Budget cuts: Who will survive?

Cuts, cuts, cuts. Cuts in state budgets, in federal budgets, in Medicare and Medicaid. There will be cuts in services to older adults, especially those in long-term care, and in some areas of the country facilities will close. What specific factors will determine who survives? What will distinguish the survivors from those who disappear?

Perhaps it is wise to examine the expenditures in long-term care. Assisted living, long-term care and healthcare providers in general are in a “service” industry. What we provide is service; service to the residents that we care for, their families, our staff and one another. Unfortunately, in many environments, service is not what has been the experience.

A large percent of any operating budget in assisted living and long-term care environments is in the cost of employees: as high as 70-80%. For emphasis: Staff is the greatest expense and the most important resource. Employees are the key to success for any business and they are critical in long-term care. Carefully selected, trained, supported, nurtured and satisfied staff provide excellent care to residents and families, who in turn are pleased and will say so to others in need, enhancing census and reputation. Employees who are not satisfied will leave or worse yet, stay and provide poor care. While there is no line item on the Profit and Loss statement that says “employee turnover cost,” it will cost you none the less.

So who will survive? Organizations that recognize that their people are valuable, understand that their staff is not easily replaced and genuinely care about their employees will likely succeed. Leaders and managers who care for their staff will in turn have staff that care for their residents and families, and who are dedicated to the organization itself.

My InnerView has published some very telling survey data that conveys what residents and families desire most from long-term care: they are not asking for live-in dogs or cats, dining selections, special closets or a tavern—they want a staff that cares about them. They want a person who is happy, kind, gentle and loving to get them up in the morning and assist them with meals when they can no longer feed themselves. They want staff members who talk to them—not about them—and who care if they are in pain, and who know that they like chocolate ice cream and Jeopardy even when they can no longer say so.

In the end, staff and residents need other people, and people ultimately need: 1) to be cared for; 2) to be cared about; 3) to be respected; 4) to be included; 5) to have a voice and be heard; 6) to know that they are important and valued; and 7) to be nurtured and, yes, even loved.

Long-term care facilities that know the value of their most important asset—their employees—will survive. Those who don’t will fail. And they may not be missed.

Susan Gilster, PhD, FACHCA, NHA, Fellow, developed the Alois Alzheimer Center, Cincinnati, Ohio, which opened in 1987 as the first freestanding dementia facility in the United States.

Jennifer L. Dalessandro, BS, NHA, is the Assistant Administrator and Research Coordinator of the Alois Alzheimer Center and has helped it evolve into a person-centered facility.

For more information, phone (513) 673-1239 or visit www.careleadership.com or www.alois.com.

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