionably, the successful evolution of integrated health care will be determined economically. Yet, the health care industry must not lose sight of its mission to satisfy the needs of patients in the process. The interests of cost and profit cannot be allowed to supersede optimal patient outcomes. In the final analysis, demand for health care services will be satisfied at the price its consumers are willing to pay. Nursing assistants in this case, must market themselves to remain a part of such demand structure and ultimately demonstrate their roles in optimizing patient care outcomes and value (Abel & Nelson, 1990; Durgin & Hanan, 1999). The Future For nursing aides, the employment forecast is excellent. Four hundred thousand new jobs for nursing should open up in the next 5 years, according to the US Department of Labor, which ranks nursing aides as the tenth fastest growing occupation requiring a high school diploma or less in the coming decade. Salaries should increase as well. Many of the reasons for this growth are the same as those that are spurring demand for more home care aides and many other types of direct caregivers; our population is growing, it is growing older, and long-term care facilities and programs for the chronically ill are expanding. Specifically, employment opportunities for nursing aides should increase in nursing homes and other long-term care facilities and decrease in general hospitals which, increasingly, are focusing only on the seriously ill who require high-technology medical care (Swanson, 2000).