Reviewed By:
Barry Goldlist, MD, FRCPC, FACP
Director, Division of Geriatric Medicine,
University of Toronto
Adding Value to Long-Term Care
An Administrator's Guide to Improving Staff Performance, Patient Experiences, and Financial Health
D. Lazer and T.L. Schwartz Cassell
Elder Clinical Resources LLC 2000
This text is clearly meant for administrators of long-term care (LTC) facilities, and not for the physicians who take care of the residents in these facilities. The basic tenet of the book, that placement in LTC facilities can be a positive experience, is to be applauded. Placement should not be considered a "failure", but rather the appropriate choice in certain circumstances. This book is a "how to" manual for creating an optimal environment, an approach that will ensure high quality resident care.
Unfortunately, this book will not help most Canadian LTC administrators. The approach they suggest--ensuring an appropriate physical environment, multidisciplinary resident assessment, programming that ensures family involvement, and continuous quality improvement--is hardly ground breaking. It is the standard approach in most Canadian LTC facilities. The best part of this text is the section on how to make use of U.S. funding sources (e.g. Medicaid) in order to achieve these goals. Unfortunately, this advice is not applicable in Canada, and will not help Canadian facilities.
There are several appendices at the end of the text that are useful for monitoring the LTC environment, but once again they are hardly innovative by Canadian standards.
One of the appendices is on how to use simulation to teach caregivers about physical changes associated with aging. This is clearly a useful section, but it is interesting how little clinical information is available in the text itself. For example, the most common reason for institutionalization is a dementing disorder, and one would think that administrators, many without clinical backgrounds, would benefit from understanding the nature of dementia and its causes. The short section on this topic in this book, is incomplete and seriously out of date. Although excellent references are given, I feel the book would be strengthened by a more comprehensive approach.
In summary, this book addresses a worthy and important topic. However, its areas of greatest strength are relevant only to LTC administration in the United States, and will not help Canadian LTC administrators. Most of the other approaches and tools are easily available from provincial LTC associations, and are specifically designed for the Canadian health care environment. Despite its excellent intentions, I really cannot recommend this book to Canadian readers.
