Since July of 1995, I have worked at The Philadelphia Nursing Home (PNH). A large County Nursing Home, the mission is to provide skilled nursing services for the medically indigent of Philadelphia County. I am not a county employee. PNH has been around since 1978 and was operated by the city until it was privitized in Jan. 1994, at which time the physical plant was deteriorating and there were serious issues with Quality of Care. I am an employee of Fairmount Long Term Care (fltc), the management company who operates the Nursing Home under a contract with the City Department of Health. The sole purpose of FLTC's existence is to operate the Nursing Home. It is a far different place today than it was when I arrived in 1995, in terms of the physical plant and quality of care. But, PNH is a social barometer of the community. Sadly, the social conditions that contribute to admissions have not changed much in the last 15 years. 97% of our residents are covered by Pennsylvania Medical Assistance and we receive an annual subsidy from the City to supplement our Operations. Because of our high rate of Medicaid admissions, any significant decrease in the City subsidy would have a very negative impact on our operations (which is why I have been tied up with meetings related to the City's Budget Crisis).
I have several reasons for this entry. I can share with fellow bloggers where I spend so many of my waking hours. Second, I am interested in Networking with other County Homes in the U.S. If by chance you are familiar with any County Nursing Homes (particularly those serving urban areas), I would be most grateful if you could share their names and locations with me. For many years, I worked at a large, urban teaching hospital. The comraderie and networking among hospital social workers throughout the U.S. was wonderful. It is very different in long term care (for many reasons beyond the scope of this entry). I have colleagues with whom I can network among the many County Nursing Homes in Pennsylvania. Frankly, they are of little help. Pennsylvania is primarily a very rural state and the scope/breadth of social problems that we face are simply unknown to my rural colleagues. Honestly, I think that our State Politicians would be happy if Philadelphia was no longer a part of Pennsylvania!
I am an Associate Administrator who is a social worker by training. I have responsibility for the non nursing clinical departments (6 departments) and act as Chair of the Ethics Committee (most issues turn out to be communication problems).Nursing Homes are one of the most highly regulated industries in the U.S.(historically, there has been good reason for this). If we admit a resident we must be able to meet all of their medical and psycosocial needs and, of course, ensure their safety. The regulation says something like "ensure that each resident attains and maintains their highest possible level of medical and psychosocial functioning in a safe environment" This is a tall order in any setting!
PNH has an atypical population as far as Nursing Homes are concerned. 48% of our residents are under the age of 65. Even out geriatric population is a younger one, with most between the ages of 65 and 85. All of our residents have significant medical problems and most have complicated psychosocial histories. Many of our residents have medical problems directly related to substance abuse, violence, &/or years of inadequate access to care. Some have wonderful family support while others have none (or have burned their bridges). Most of our referrals come from local hospitals. Ideally we would function as part of a Continuum of Care and be able to discharge people, especially our younger residents, back to the community.But there is a severe shortage of affordable housing in Phila. While there is much talk about community based sevices to keep people in their own homes, the truth is that the current infrastructure cannot manage people with complex medical and social problems in the community at this time. And the service delivery system is pretty fragmented with not much coordination/cooperation between Health, Aging, Disabilities, and Mental Health Services. Each seems to have their own little (or big) fifedom! Other Nursing Homes have a cap on the number of Medicaid recipients they can/will admit, most will not accept people under the age of 60, and most will not entertain referrals on individuals with serious mental illness &/or substance abuse histories. So PNH becomes home to many who fall through the cracks!
I am happy to say that despite the obstacles, we mange to discharge 75 - 80 residents/year back to the Community. I am hoping that down the road there will be better coordination of community based services. At the State Level, the Department of Aging and the Disability Network will be rolled into the Office of Long Term Living under the Department of Health. Hopefully this will promote a level of cooperation that some day will trickle down to the City. I have recently been appointed to the Board of our Area Agency on Aging in Philadelphia so hopefully I can have some impact on how these changes trickle down to the cCity. Unfortunately, I have no idea as to how the Office of Mental Health will fit into the future picture. Their services will be vital to community living arrangements for our population.
I always feel better after I vent about the complexities of my work life! The truth is, I thrive on the political nature of the beast and on the opportunitiy to help unravel some of the complexities - even if it takes far longer than I would like!