Management Problems1

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Management Problems

in Government and

Private Old Age Homes

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Management problems in private and

government old age homes in Israel

� Old age homes in Israel include private and

government or public homes.� Government or public old age homes are

NFP (not-for profit).

� Private homes are FP (for profit) institutions.

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� They both get funds from Social Security,

health insurance companies and thefamilies of the elderly.

� However, FP homes need to make profits

and that goes to shareholders or owners

while NFP homes do not need to make

profit and even when there is profit the

money is invested back in the nursing

home.

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� Like in every company there are

management problems also in old agehomes. Here we are focusing onproblems that may arise from thedifference between the homes based on

the FP and NFP criteria.

� Lack of budget in private homes and thedemands of the patients can lead to astressing situation for the management.

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Private old age homes

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� Management in private homes hires less

skilled and professional staff to savesmoney. The unskilled staff can cause

many management problems.

� Management saves on medical

equipment.

� Management saves on developing thestaff's professional skills.

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� The home may choose to appoint a non-

professional manager in order to save on

salaries. If he/she isn't expert on running

old age homes then there is no contact with

the staff and many mistakes are made.

� One of the most common mistakes is when

the manager interferes with decisions of

the nurse in charge in order to save moneywhile that can lead to harming the

residents/sick elderly people.

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� An example from our own experience:

� As a nurse in charge I had to send a resident of

our home to the hospital because of a seriousproblem. I decided based on my medicalknowledge that the patient needed to beaccompanied. The manager who wanted to

save money refused to hire someone toaccompany him because she thought that itwasn't necessary.

� This of course caused many more problems

much more serious than the moneymanagement had to pay for the extra staff. It isa result of decisions taken by non-professionalmanagers!

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� Saving on medical equipment: gloves,

medicines, food and night-nurses canharm staff and residents of the home. As

part of saving money policy,

management in private homes buysfewer gloves, cheaper or equivalent

drugs that the residents need and hires

unskilled assistants instead of authorizednurses for night-shifts.

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� This situation may cause unnecessary and preventable

problems. Fewer gloves means that staff and residents of

the home can get infections.� Cheaper drugs mean deterioration of the residents' health.

This may cause to lawsuits from the residents' families.

� Unskilled assistants on night-shifts instead of nurses may

cause serious problems since the assistant can't takemedical decisions in case of an emergency and that can

even lead to the death of a sick old person in the home.

� In a recent survey the findings were that in 22 percent of

private old age homes, the elderly have nutrition problems

and in third of the homes there are problems with

physiotherapy .

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� Another management problem can arise

from the frustration of the staff. Since

they don't get the same salaries and

working conditions and aren't sent to

continuing education programs, the staff

in private old age homes doesn't feel

motivated to try its best.

� The result of such a situation is neglect of the residents and even abuse.

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Government Old Age Homes

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� On the other hand, government old age

homes are NFP because all their funds

come from the government, socialsecurity as well as the resident himself or

his family. So they don't really have to

worry about budgets. Here managementproblems arise from different motives/

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� Staff enjoys stable, good workingconditions.

� This causes a certain feeling of over

confidence and doesn't motivate the

staff to improve themselves since they

are safe and sound concerning their

place of work.

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� Management and staff tend tocare less about the residents

especially when the resident

has no family. So they do not

attend to most of the resident's

needs .

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� There are more people in

government old age home and thatmeans more work and less attention

to the elderly. When a nurse has to

take care of 10 patients instead of 4or 5 she gives them less attention

and she may miss some health

problem with some of the patients.

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� Managers in government old age homes

are usually civil servants. Change is hardsince management is usually used to its

habits and isn't interested in innovation.

It is much harder to convince a managerwho has been working many years in

managerial position to make some

changes in the organization and in ourcase in the old age homes.

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� The healthcare system functions through

complex interactions among government,

health professionals, consumers, third

party payers, employers and delivery

systems. In this case, bureaucracy can be

a very serious obstacle in managing an old

age home. In government homes

bureaucracy plays an important role in

management. It is often the cause to

many management problems.

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� To conclude, the relationship

between need and demand must beconsidered as health services are

planned. Health needs and health

service provision must be in harmonyin order to make old age homes work

for the residents as well as for the

staff.

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� We came to conclusions based on our

work experiences and after comparingour experiences with studies in the field

we can say that in Israel, FP homes

provide poorer care than NFPs, possiblydue to a conflict between the demands

of patient care and the desire to

maximize profits in the FP institutions.

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BIBLIOGRAPHY

� http://www2.jdc.org.il/category/home-for-aged

� http://www.journals.elsevierhealth.com/periodicals

/agg/article/PIIS0167494308000022/abstract

� http://www.human.co.il/Default.aspx?tabid=277

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