If you work in long term care long enough, a bit of a bunker mentality can start to take hold. You feel beset on all sides by enemies: bureaucrats adding to a regulatory burden that already exceeds that of the nuclear power industry, legislators making draconian cuts to reimbursement rates, state surveyors looking to tag you for so much as an improperly folded sheet, media outlets sensationalizing every adverse event, family members wracked with guilt, stress, and frustration, and of course trial attorneys looking to profit from any mistake you make.
A friend recently told me that nursing home administrators and DoN’s are the only professionals in America who can literally lose their licenses AND potentially face criminal charges for acts or omissions by their employees–even when they aren’t in the building! It is truly a 24/7 profession.
And then there is the work itself– physically, emotionally, and mentally taxing. The amount of information that nursing home workers have to process would keep your average Supercomputer busy for days at a time.
It is no wonder that burnout rates and turnover are so high in our industry. You have to truly love this work in order to survive.
And most of us do. The CNAs I’ve worked alongside, the nurses and administrators, and my fellow office-dwellers all seem to be motivated by something much bigger than money, advancement, or power. They are motivated by a sense of purpose and meaning. They know what Victor Frankl taught us in Man’s Search for Meaning: “Those who have a ‘why’ to live, can bear with almost any ‘how’.”
This is why it is so infuriating to read about the alleged improprieties at another long term care chain that stands accused of Medicare fraud. I don’t want to cast stones because I am sure that many, if not most, of the people who work there wanted more than anything to do the right thing, to be allowed to provide good, loving care to the sick and the old. But when the second in command of a nursing home company is alleged to have told subordinates, repeatedly, “your job is to make money for our owner,” something is very, very wrong. That is the worst kind of abuse and management malpractice you can inflict on people who are drawn to work in this field. It is an attempt to rob them of the thing they value most–their sense of purpose and meaning. It cheapens and demeans the important work they do every day. It presses them into a kind of mental slavery. Ultimately, I believe it makes it almost impossible to provide high quality care.
In our customer experience surveys, we ask a question that gets to the heart of this issue: “Do you believe that this facility puts the health and well-being of your loved one above profits and other financial considerations.” No question speaks to the level of trust between a family member and a facility more than this one. I wonder how the residents and loved ones at the above-mentioned company would have answered this question. If the company had been bold enough to ask a question like that, would the answers have been enough to change the company’s culture and priorities and avert this disaster? I don’t know, but I am extremely proud to say that our scores on the question are consistently high.
Please don’t mistake me for an idealistic socialist. I believe wholeheartedly in private enterprise and for-profit healthcare. Making profits is what allows us the extraordinary privilege of working in this field. It is a necessary precondition of the “radical change” that is Signature’s vision. But it cannot ever be the highest purpose. It can never be the ultimate “why” in our professional lives.
