Communication Challenges in Nursing Home Care Across Income Levels

Introduction and Community Overview

The local area has an interesting blend of nursing homes shaped by the socioeconomic makeup of the community. Parts of the community are incredibly wealthy, and there is an upscale retirement community in the area with an on-site nursing home that allows residents to transition from independent living into an assisted living environment. However, the community also includes areas of extreme poverty, and one of the nursing homes clearly draws from that population, offering a no-frills setting. The community also has a nursing home facility that would be considered standard middle-class.

Interestingly, the staff at all three nursing homes appeared very similar in composition. They were almost all minorities — predominantly African-American — working in an area that is largely white and Hispanic. Interviews were conducted with staff from each facility: one who worked at the lower-income facility, one at the mid-income facility, and one at the upper-income facility. The staff shared very similar educational backgrounds regardless of the facility. Moreover, pay across the three facilities was comparable, though the ratio of patients to staff was noticeably lower at the most expensive facility.

Staffing Observations and Staff Perspectives

Given some of the other problems that staff members discussed and what was observed during facility visits, understaffing appeared likely to be the most common concern raised by nursing home workers. However, when staffing issues were explored directly with interviewees, none of them felt that staffing was the problem it appeared to be from an outside perspective. The busyness that seemed to suggest understaffing was, in fact, something that all three staff members described as a sign of productivity in care work.

One staff member at the upper-income facility actually felt there was a surplus of staff at her location, and that idleness among workers sometimes led to certain employees failing to take responsibility for their assigned duties. This perspective challenged initial assumptions and shifted the focus of inquiry toward other issues in the facilities.

Communication as the Central Challenge

All three staff members identified communication as a significant issue at their respective facilities. They described situations in which doctors were not always clear about communicating care guidelines to patients, leaving staff to mediate between physicians and families in ways that complicated their roles. Patients and family members would frequently express concerns to familiar staff members that they would not bring directly to doctors, placing nursing home workers in a difficult intermediary position.

This challenge is well recognized within the broader healthcare community. As noted by AARP, "Communication among families is so important that Medicaid and Medicare nursing homes are required to allow families to form councils that meet privately in the facility" (AARP, 2007). The existence of such a regulatory requirement underscores how pervasive and consequential communication breakdowns in nursing home settings can be.

References

AARP. (2007). Nursing homes: Learning the system. Retrieved May 13, 2013, from AARP.org website: http://assets.aarp.org/external_sites/caregiving/options/nursing_home_system.html

Palmer, J. (2012). Caregivers' desired patterns of communication with nursing home staff — just TALKKK! Journal of Gerontological Nursing, 38(4), 47–54. doi:10.3928/00989134-20120207-03