The management of human resources in long term health care is challenging. Whether it is home care, skilled nursing care, hospice care, rehabilitation, case management, medical supply, or pharmacy, the work force consists of skilled, licensed professionals. In a case study of a vertically integrated long term care organization operating in several states, the turnover rates for various positions and types of organization were calculated and analyzed. The results point to acuity level, type of long term care provider, and the possibility of low pay as factors for turnover rates from an acceptable level to extremely high and unacceptable levels.Keywords: Turnover, Long term care, Human Resources, INTRODUCTIONOne of the most perplexing human resource management problems among health care organizations is employee turnover. This is costly and is a problem that impacts the quality of care. In the long term care arena, turnover is an even more exacerbating problem. The proportion of entry level employees to professional health care providers is larger than in other areas of health care. While it might be assumed that replacement costs for entry level health care employees is lower than those for professional level employees, the volume of entry level turnover makes employee turnover expense even larger than for professional health care employees.

Objectives: This study aimed to investigate the prevalence and current treatment status of immune thrombocytopenia (ITP) in Taiwan.Methods: This was a retrospective study conducted using claim data collected from the Bureau of National Health Insurance (BNHI) of Taiwan from 2003 to 2007. ITP patients were identified using the ICD-9 code, 287.3 (primary thrombocytopenia), with two diagnoses separated by at least 14 days for diagnostic specificity. In addition, sensitivity analysis was based on 28 (ITP-28) and 84 (ITP-84) days.Results: ITP prevalence ranged from 10.35 to 11.02 (per 100,000 individuals) with an annual number of 2,300 to 2,500 patients, and sensitivity analyses using ITP-28 and ITP-84 criteria showed that the prevalence were "9.52 to 10.35" and "6.87 to 8.14" in 5,445 ITP patients, respectively. The median age of ITP-14 patients was 46.5 years. In children, the female-to-male ratio was nearly equal (0.93), whereas in adults, it was 1.91. About 3.9% received splenectomy, of which 64.3% were responsive to splenectomy. Further, 92.6% were responsive to steroids. The average costs per visit were US$ 36 and US$ 1,700 for outpatients and inpatients, respectively. For steroid-responsive patients, the mean costs for clinic visits and hospitalization were US$ 35 and US$ 1,415, respectively. In contrast, the medical expense for steroid-refractory patients was approximately one and a half times the costs for responsive patients (inpatient: US$ 54; outpatient: US$ 2,349). For splenectomy-responsive inpatients, the average expenses prior to, at, and after splenectomy were US$ 1,877, 5,476, and 2,061, respectively. For splenectomy-refractory inpatients, the costs were comparable to those of responsive patients (P> 0.05). On the contrary, there were significant differences between the expenditure for splenectomy-responsive and -refractory outpatients. Among ITP patients in Taiwan, 7.4% and 6.4% had hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, respectively, and 1.5% had both HBV and HCV infections. Patients with HBV were significantly high in the splenectomy group (splenectomy vs. non-splenectomy 11.7% vs. 7.2%, P = 0.01), and those who were more responsive to splenectomy had a low HCV infection rate, i.e., 14.5% had HCV infection in splenectomy-refractory group vs. 4.38% in splenectomy-responsive group (P = 0.02). Conclusions:The epidemiology of ITP in Taiwan, including the age and sex, was comparable with that in western countries, except with lower incidence of splenectomy in our patients. The status of HBV and HCV infection in splenectomized patients should be closely monitored. The medical expenditure in Taiwan was much lower than that in western countries. We suggest that novel agents or more aggressive treatment strategies should be further explored or considered in Taiwan.

Achieving diversity is a necessity in any organization but is especially important in long-term care. The care delivered is to a diverse group of patients and their families. Therefore, this case allows the analysis of diversity in one long-term care company. While Federal EEO requirements include a report of diversity annually for employers and contractors, this is a further analysis of the diversity data used for reporting. Looking into frequency and distributive statistics allows a better understanding of the diversity of this company.

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