Baby Boomers – A Healthcare Crisis Nears

Baby boomers are quickly approaching retirement age, and as they do, there are a number of concerns that need to be addressed, particularly in the area of healthcare. Unfortunately, there appears to be no easy answers to the healthcare problems that baby boomers, and the population in general, will face in the very near future.

Baby Boomers are people who were born between 1946 and 1964. During this period of time the United States of America saw an explosion in birthrates that had never been seen before and nothing like it has been seen since. Today, baby boomers make up approximately 28% of the total United States of America population.

With this group of people occupying such a large segment of the population, it is predicted that there will be a major financial strain on the healthcare industry as a whole, as baby boomers reach retirement age. There are many reasons why the healthcare industry will face problems as baby boomers begin to retire and begin to need long-term care services.

Baby Boomers Are The Nurses

Go to any healthcare facility today and look around at the nurses who are working there. One thing will become abundantly clear to you; the vast majority of nurses working in healthcare are in fact baby boomers themselves. We have heard for the past few years about nursing shortages and predictions that these nursing shortages will only get worse.

There are many reasons why the United States of America currently faces nursing shortages. Traditionally, nursing has been a career dominated by women. Women have made great strides in efforts to gain equality over the past few decades; much of this progress is attributed to women who are from the baby boomer generation. With these strides in equality, women have realized that they have many more career choices other than being a nurse, a schoolteacher, or a homemaker. Today women are running the largest corporations in America, making great salaries, and receiving high levels of prestige.

A Two-Fold Problem

As baby boomers retire a two-fold problem is created. First, there will be even fewer nurses, because baby boomers make up such a large part of the current nursing workforce. The second part of the problem is that as baby boomers, 28% of our population, retire they will require more healthcare as a part of the aging process.

As you can see, there are some serious healthcare problems that need to be addressed. Leaders in the healthcare industry have been working extremely hard in trying to find a solution. Sadly their efforts are only making minimal impacts in increasing the nursing workforce.

Healthcare companies have tried everything from raising salaries to offering outrageous sign on bonuses. Money does not seem to be the key to get people interested in nursing. Survey a group of nurses and most will not complain about their salary. What they will complain about is the day-to-day workloads that they face. Nurses are overworked and carry larger and larger patient loads as a result of shortages.

Combine this with the fact that nurses, who typically get into healthcare to provide direct patient care, are being forced to do more administrative type tasks. Some of these tasks include excessive charting to meet requirements set forth by Medicare and insurance companies, and trying to get patients care certified, or paid for, by insurance companies. Most nurses did not become nurses to sit behind a computer and to talk on the phone for hours.

How This Will Affect Baby Boomers?

Advancements in medical technology and science means that people are living longer. This does not always mean that there is a high quality of life for those that are living longer though. Many of these people who would have died from a medical condition two decades ago can now live for a long time to come. These people often require a great deal of long-term care, whether it is at home or in a long-term care facility.

Those receiving long-term care at home require nurses to help them with their day-to-day tasks. The following is a quote taken directly from the Medicare website (http://www.medicare.gov/LongTermCare/Static/Home.asp)

“Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called “custodial care”. Custodial care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring.”

There is also a great deal of talk about whether or not Medicare will even be around in the coming decades. Consider the fact that 28% of the population will no longer be contributing to Medicare via taxes, while at the same time that 28% will be using more of the resources.

Is It All Really That Bleak?

Yes and no. It is true that there are no easy solutions in the foreseeable future to help deal with the nursing shortage, while the need for nurses will increase dramatically. It is also true that the economics of supply and demand will create a situation where healthcare will become even more expensive, while healthcare providers continue to raise salaries in hopes of attracting nurses.

So where is the good news you ask? The good news is that nurse recruitments are showing “some” success. Young people are showing a renewed interest in nursing, due in large part to huge marketing campaigns put out by nursing schools and healthcare organizations. The flip side of this is that these young people are going for the high level nursing degrees such as Registered Nurse (R.N.) and Nurse Practitioners (N.P.), but the lower level (lower paying) jobs such as Certified Nursing Assistants (C.N.A.’s) and Certified Medical Assistants (C.M.A.’s) remain understaffed. These are the ones usually providing direct care while the RN’s and Licensed Practical Nurses (L.P.N.’s) are meeting accreditation requirements by doing all of the charting and talking to insurance companies.

The other good news is that insurance companies are planning ahead and offering long-term care insurance plans that will allow you or your loved ones the ability to be able to pay nurses for long-term care services. Many baby boomers are taking their future into their own hands by taking out these long-term care insurance policies.

Finally, leaders in government and the healthcare industry are working diligently to address what is a predictable issue. Since these are predictable events, they can be planned for as much as possible.

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Power of Lean Healthcare

As health care costs increase at a faster rate than other products or services, health care providers, in particular hospitals, are under continuous pressure to dramatically improve service, reduce costs, improve patient safety, reduce waiting times, and reduce errors and associated litigation.

However, hospitals are not making the necessary improvements in cost, quality, and safety. A report by the U.S. HHS Office of the Inspector General finds that 20% of consecutive inpatient stay sequences were associated with poor quality care, unnecessary fragmentation of care, or both. The current organization and management of hospitals is an imperfect system that cannot effectively address these issues. Major projects to restructure hospitals, dramatically reduce cost, and improve customer care have had little impact on quality or cost.

In simplistic terms, current healthcare systems are not designed to make the process or ‘value stream’ of care flow smoothly. Healthcare services are often ‘batch and queue’, with patients spending most of their time waiting until the Healthcare Professional is ready i.e. push versus pull. As the population matures, patient cycle times in the hospitals, post-care facilities, and laboratories become key measurements that need to improve.

Our belief is that Lean Healthcare can provide a solution to successfully address some of these concerns with minimal cost but maximum benefit.

Lean in Healthcare

The essence of Lean Thinking is to eliminate waste through understanding how the patient defines value and how to deliver that value. Lean Thinking focuses on creating an efficient, waste-free continuous flow built on a pull vs. ‘batch and queue’ approach aligned with the continual pursuit of a perfect system.

Examples of Healthcare Waste:

– Redundant capture of information on admission

– Multiple recording of patient information

– Excess supplies stored in multiple locations

– Excess time spent looking for charts

– Patient waiting rooms

– Excess time spent waiting for equipment, lab results, x-rays etc.

– Excess time spent dealing with service complaints

Hospitals are made up of a series of processes with diverse lines of business. As a consequence, they need to build their delivery systems with these lines of business in mind. Hospitals need to know the businesses that drive 80% of their value proposition. They need to streamline their organization systems and processes to fully support the process required to deliver high quality care.

Commitment and support for any lean initiative needs to not only come from top healthcare management but, even more critically, from the ‘bottom up’ for implementation. Decision making and system development need to be pushed down to the lowest levels of any healthcare organization.

Management consultants are normally engaged as Lean change agents rather than as Lean facilitators. Healthcare staff should lead any Lean implementation program. These people are best equipped to understand the work environment, issues, challenges, what will work and what won’t. An empowered and knowledgeable team is therefore essential to achieve sustainable improvements and long-term success in any Lean initiative. Put simply, Lean will not work without an educated workforce.

Examples of Lean Healthcare Performance Metrics

– Improved patient satisfaction

– Increased operating room utilization

– Reduced time between procedures

– Lower tools and supplies inventory

– Reduced laboratory space

– Improved cost effectiveness

Lean Healthcare Accreditation

A new Lean Healthcare Green Belt Certification program was recently developed to enable effective staff empowerment. The on-line program represents the first International Healthcare Certification of its kind, and provides an essential ‘first step’ to not only understanding the theory but also the application of Lean tools and practices through detailed work assignments, in-line assessments, and final examination.

The program has been designed in association with the Irish Institute of Industrial Engineers, the Canadian Professional Logistics Institute, Lean Experts, and Healthcare Consultants in conjunction with the Leading Edge Group. It is open to personnel involved in any organization within the healthcare field, particularly those associated with hospitals, clinics, nursing homes, blood banks, laboratories, and pharmacies. Once these people have the ‘appropriate’ knowledge, they will be able to envisage and achieve results and, most importantly, meet the needs of patients now and in the future.

Joe Aherne CPA

Chief Executive Officer

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