I have worked in long-term care for more than 30 years. In response to Maureen Shawn Kennedy's Editorial in the November 2014 issue, "'Nursing Homes': A Misnomer," I believe her opinion of long- and short-term care and rehabilitation facilities is biased toward an RN-only mentality.

The report Kennedy mentions from the Department of Health and Human Services' Office of Inspector General includes four categories of adverse effects1: prolonged skilled nursing facility (SNF) stays or hospitalizations, including ED visits; permanent harm; life-sustaining interventions; and death. Hospital discharges are now accelerated. Many patients are unstable at discharge, when they are accepted by a SNF. If a patient returns to the hospital with undiagnosed pneumonia, deep vein thrombosis, or congestive heart failure, or is unable to return home because of advanced dementia or physical decline, the SNF will be penalized based on these criteria.

I have worked, with pride, for a nonprofit SNF for 16 years. As a unit manager, I rely on my staff of RNs, LPNs, and certified nursing assistants. LPNs are the backbone of the facility. Every attempt to keep a higher percentage of RNs in the facility has failed.

The shift to a community-based health care system needs many hands. Relying on LPNs or LVNs who are supervised by RNs is cost-effective for an SNF. Until RNs see nursing homes as a viable long-term employment option, we need the contribution of LPNs.

Maybe the real question is: "Do for-profit facilities provide medical care that puts patients first?"-whether in regard to critical care at the hospital or lesser acuity care at SNFs.

Sharon J. Schuttauf, RN

Raynham, MA

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