L E T T E R S

An Intolerable Situation

I am a nurse with almost 10 years experience in nurs- ing home care. For approximately 5 years of that time, I have worked as director of nursing in the nursing home. I have become increasingly concerned with the role of nursing and the overall management structure in these homes. Some of the nursing home administrators and owners with whom I have worked unfortunately seem much more concerned with profit than with quality resi- dent care.

The current structure of nursing home management, at least where I practice, is not particularly beneficial to the residents or the nurses in those homes. Administrators, who often are not ethical in their administrations, have complete control of the nursing homes. Nursing home owners rarely will question decisions of administrators if they are satisfied with the margin of profit the home is re- alizing.

I personally find this situation intolerable. Because there is no balance of power between nursing administra- tion, which deals with staffing and resident care issues, and administrators, who deal with the financial issue, res- ident care will continue to suffer. I do not think nurses, who take an oath to act as advocates for the people they care for, can do so without the real fear of losing their job.

AMY SHACKLEFORD Richmond, Indiana

Editor's note: Comments from readers would be most appreciated.

A Fair Comparison?

This letter is in response to the article by Ann Walker, "The Cost-effectiveness of Home Health: A Case Presentation," published in the January/February issue of Geriatric Nursing (1996;17:37-40). Ms. Walker's article proclaims the cost-effectiveness of home care when com- pared with nursing home care. I would like to point out that the author did not include all costs related to the pa- tient's care when she compared the two types of service.

If we are going to compare apples to apples, other costs involved with Mary 's care need to be included. For example, the cost of renting or purchasing the medical equipment is included in the skilled nursing facility charge, but not in the cost of home care. The article does not indicate whether Tom is a paid companion, but the cost of 24-hour care is not included. Also the cost of room, board, and utilities needs to be added to the total cost of maintaining Mary at home. T h e nursing home would also have other additional costs such as activities, restorative care, laundry, dietician services, and wound care supplies.

Although I have no argument with the quality and scope of care that can be provided in the home setting, I do believe we need to be fair to the nursing home indus- try when these comparisons are made. Exciting things are happening in nursing homes today. They are not what they once were, and to make a blanket statement that "maintaining the recipient's dignity and independence, qualities that are all too often lost even in the best insti- tutions" is totally unfair and certainly is not applicable to the quality of care that is provided by the nursing home industry today.

MARY K. FEIT, RN, BSN Nebraska Health Care Association

Lincoln, Nebraska

Reply

It was not my intent to criticize the nursing home in- dustry. As an employee of The Philadelphia Geriatric Center, I witness the wonderful care our nursing home residents receive. As a home health care provider, I advo- cate for nursing home placement of our patients who can no longer manage at home. But I am aware of senior cit- izens' preference for home care. A 1991 survey by The American Association of Retired Persons (AARP) found that three of four Americans prefer home care to some other type of long-term care service.

When comparing home care costs to skilled nursing facility (SNF) costs, a straight comparison of billable charges was used. It was not customary to include the costs of room, board, and utilities in cost comparisons be- cause many persons who are placed in SNFs have others still living in the home, and the home expenses continue. This would have been the case in this presentation be- cause Thomas was Mary's common law husband, and the costs of the household would have continued if Mary was placed.

I thank Mary K. Feit for her thoughtful comments and express my admiration and regard for the hard-working, caring providers in the nursing home industry.

ANN WALKER, RN, MSN Philadelphia Geriatric Center

Philadelphia, Pa.

Impressions

In response to Carolyn E Leming Troupe's letter enti- tled "Florence Nightingale, Where Are You?" (Geriatr Nurs 1996;2:54), I offer the following impressions.

As a child I recall reading many books of adventurous women whose lives were wrought with savvy and pur- pose. These books made a great deal of sense to me be- cause they were congruent with the lifestyle of my parents. I recall the ease with which these heroines per-

260 Letters November/December GERIATRIC NURSING