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 A Place for Aging. Story by Anita Neal Harrison.


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Less obvious, but no less responsible for dissatisfaction, Wright says, are the effects of high staff turnover rates. Without well-trained, caring personnel, no nursing facility, no matter how many amenities it boasts, can function properly. Yet low wages, heavy workloads, inadequate training and poor working conditions for direct care workers ensure that few highly qualified nursing home staff members remain on the job for long. "There is difficulty finding good people and retaining them," Wright says. "The worker shortage has led to a big problem with the quality of care, not only in nursing homes but in all long-term care facilities."

Wright's explanation of the third problem, enforcement of quality standards, leads her into a discussion of the 1987 Nursing Home Reform Act, part of the federal Omnibus Budget Reconciliation Act of the same year. This legislation was meant to force states to get serious about improving the sometimes deplorable living conditions found in many nursing homes. The law established quality standards and defined a survey and certification process meant to enforce the standards.

While well-intentioned, Wright says, the law has not done nearly enough. "The enforcement process is very weak and inconsistent. Often, problems are understated or overlooked, and remedies aren't imposed when they should be."

Rantz was well aware of these problems when she came to MU in 1992. She joined the faculty with two goals: improving existing nursing homes and, perhaps more important, developing alternatives to the institutionalized care status quo.

Within a year of her arrival, Rantz brought together an interdisciplinary group of faculty and challenged them to come up with ideas for improving Missouri nursing homes. What emerged was the Quality Improvement Program for Missouri, a program funded by the Missouri Department of Health and Senior Services, which uses assessment information about residents gathered from Missouri nursing homes to create detailed reports for improving care.

These "Show-Me Reports" provide detailed game plans outlining how individual nursing homes can improve their services. Before the program, the state gathered information but provided no feedback on how facilities could improve. "It seemed to me that if you could feed the information back to the facility, it would help them in their quality improvement," Rantz says. Studies by the Sinclair School of Nursing have proven her right. When a well-trained nurse helps a facility's staff interpret its Show-Me Report, a facility's residents fall less, have fewer behavior-related problems and are less likely to get pressure ulcers. Missouri legislators have embraced the Quality Improvement Program's success and continue to set aside funds for it.

Rantz, whose work in quality assurance was cited in the Lifetime Achievement Award she received from the National Gerontological Nursing Association last fall, says she's proud of what the Quality Improvement Program has achieved. Yet she's even more passionate about her second goal: developing alternatives to traditional nursing homes.

"My interest has always been 'How do we help people stay out of the nursing home?'" Rantz says. "My clinical experience was as a nursing home administrator, and it seemed very clear to me, looking at the aging statistics, that nursing homes are not going to be the answer."

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Published by the Office of Research.

©2006 Curators of the University of Missouri. Click here to contact the editor.