Case 2: Why Change Is The Only Path Forward
Long-term care facilities play a vital role in supporting a significant portion of our senior population. However, these facilities are currently grappling with a critical and often overlooked challenge: incontinence care. As our population ages rapidly, access to long-term care is diminishing. A report from AHCA/NCAL reveals that over 30,000 residents have already been displaced since the onset of the pandemic, primarily from 4 or 5-star communities. Alarmingly, projections suggest that an additional 290,000 residents are at risk of displacement due to impending staffing mandates that could lead to further closures. (Source) Moreover, 57% of nursing homes report having a waitlist for entry, primarily due to understaffing issues. (Source)
The primary challenge facing nursing homes today, often referred to as a “staffing crisis,” is the ongoing shortage of staff. A recent report found that 96% of nursing homes are operating with too few Certified Nursing Assistants (CNAs), making this the most critical staffing issue in long-term care. (Source) In some instances, the National Guard has been called in to help fulfill the responsibilities of CNAs, underscoring the essential nature of their work. (Source) Interestingly, a study revealed that more than 56% of a CNA’s duties involve managing incontinence. (Source) This role is plagued by high turnover rates, often exceeding 100%, and a rapidly dwindling pool of candidates to fill vacancies. To comply with recent staffing mandates, it has been estimated that 92% of rural nursing homes will need to hire additional staff to meet minimum requirements. (Source) The staffing crisis is increasingly recognized as a key factor influencing the quality of care. Recent observations indicate a rise in average deficiencies (Source), as well as increases in pressure ulcers, infections, antipsychotic drug use, depression, and excessive weight loss—all of which are linked to staffing levels. With over 65% of nursing home residents experiencing incontinence (Source), the challenges faced by CNAs will likely remain daunting, stressful, and time-consuming, compounded by these complications and adverse outcomes.
As challenges continue to mount in the news regarding long-term care facilities—such as staffing shortages, new mandates, heightened regulatory scrutiny, tighter financial margins, stricter reimbursement criteria, and additional reporting requirements, not to mention the impacts of this hurricane season—the most alarming statistic is a nearly 53% increase in serious deficiencies reported by KFF between 2015 and 2023. (Source) Furthermore, nursing homes are witnessing an influx of sicker residents. (Source) Consequently, the quality of care is declining, access to services is becoming more difficult, and financial margins are growing ever thinner.
A comprehensive review of studies highlights the numerous adverse outcomes associated with incontinence, revealing significant correlations with depression, social isolation, functional deficits, behavioral issues, falls (including serious injuries), infections, sepsis, hospitalization, institutionalization, emergency room visits, skin breakdown, incontinence-associated dermatitis, pressure ulcers, delayed wound healing, ageism, and even mortality. It is no surprise that the Centers for Medicare & Medicaid Services (CMS) has designated Federal Tag 690—Incontinence of Bowel and Bladder—as one of the most long-standing and detailed compliance tags for nursing homes across the country. This tag includes a clinical pathway that guides surveyors through various departmental areas that influence incontinence, leaving few, if any, untouched. As outlined in the 2016 final rule, facilities are accountable for ensuring that residents either do not become incontinent or improve their incontinence (Ftag 690, SOM, CMS). Given the declining quality measures associated with these adverse outcomes, it is clear that our industry must undergo transformation. We have a responsibility to the older adults we serve to rethink our standard practices and embrace a path of innovation, creativity, and courage to drive meaningful change.
One profound statement found tucked away in a recent study provided much clarity on the path to move forward, the only path forward: “...to implement quality monitoring programs that collect information for improvement purposes as opposed to compliance purposes. This information could be stored out of the medical record and hence protected from survey scrutiny which reduces another source of motivation for inaccurate documentation.” (Source) The path that has led us to this point appears to be rooted in outcomes resulting from federal regulatory focus as well as the method for quality reporting while the path forward should be paved with the contrary; “improvements to care processes”. (Source)
The groundbreaking eBrief™ technology is achieving just that. It is transforming incontinence care by delivering insights and data that were previously unavailable. eBrief™ equips dedicated staff with essential tools to lighten their workloads and enhance efficiency. By adopting the eBrief™ System, communities are embracing innovative change, eliminating the guesswork in incontinence care, and paving a new path forward.
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About etectRx:
etectRx is a leading digital health sensor platform company offering a unique combination of wireless sensor technology, intelligent software, and services through our novel eBurst technology. This technology supports remote monitoring of multiple health conditions – enhancing patient engagement and healthcare outcomes across stakeholders including patients, providers, and payers, by promoting accountability and awareness.
