Help needed to change Legislature.

[doormouse]

Now I wait to see if there will be a loud *CLANG*, or not.

*Clang*

Sorry, mousie frypans are the size of pin heads

Ooh, I'm in a violent mood LOL

 

[Lucifer_Carroll]

*Clang*

Sorry, mousie frypans are the size of pin heads

Ooh, I'm in a violent mood LOL

<Rubbing my head and doing a Jack Sparrow imitation>

I'm not sure I deserved that.

 

[Guest]

But no one has answered the question -

of the differences between LPN and RN (or BSN, for that matter).

I don't have the exact numbers and I need to get ready for work but basically it has to do with the amount of college training the person has received.

It is cheaper to hire LPN's because they don't have as much college as RN's. (And a BSN is an actual Bachelor in nursing - many RN's will continue taking classes in order to get the official degree).

Details to follow -

 

[impressive]

LDW,

Do you have a template letter that we out-of-staters could send to your legislators or governor's office (as well as a link to their webforms)? I don't know how much weight it would carry -- given that we are not constituents -- but I'm willing to send it anyway.

I actively participated in "Nick's Crusade" last year -- to enable him and others to keep their in-home nursing services when reaching age 21 -- as did many from outside Alabama's borders. I think all the attention played a big role in affecting change in that area.

 

[Rumple Foreskin]

LDW,

If you haven't already contacted the AARP and senior citizen centers in the state, that might help with lobbying.

Joe,

The advantage of enacting a patient/care-giver ratio is it no longer allows/forces institutions to balance the budget or hike profits by reducing services to patients. Most states have the type of law LDW is pushing for in Alabama. "For profit" institutions in those states are still doing business and making money.

The institutional owners will fight enacting such a law. At first it will cut profits and may force a few badly run facilities out of business. But the rest will quickly learn to cope and start giving better patient care. Meanwhile new, more cost-effective operations will come in to take up any slack.

It's a good, common sense law.

Rumple Foreskin

--

Someone mentioned not knowing the difference in care-givers. What follows is general, not complete, and can vary slightly from state-to-state.

RN - Registered Nurse - 2-4 years of college plus passing a state exam with mandatory continuing education

LPN - Lic. Practical Nurse - One year, usually at a technical school plus a state exam

CNA - Certified Nursing Assistant - Six weeks training

 

[doormouse]

<Rubbing my head and doing a Jack Sparrow imitation>

I'm not sure I deserved that.

Salivating and changing damp panties.... Mmmmmmmmmmmmmmmmmmmmmmmmm Jack Sparrow?????

 

[Joe Wordsworth]

Originally posted by Rumple Foreskin
Joe,

The advantage of enacting a patient/care-giver ratio is it no longer allows/forces institutions to balance the budget or hike profits by reducing services to patients. Most states have the type of law LDW is pushing for in Alabama. "For profit" institutions in those states are still doing business and making money.

The institutional owners will fight enacting such a law. At first it will cut profits and may force a few badly run facilities out of business. But the rest will quickly learn to cope and start giving better patient care. Meanwhile new, more cost-effective operations will come in to take up any slack.

O.k., might have to go a bit slower for me. I'm very much not abreast of the medical business--not my area of expertise.

The advantage is that is doesn't allow companies to make money by reducing services? Do I read that right? But isn't a real fear still that, for those companies that aren't well funded, that they will be forced to increase their expediture?

Twice as many employees is still twice as many paychecks... the money has to come from somewhere, right? Someone's paying for it, aren't they?

(I'm very curious, I don't get to learn new things very often)

 

[Rumple Foreskin]

But isn't a real fear still that, for those companies that aren't well funded, that they will be forced to increase their expediture

Joe, they will either have to increase expenditures and thus cut profits or find other areas to cut costs. Those that can do it will make the transition.

Twice as many employees is still twice as many paychecks... the money has to come from somewhere, right? Someone's paying for it, aren't

Joe, it would not result in an automatic doubling of staff or payroll. Direct care-givers are a major compontent of a facilities payroll, but there are many other personal areas such as maintenance, dietary, administrative and the ever-growing medical records.

As I said, it's very possible some companines will fail. Those would be the marginal operations that are the most likely to provide sub-standard care. However, most of the facilities will adjust. After all, there are thousands making steady profits in states with the type of law LDW is pushing to enact in Alabama.

Rumple Foreskin

 

[Joe Wordsworth]

So, essentially...

The ones that provide sub-par care and haven't got much money will die off.

The ones that provide good care and haven't got much money won't die off.

The ones that provide sub-par care and have a ton of money will cut profits or die off.

The ones that provide good care and have a ton of money will also cut profits or die off.

That right?

 

[Just-Legal]

Joe, I *think* I have a handle on this, I'll try to explain although I'll probably be re-hashing what someone else has said.

There are a certain amount of nurses to care for a certain amout of people. There are only enough nurses to deal with one patient going into arrest (or something like that I think) at a time, so the rest get neglected. Now, if two go into arrest at the same time, and one dies, the insurance company has to pay out X amount for the death of that person.

Imagine said person is insured for $150,000 (I know my Dad is insured for £150,000 which is... what, $200,000?) The insurance company has to pay the hospital fees AND the life policy.

Now imagine 10 patients die a month, because there's not enough nurses. Thats... what? $1,500,500 (obviously a bit inflated but n/m)

Now, times that by 12 months.

Owch.

It would be cheaper to employ more nurses at whatever their rate of pay is (my partner is a Neurological Rehabilitation Assistant and is on about £13k a year) to stop people from dying and the insurance companies from paying out.

I think

I may be waaaay off the mark...

 

[Rumple Foreskin]

So, essentially...

The ones that provide sub-par care and haven't got much money will die off.

The ones that provide good care and haven't got much money won't die off.

The ones that provide sub-par care and have a ton of money will cut profits or die off.

The ones that provide good care and have a ton of money will also cut profits or die off.

That right?

Close, but no cigar. It's a two-pronged deal. Profits are a function of income minus expenses. The law would result in either: 1. a reduction in the number of patients, hence less income, 2. more care givers being hired which would increase that expense or, 3. a combination of both.

However, as I mentioned earlier, salaries for those involved in direct patient care are only one part of the expense equation. Therefore the business can: cut some of the other expenses, accept reduced profit margins, acquire other income streams, or go out of business.

The law works well in the other states. It allows the free enterprise system to continue in the health care field but it takes the issue of staff-to-patient ratio off the profit and loss ledger. Since it applies equally to all institutions, none are place at a competitive disadvantage to the others because they provide appropriate care.

RF.

 

[Joe Wordsworth]

Originally posted by Rumple Foreskin
Close, but no cigar. It's a two-pronged deal. Profits are a function of income minus expenses. The law would result in either: 1. a reduction in the number of patients, hence less income, 2. more care givers being hired which would increase that expense or, 3. a combination of both.

However, as I mentioned earlier, salaries for those involved in direct patient care are only one part of the expense equation. Therefore the business can: cut some of the other expenses, accept reduced profit margins, acquire other income streams, or go out of business.

The law works well in the other states. It allows the free enterprise system to continue in the health care field but it takes the issue of staff-to-patient ratio off the profit and loss ledger. Since it applies equally to all institutions, none are place at a competitive disadvantage to the others because they provide appropriate care.

RF.

So... this law could raise the cost of health care?

 

[SeaCat]

I'm not quite sure I follow that. If you hire more nurses, the insurance companies and corporations pay for it, but because there are less nurses, tax payers have to fund out more?? That doesn't make sense to me.
How does medicare not pay for nurses, but it pays for bedsores?

And, I know how bad the government is with handing out money for anything, but corporations are notorious for keeping it for themselves, and insurance companies are even worse. But, i suppose, if there was a law that said more nurses needed to be available, then corporations and insurance companies would make that possible. Kinda scary though, that corporations and insurance companies are people figuring out how much healthcare and staff we should have.

And I am sorry, hate to bug you LDW, but I still don't understand all these terms for nurses, CNA. I know the N in there is Nurse (at least, I think it is). I'm not trying to bug you... or be mean saying, "Hey, there are all these unneeded people with different letters, maybe that's the problem." I just want to know, seems like knowledge I should have picked up somewhere along the line, but never did. I always thought a nurse was a nurse, that's that.

Pooh,

Nurses come in four grades. These are from the bottom up, C.N.A.'s (Certified Nurses Aides/ Certified nursing Assistants. {We used to be called orderlies. The Certified is a false show, we do have to be liscenced and we do have to renew our liscenses.}) L.P.N.'s, (Liscneced Practicle Nurses.) R.N.'s, (Registered Nurses) and at the very top you have N.P.'s. (Nurse Practioners) The difference between these grades is the amount of schooling they have gone through.

C.N.A.'s have between six weeks and several years worth of training depending on their rating.
L.P.N.'s have one year of training.
R.N.'s have between two years and four years of training.
N.P.'s usually have at least a masters degree.

As for the insurance angle, yes it is one of the controlling factors in the staffing levels in hospitals and other facilities. I'm still not sure how the money trickles down but it is the insutrance companies and not the state or federal government who controlls how much the facilities get paid. It'shard to describe how this works out. (Hell it took me a couple of years to figure it out, and I'm still not sure on some aspects of it.)

Oh and by the way, it is the C.N.A.'s who you will usually see cleaning up your mother or father while the L.P.N. is giving them the meds and the R.n. is doing the paperwork. If you ever want to see how your money is spent in a hospital figure it out. The people cleaning your mother, father, or spouse, not to mention walking them, feeding them, and watching over them, are the C.N.A.'s (Paid roughly $8.00-$10.00 an hour in Florida.) The people giving your family members the medications are L.P.N.'s (Paid roughly $15.00 an hour in Florida.) and the people writing the reports and talking with the doctors are the R.N.'s (Paid between $20.00-$30.00 an hour in Florida.)

Cat

 

[Rumple Foreskin]

So... this law could raise the cost of health care?

The operative term is, could. However, the free market system will tend to keep that in check.

To the best of my knowledge, this law would not effect facilities that accept Medicare payments, which includes most medical centers/hospitals. The feds already impose patient/staff ratios on them. The target group would be long-term care facilities which primarily serve the elderly, ie, old folks homes.

The choice is between:

1. A libertarian, totally unregulated, maximize-profit-at-any-cost approach to long-term health care, which is the current situation in Alabama.

2. A government run system, and they tend to be inefficient,

3. A free market run system in which the government imposes regulations that give everyone in the industry a level playing field while at the same time giving the patients, in this case the elderly, some protection.

RF

 

[Lord DragonsWing]

Also, by having an increased staff the facilities do not have to spend so much money a year for accidents and wounds which patients receive while in their care. An example is if a patient falls in the facility and breaks their hip and that facility is responsible then they must pay the cost. If a patient acquires bedsores while in the facility they also must pay. That doesn't count the lawsuits that follow each of them and the settlements given. Including investigation of the nurses and staff. Which can even lead to criminal charges.
The company I worked for had their stock go from $10 a share up to $54 a share in a year. Their year end report stated profits would have been higher with a lower amount of nurses. The next thing we knew, we were given 60 patients instead of the 30 we normally had. Now, the patients get even less care. The occurence of "accidents" have increased due to the lack of staff, the increase in deaths are up, a large increase in bedsores. All of which cost medical facilities billions of dollars a year.
The states that have staffing laws have a decrease in incidents and the companies are making a good profit, the patients are happy and receiving much better care and the nurses are less stressed and stay at these facilities for the long term. Lower training cost for the facility, lower call-ins for staff and better attitudes overall.

 

[Joe Wordsworth]

(now before I get flamed, if you disagree with me please do so politely and reasonably and direct criticisms at my reasons for things and not my character... I don't know how popular this is going to be)

It seems like a bit of mysticism, really. I don't know that the solution lies in that law. It may be that I'm just removed from the ground-floor of the medical community (which is entirely possible), but I can't really wrap my mind around the levels of faith we're having in the system just balancing itself out in a positive way--when it could do so in a negative way.

 

[Rumple Foreskin]

(now before I get flamed, if you disagree with me please do so politely and reasonably and direct criticisms at my reasons for things and not my character... I don't know how popular this is going to be)

It seems like a bit of mysticism, really. I don't know that the solution lies in that law. It may be that I'm just removed from the ground-floor of the medical community (which is entirely possible), but I can't really wrap my mind around the levels of faith we're having in the system just balancing itself out in a positive way--when it could do so in a negative way.

In the free market system, those who adapt thrive, those who don't perish. The problem is health care works with the nation's weakest and poorest, the sick and elderly.

Since taxpayer money from the state, in the form of Medicaid payments, makes up a significant slug of the income received by most "old folks homes" the state has a right to insure the care being provided is adequat.

In the past, when most nursing homes were locally owned businesses, it was relatively easy for the families of patients to insist on quality care. So perhaps the law wasn't needed in Alabama. Today, a significant number of homes are owned by corperations who are harder to access and must answer to stockholders. That puts incredible pressure on administrators to hold down costs in order to maximize profits, thereby increasing the value of the company's stock. The easiest way to hold down costs is to reduce the level of care provided to patients.

This new law might drive some marginal providers out of business and some dislocations are possible. But the system will not collapse. If there is a profit to be made, new providers will come in and/or those that survive expand to fill the need.

One last note. It is possible the state could find itself paying more to provide better service for the same number of patients. As you may know, Mississippi recently imposed drastic cuts in Medicaid funding. My guess is the fear of increased Medicaid payments and the lobbying of the nursing home industry will kill LDW's bill in the Alabama legislature.

IMHO, trying to save taxes or generate extra profits at the expense of the sick and elderly is disgusting, but then I'm a Democrat.

RF

 

[poohlive]

If the hospital is understaffed, why don't they just tell the insurance companies and everyone else "hey, we need more money for staff." It seems like the way your describing it, the corporation is running the hospital more than anyone else.
If we're going to change laws, why don't we make a law that says the corporations and insurance companies have no say in hospital policy, and the hospitals can hire however many medical care professionals they seem worthy for the amount of staff present.
I can see a corporation screwing people over, and I can really see insurance companies taking us up the butt, but a hospital? When did the control all get shifted over?