In the past six months or so, the Star Tribune has run a series of articles revealing nursing homes where human error has resulted in death, injuries and overall poor care. The articles have rightly brought focus on a population whose needs deserve special attention as so many of these patients are unable to speak for themselves. But what is it about the system that is allowing all these mistakes to happen, or even contributing to these errors?
I am not excusing the nursing homes or the workers, but I do believe we need to move past the idea that there were evil caregivers or profit-minded nursing homes that caused these deaths and that the only thing we can do is make sure these people never work in health care again. There is more we can do.
Minnesota’s nursing homes are in a sorry state. Almost a third of the nursing homes in Minnesota are working on a negative operating budget. Governor Pawlenty has proposed cutting another 2.5% in reimbursement rates for the next biennium. Operating in the red forces difficult choices, such as cutting staff and hours, and relying more heavily on nursing assistants rather than registered nursess or physician assistants rather than physicians. Under-staffing decreases care, and overtime and longer shifts increases risk of errors. Journal of Safety Research published research that found a strong correlation between 40+ hr work weeks and negative occurrences and mistakes.
It is important to look beyond the headlines and remember that a more efficient approach to this kind of problem is not to get rid of every care provider who makes a mistake, but to improve the system so that those mistakes are less likely to happen. After all, as any good doctor or nurse will tell you, taking care of the symptom does not get rid of the disease.