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Fewer nurses for fuller nursing homes

By Robert P. HeyStaff writer of The Christian Science Monitor / May 25, 1988

Providence, R.I.

When Rhode Island held a job fair at the Providence Civic Center a few weeks ago, Judith Robidoux was there. As director of nursing at the Waterman Heights Nursing Home in nearby Greenville, she was seeking to recruit nurses and nurse's aides. So were the representatives of half a dozen other health organizations.

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Ms. Robidoux was making an effort to deal with one of the most serious problems facing nursing homes and other groups that provide long-term care to elderly Americans: not enough nurses.

``There is a real shortage,'' says Paul Willging, executive vice-president of the American Health Care Association, which primarily represents nursing homes across the United States. ``Two-thirds of our members have nursing vacancies; one-third of them have vacancies that'' force them to have staff members to work double shifts or take similarly extraordinary measures to meet state and federal standards.

Experts say today's problems will worsen unless more Americans enter and remain in the fields of nursing and nursing aides. Health-care facilities ``will need 29 percent more employees by 1995'' just as the pool of prospects for low-skilled jobs, such as nurse's aides, is shrinking, says James Paxton. As vice-president for human resources of Beverly Enterprises, he works for America's largest nursing-home chain, with nearly 1,100 facilities.

``We compete for unskilled employees'' with hotels, schools, government, and restaurants, Mr. Paxton says.

The US Department of Labor forecasts that the demand for nurses and nurse's aides will rise much faster than the average for all occupations through the year 2000. Behind this demand is the immense growth forecast in the number of elderly Americans: They make up 90 percent of those requiring long-term care, such as help in walking, dressing, and caring for themselves.

Moreover, new federal and state regulations will soon require added nurses and better trained aides in nursing homes. Yet ``nursing schools are closing,'' Mr. Willging says. ``Enrollment is dropping dramatically.''

Nursing homes and other long-term care facilities face other serious problems: the amount government programs pay them; the paper work these programs require; and the slow pace of construction of care facilities. There's also the persistent issue of the quality of care, widely agreed to be much better than in the 1970s but still far from first rate in many places.

Finally, there is the challenge of planning for the future. Will technological improvements in medical care mean that, as some experts say, many more Americans, such as accident victims, will be cared for in nursing homes, with a resultant need for bigger staffs? Or will it mean a dramatic increase in at-home care, meaning a lower-than-expected demand for institutional staffs?

Will the US develop a policy on long-term care, as the result of the many proposals now being considered? If so, how will this policy affect nursing homes?

The heart of a nursing home is its staff - the nurses who are largely responsible for planning care and supervising it; and the aides, who provide 90 percent of the day-to-day care. Without enough trained staff members, the quality of assistance is compromised.

In the short run, the efforts of resourceful institutions like Waterman Heights Nursing Home can pay off. Judith Robidoux called her day at the Rhode Island job fair very successful. She talked with more than 100 prospects and gave out 75 applications: ``If I get 5 to 10 good employees, it will be well worthwhile.''

Dealing with the long-run problem of nursing shortages requires national planning. Consequently, a commission on nursing appointed by the US Department of Health and Human Services is studying the problem. In December it is to report its findings and recommendations to Otis Bowen, secretary of the department.