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 the
families 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 age
homes. Here we are focusing on
problems that may arise from the
difference between the homes based on
the FP and NFP criteria.
• Lack of budget in private homes and the
demands of the patients can lead to a
stressing situation for the management.

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 Private old age homes

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• Private homes have to look for ways to
have maximum patients in order to
have money to maintain the home and
make profits.
• While government homes do not have
to worry about this issue since it is a
NFP organization and elderly people are
sent by Social Security to these homes.

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• Management in private homes hires less
skilled and professional staff to saves
money. The unskilled staff can cause
many management problems.
• Management saves on medical
equipment.
• Management saves on developing the
staff'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 money
while 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 serious
problem. I decided based on my medical
knowledge that the patient needed to be
accompanied. The manager who wanted to save
money refused to hire someone to accompany
him because she thought that it wasn't necessary.
• This of course caused many more problems much
more serious than the money management had
to pay for the extra staff. It is a result of decisions
taken by non-professional managers!
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• Saving on medical equipment: gloves,
medicines, food and night-nurses can
harm staff and residents of the home. As
part of saving money policy,
management in private homes buys
fewer gloves, cheaper or equivalent
drugs that the residents need and hires
unskilled assistants instead of authorized
nurses 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 take
medical 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, social
security as well as the resident himself or
his family. So they don't really have to
worry about budgets. Here management
problems arise from different motives/

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• Staff enjoys stable, good working
conditions.
• 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 to
care 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 that
means more work and less attention
to the elderly. When a nurse has to
take care of 10 patients instead of 4
or 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 hard
since management is usually used to its
habits and isn't interested in innovation.
It is much harder to convince a manager
who has been working many years in
managerial position to make some
changes in the organization and in our
case 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 be
considered as health services are
planned. Health needs and health
service provision must be in harmony
in 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 comparing
our experiences with studies in the field
we can say that in Israel, FP homes
provide poorer care than NFPs, possibly
due 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/periodi
cals/agg/article/PIIS0167494308000022/abstract

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

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