Introduction
Even if it only included expanding an existing well-structured and functional long-term care system, expanding the nation’s ability to meet the increases in long-term care demands would pose planning, management, and resource allocation difficulties. The theory-driven LOCK framework could arguably benefit in addressing the two largest issues with modern long-term care in the U.S.: accessibility and price (Mills et al., 2018). Nevertheless, there is general agreement that the existing system as it is constructed is being pushed to its limits, with issues in cost and funding, as well as access to and quality of long-term care services.
Main body
The majority of official, coordinated and compensated long-term care services are delivered in institutions. Nursing homes, comprising both skilled nursing and intermediate care facilities, offer more than half of institutional care; the balance is given by long-stay hospitals, including mental hospitals, and residential care facilities, such as board and care homes. Approximately 80% of nursing home beds in the United States are private; the remaining are in public and non-profit facilities. The availability and usage of nursing home beds by the elderly varies greatly among states, but the issues they face remain largely consistent and have a predominantly structural nature.
The LOCK framework contains five principles: seek the bright spots, observe, collaborate in huddles, keep it bite-sized, and facilitate. It argues that institutionalized care is inherently personal and collaborative on an organizational level. The model personalizes the management of care institutions, offering an individualized, case-by-case approach to a systemic issue. Despite appearing to be counterintuitive, this manner ensures a management model that is conscious of its flaws and aware of its strengths at the same time and is taking action to reduce one and emphasize the other.
Access to nursing home beds is a major issue in many parts of the country, which becomes progressively worse for patients of marginalized backgrounds. Nursing home occupancy rates are often quite high, and many areas report extensive waiting lists for the placement of functionally dependent people in nursing homes (Moore, 2019). The usually average, and sometimes extremely bad, quality of nursing home care was widely recognized and vividly presented nationally throughout the 1970s, and while anecdotal evidence shows some overall improvement, quality of care in all long-term care facilities remains a persistent problem. LOCK framework, built upon collaborative efforts of relationship-based teams, would remove additional barriers to a successful, caring routine once the patient has entered the system.
The government and private firms alike have not been efficient in assuring quality, most likely due to a combination of excess demand, a lack of bed availability, or inadequate payment rates and fiscal incentives – the latter of which is frequently highlighted as a major factor by the nursing home business (Bowman, 2018). Inefficient recruitment and retention of trained professionals for institutional staff, as well as less skilled individuals, is an indirect predictor of quality of care issues. Overall, there is worry regarding the quality of care in room and board and other residential care facilities, where there are minimal quality control measures in place.
Another issue lies in the astonishing prices of long-term institutional care, which becomes more and more inaccessible as time goes on. The average duration of residence in nursing homes in the United States is roughly two years, although the average masks the reality that there are many short-term residents as well as some extremely long-term residents. And yet, simply cutting them down without an appropriate level of governmental support is not a sustainable solution since it would likely involve reducing the wages or benefits of employees that already work long hours at a mentally exhausting job.
Conclusion
In conclusion, the lack of systemic governmental support undermines the best efforts of staff to create a service that is efficient and ethical toward patients and their relatives. It is up to debate whether and to which extent theories like the LOCK model can navigate the current difficulties in the long term. However, in the short term, the theory’s effort on collaborative relationship-based management secures an accepting environment amidst the general chaos of the industry.
Reference List
Bowman, C. (2018). Institutional care of older people in the community. In Community Care of Older People (pp. 108-113). CRC Press.
Mills, W. L. et al., (2018). Applying a Theory-Driven Framework to Guide Quality Improvement Efforts in Nursing Homes: The LOCK Model. The Gerontologist, 58(3), 598–605. Web.
Moore, S. (2019), “The relativity of theory: applying theories of social psychology to illuminate the causes of the abuse of older people in care homes”, The Journal of Adult Protection, Vol. 21 No. 2, pp. 89-110. Web.