Introduction
Service provision in long-term care (LTC) facilities involves a great number of risks that require constant monitoring and quality improvement initiatives. One way to classify the existing risks is to focus on the affected party. This report discusses common and well-studied risks affecting patients (infections, falls), LTC staff (violence from residents/visitors), and LTC facilities (staff turnover, staff knowledge gaps).
Risks to Patients
The risks that primarily affect LTC patients are associated with the transmission of infections. According to the review by Katz and Gurses (2019), the guidelines for infection prevention procedures in LTC facilities are still vague, and the inadequate staffing levels also affect patient safety. As a result of rising care costs, healthcare professionals are urged to transfer patients to LTC facilities earlier, but no corresponding changes are implemented to address the increasing workload on LTC staff members. That resulted in a recent increase in infection and “colonization with multidrug-resistant organisms” in LTC patients (Katz & Gurses, 2019, p. 95). Without efforts to improve the content and implementation of infection prevention guidelines, as well as initiate research to learn more about infection prevention in frail older adults, the risks for patients will remain significant.
Common risks for patients in LTC facilities are also presented by patient falls and their devastating consequences. In elderly LTC patients, the consequences of falls include bone fractures requiring rehabilitation, disabilities, further loss of independence, phobic disorders, and even lethal outcomes (Bowen & Rowe, 2016). In LTC facilities in the U.S., the risks of falling remain rather high – approximately 1800 LTC residents die annually as a result of falls, and many more get fall-related injuries (Bowen & Rowe, 2016). Many LTC patients initially have walking issues and low extremity strength, so effective fall prevention strategies are absolutely necessary.
Risks to Healthcare Professionals
Apart from exhaustion stemming from high workloads, caring for patients as a staff member in LTC facilities is associated with the risks of violence. The prevalence of violence against nurses is probably lower in LTC compared to intensive and emergency care since LTC staff often deal with frail older adults. However, such cases are still very common – according to case studies in different countries, about 90% of LTC caregivers have experienced physical violence from residents/visitors at least once (Brophy et al., 2019). The risks of type II violence are especially high for female LTC staff, and more than 40% of employees report exposure to violence on a daily basis (Brophy et al., 2019). Effective measures to recognize potential perpetrators and take safety precautions prior to admitting them to LTC facilities are essential in this case.
Risks to Long-Term Care Facilities
Long-term care facilities are currently affected by multiple factors that create the risks of poor patient outcomes and reputational losses. For instance, staff turnover, staff members’ knowledge gaps, and the lack of organizational support are common examples of such risks (Katz & Gurses, 2019). Many risks to LTC facilities stem from staff members’ insufficient knowledge – for instance, almost three-fourths of antibiotic prescriptions ordered in LTC turn out to be unnecessary (Katz & Gurses, 2019). Staff turnover is another risk factor that affects LTC facilities’ professional reputation and operations. Based on nationwide statistical reports and case studies in the U.S., turnover rates for healthcare workers in LTC vary from 53% to 94%, with 65% as an average rate (Fuqua et al., 2018). The situation with turnover is indicative of care providers’ low satisfaction with employment conditions and creates enormous risks for LTC facilities by causing inadequate and unsafe nurse-to-patient ratios.
Conclusion
Quality improvement in LTC facilities remains a significant issue given that modern researchers report multiple risks that affect different stakeholder groups. Patients face the risks of poor health outcomes resulting from imperfect infection and fall prevention guidelines. Care professionals often become victims of physical violence, whereas LTC facilities are largely affected by staff members’ knowledge gaps and high employee turnover rates.
References
Bowen, M. E., & Rowe, M. (2016). Intraindividual changes in ambulation associated with falls in a population of vulnerable older adults in long-term care. Archives of Physical Medicine and Rehabilitation, 97(11), 1963-1968. Web.
Brophy, J., Keith, M., & Hurley, M. (2019). Breaking point: Violence against long-term care staff. New Solutions: A Journal of Environmental and Occupational Health Policy, 29(1), 10-35. Web.
Fuqua, R. M., Walden, L., & Smith, K. (2018). Human resource management in health care: A case of turnover in long term care. Advances in Social Sciences Research Journal, 5(5), 173-180. Web.
Katz, M. J., & Gurses, A. P. (2019). Infection prevention in long-term care: Re-evaluating the system using a human factors engineering approach. Infection Control & Hospital Epidemiology, 40(1), 95-99. Web.