Policy solutions are needed to address factors influencing poor quality of care in long-term care facilities. A major barrier is lack of financial resources. Understaffing contributes to low quality due to burnout. Medicaid facilities have limited funding, so care quality suffers, dividing facilities into upper and lower tiers. Rural facilities face staffing and funding challenges. Disparities also exist for minorities and veterans with complex needs.

1. Identify possible policy solutions or industry changes that are
needed in response to these problem factors. What are barriers
to these policy solutions? Is it lack of need, financial resources,
etc.? posts should be 100 to 150 words, with a minimum of one
supporting reference included.
Response 1
Identify differences in the quality of care residents receive in
long-term care facilities and discuss why.
According to White et al. (2020), a major factor driving poor
quality care in nursing homes is nurse burnout and job
dissatisfaction. With that being said, I would like to include
nursing support staff in this statement. Certified Nurse’s Aides
(CNAs), have more time with hands-on care and bedside care
with the patient than nurses do in the nursing home setting.
They are the backbone of the care the residents receive.
Donoghue (2010) reported that the turnover rate for CNAs in
nursing homes was about 74.5%! This was followed by 56.1%
for registered nurses and 51% for licensed practical nurses. On
the other hand, White et al. (2020) report that strong leadership
and staff involvement in organizational decisions can improve
teamwork and safety climate leading to better quality care.
Shared-governance is a term I learned when working at a
community hospital. The goal of shared-governance was to
empower nurses in making the work environment better for all
and subsequently improving the quality of care and reducing
cost. Barden et al. (2011) state that through empowering nurses
by way of professional practice models of shared governance
retention of staff was evident, as well as improved quality
patient care and cost containment.
Discuss the disparities within long-term care and what factors
you find surprising. Discuss root causes connected to these

2. factors, and discuss why.
After learning the reality of the astronomical costs to residents
in long-term care, it surprises me that these facilities are so
understaffed (White et al., 2020). I was also surprised to hear
that segregation is prevalent in nursing homes (Mack et al.,
2020). Both issues contribute to poor quality care. The root
cause connected to these factors are the lack of good leadership.
A good leader and adequate staffing can have the resources to
implement innovative ways of inclusive care.
What differences between rural and urban health care offerings
did you find interesting? Why?
I found it surprising that staff shortage didn’t make up a bigger
part of the disparities between rural and urban nursing homes
(Bowblis et al., 2013). That is still a sad fact, that no matter the
location, nursing homes are still short-staffed. According to
Temkin-Greener et al. (2012), both urban and rural nursing
home staff have low-quality training. The staff is the backbone
of any company. We need to recognize that if we are to truly
improve the quality of care in nursing homes. Rajamohan et al.
(2019) found that job satisfaction among nursing home
employees not only increased the quality of care delivered but
al the quality of life of residents. It really isn’t rocket science.
Identify unique challenges aging veterans experience in long-
term care settings.
Some unique challenges aging veterans experience include
homelessness, alcohol abuse, being admitted to nursing homes
from the hospital if homeless (Jutkowitz et al., 2019). Mental
health and substance abuse are two challenges that make caring
for aging veterans in a nursing home a challenge.

3. Response 2
identify possible policy solutions or industry changes that are
needed in response to these problem factors. What are barriers
to these policy solutions? Is it lack of need, financial resources,
etc.? Your reply posts should be 100 to 150 words, with a
minimum of one supporting reference included.
Unfortunately, the quality of care that residents receive in
long-term care facilities varies based on the facility in which
they reside. The quality of care that the residents receive can be
greatly influenced by staff work environments. Nurses play a
major role in care management, and studies have shown that a
positive work environment can improve care quality. In a study
completed by White et al. (2020), results showed that nursing
homes with wholesome work environments had decreased rates
of hospitalizations, pressure ulcers, and antipsychotic use
amongst their residents. In addition, nurses working in these
nursing homes were less likely to experience burnout (White et
al., 2020). Nurses are better able to perform their duties and
properly care for their residents when they have adequate
staffing ratios, positive management, and adequate resources.
Some disparities that exist within long-term care facilities are
influenced by socioeconomics, race, ethnicity, and location.
Nursing homes that primarily house Medicaid patients have
limited resources due to financial constraints. The quality of
care within these nursing homes can be negatively impacted due
to the inability to afford the resources they need to properly
care for their patients. Medicaid reimburses at lower rates, and
when a nursing home does not have an adequate number of
residents with insurance that providers higher reimbursement
rates, they are unable cross subsidize by using surplus from

4. other resources to cover the Medicaid deficit (Mor et al., 2004).
I find it most surprising that nursing homes are divided into two
tiers; an upper tier and a lower tier. Lower tier nursing homes
are primarily funded by Medicaid, and care quality is hindered
due to inadequate resources. I find this unsettling as a patient’s
quality of care should not suffer due to their inability to pay for
private health insurance, considering Medicare does not cover
the cost of long-term care.
Race and ethnicity can also influence the quality of care
received. One example being that African Americans are more
likely to reside in a lower tier nursing home than whites (Mor et
al., 2004). For this particular reason, African Americans may
experience reduced care quality due to inadequate resources
within the facility that they reside. Health care disparities also
exist amongst long-term care facilities in rural and urban areas.
Long-term care facilities in rural areas have inferior care
quality due to inadequate staffing ratios, facility structure, and
finance sources (Bowblis et al., 2013). Since long-term care
facilities in urban areas are better able to obtain the resources
they need, patients residing in these areas are more likely to
receive a greater quality of care. I find it particularly interesting
that long-term care facilities in rural areas are less likely to
offer specialized services to their residents. This can also
impact their quality of care as they may be less likely to receive
the physical therapy that they need, or less likely to socialize
due to lack of an activities program. Disparities also exist
amongst aging Veterans that reside in long-term care facilities.
Homeless Veterans are more likely to enter a nursing home at a
younger age due to many of them suffering from substance use,
mental illness, physical illness, and unique social needs
(Jutkowitz et al., 2019). Due to the complex health needs of the
homeless Veteran as it relates to physical, social, and mental
health; long-term care facilities may struggle with providing
Veterans with the services that they need.