How to Make the Good News of PALTC Newsworthy

June 25, 2019


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The June 10 AMDA On-The-Go podcast--Are SNFs Dealt an Impossible Hand?—started on a bit of a discouraging note. However, program guest (and Society president) Arif Nazir, MD, FACP, CMD, AGSF, quickly turned the discussion around.

Podcast host Wayne Saltsman, MD, PhD, CMD, began by referring to a 2017 New York Times article that talked about the “anticipatory horror” many people have of nursing homes. He asked, “Where did this sentiment come from—why? Of the 15,000 nursing facilities in our country, many of which are considered ‘home’ for those who are chronically or seriously infirm or can no longer care for themselves, how could such a strong, negative mantra come to pass and be acceptable?”

He posed this question to the right person, as Dr. Nazir is one of the authors of a recent JAMDA editorial, No One Cares When Plans Don’t Crash: The Message for Long-term Care. This piece offered a possible explanation for the negativity, primarily that “negative” translates to newsworthy, while “positive” is considered as uneventful as “watching a plane land safely.”

Looking at how to address this, Dr. Nazir offered some historical insights. Over the years, he said, expectations have evolved to the point where post-acute and long-term care (PALTC) communities are providing hospital-level care for patients. He stressed, “Patients are really that sick.” That evolution, he noted, has not been matched by a similar evolution in other aspects of health care such as policy, support, reimbursement, training, and so forth. More importantly, he observed, “There hasn’t been much evolution in the regulatory framework used to hold facilities accountable; so a system that was set to create accountability for a custodial model of care is being used in a very simplistic way to address accountability for a medical model where complexity of patients’ needs is much greater than [before].” This has led to a mismatch and the creation of negativity in the model.

“An important part of accountability is not to put people on the defensive. If you don’t believe and trust people, then you pretty much assume that the moment you take your eyes off them, they will be up to no good,” said Dr. Nazir, adding, “The vast majority of the people on the front lines are trying to do the right thing.” He further observed that front-line caregivers “need to be able to decide what kind of care they want to provide and what kind of relationship they want with their patients.” Unfortunately, he observed, caregivers increasingly see the accountability system “coming between their patients and themselves and that is taking the fun out of providing care.”

Dr. Nazir said, “We need to change the paradigm around accountability.” We need to trust caregivers, he noted, “to do very, very hard jobs, which are more of a vocation, and empower them with good support, education, respect, and acknowledgement.” We need to give them autonomy and purpose, he suggested, then “get out of their way and stop breathing down their necks.” He added, “Trust them to do their magic, and the magic will happen.” In short, Dr. Nazir observed, “We need a culture upgrade.”

What are the first steps? The podcast conversation is a good start, Dr. Nazir said. “This current system is not going to be enough to truly meet the needs and expectations of our patients, families, and loved ones who will [require] care at some point. We need to be talking more and more about this.”  Elsewhere, medical directors must be better leaders, he suggested, explaining, “We need to operationalize selfless leadership on the front line. We need to acknowledge our team members more than ever because they are under more pressure than ever before.” This is essential to attracting good people to the field as well. As Dr. Nazir said, “We are thousands of nurses short because of the hardships in our setting. We have to focus a lot more on medical leadership and the role of leaders in making the team more acknowledged, more satisfied…and making sure we are adding to the wellness and well-being of front-line people.”

Look for the Society and its leaders to focus more on these concerns moving forward. As Dr. Nazir explained, “We have our work cut out to make sure this issue is really understood and that we are as united as we can be on this and on the strategies we need to fight the negativity. We need to make sure every Society member is part of this campaign.”

Click here to listen to the full podcast and hear more of Dr. Nazir’s innovative ideas and insights. Check out a full list of archived episodes you can listen to at your convenience. CME is available for these programs.