Burnout in Los Angeles Nursing Homes and How It Affects Quality of Care

Caring for the elderly is no easy task. While some elderly adults require acute care in skilled nursing facilities, others remain at home, often living with their children. Regardless of where they live, caregivers often experience burnout due to the high levels of stress encountered when caring for the elderly. A study recently published in the June 2012 issue of the Journal of American Medical Association compares job burnout in different healthcare settings. The article, titled “Professional Caregivers’ Mental Health Problems and Burnout in Small-Scale and Traditional Long Term Care Settings for Elderly People with Dementia in the Netherlands and Belgium” hypothesizes that caregivers in small-scale facilities experience less burnout than their counterparts in larger facilities.

These small-scale facilities refer to a relatively new type of care facility for dementia patients that treat dementia by allowing residents to maintain their own lifestyles and continue carrying out old habits, hobbies, and activities of daily living for as long as possible. Because these facilities are smaller, tasks are more integrated, meaning that a nurse is required not only to care for patients, but also to perform housekeeping and administrative tasks.

The benefits of a small-scale facility include a greater emphasis upon interaction with individual patients and more individualized care. For example, in larger facilities, all residents are forced to comply with daily routines and schedules, whereas in these small-scale facilities, daily schedules are based on each individual’s need. This highlights the inflexibility of care routines that is often a problem in larger facilities since previous studies have recommended that in order to effectively treat dementia, facilities should be open to modifying care routines to fit the needs of individual patients.

The study obtained its data by questioning workers in five different small-scale facilities and focused on those who care specifically for dementia patients, since the increased level of care required by dementia patients is often correlated with higher rates of job burnout, job dissatisfaction, stress, and mental health problems. “Burnout” was defined as feelings of exhaustion, depersonalization and disconnect from the individual’s job, and a reduced amount of personal accomplishments.

Interestingly enough, the results of the study disproved the hypothesis that caregivers in small-scale facilities experience less burnout than those in larger facilities. Despite the differences in care settings, workers in both types of facilities were observed to experience approximately equal amounts of burnout. However, the study determined that over time, caregivers in all types of care facilities, large or small, experience increased levels of burnout.

In conclusion, the researchers determined that the increased levels of job burnout in care facilities are a result of understaffing.

While these facilities are expected to provide the same quality of care with significantly fewer resources, government agencies are also increasing accountability in nursing homes by conducting inspections and issuing deficiency citations. Some government agencies even offer incentive programs to nursing homes that provide a high quality of care. Others base their funding on quantifiable factors such as number of incidents of preventable fall-related injuries and facility-acquired pressure ulcers. While Medicare’s ‘No-Pay’ rule has proven to effectively improve infection control measures, other programs, unfortunately, have often led nursing homes to withhold care and “downcode” certain injuries in order to avoid liability and continue receiving funds. For this reason, you must be extremely cautious when nursing homes report your loved ones health condition. Even if your loved one is being treated and assessed by nurses and physicians, it is still important for you to personally examine your loved one often since nursing homes often have incentives to conceal certain health conditions.

Many factors such as understaffing and consequently job burnout can prevent a nursing home from providing your loved one with the care that he or she requires. However, regardless of recent budget cuts and sometimes difficult working conditions, skilled nursing facilities continue to carry an obligation to provide your loved one with an adequately staffed facility and a high quality of care. They must learn to adapt and allocate their funding appropriately. For example, despite decreased levels of funding, many nursing homes continue to use their money wastefully by prescribing antipsychotic drugs in order to chemically restrain dementia patients, rather than using this money to increase staffing levels. Your loved one may be a victim of nursing home neglect and elder abuse if his or her nursing home is failing to provide him or her with proper care and an adequately staffed facility.