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No Trust For Obama, on LTC Issues
Published Jun 27, 2008 By Kim in LTC Politics, News, Opinion /Print This Post
Copyright © 2008 NursingAssistants.Net

This is surprising. Long Term Living (formerly Nursing Homes Magazine) recently wrote an article about Barack Obama’s plans for health care reform. A poll was also done. A whopping 73% don’t believe Obama’s ideas will make any difference. Also, several comments indicate that people don’t trust Obama has enough experience to do the job.

We tallied the votes and compiled your comments, discovering a striking display of distrust from you, our readers, in Obama’s healthcare reform. A week after posting “Questioning Obama’s Healthcare Reform…,” 17% who read the article decided to vote in the poll that accompanies it, resulting in 73% of that group expressing their doubt of the presidential candidate.

A while back we posted on the (at the time) three major candidates positions regarding health and long term care. Obama, McCain and Clinton each had their plans up at their web sites. Senator Clinton had the most comprehensive and detailed reform ideas of the three. Obama has the least; and McCain is in the middle.

Still, I’m shocked to see so many have little faith in Obama. I tend to agree with most of the comments left on this: He doesn’t have the experience, clout and political will to make the changes necessary to take this on. The lack of mention of health care workers is disturbing to me. The major unions have endorsed him at this point though; previously they had endorsed Mrs. Clinton.

However, Senator McCain’s reform plans don’t go into enough detail to give me any sense of direction. I do know that McCain’s Immigration reform plans can and will have a huge impact on the health care worker crisis: Immigrants will be employed more and more to work as CNA’s, direct care workers and the like. This work is one of those jobs Americans “won’t do”…Immigrants will be given access to work in the US, for periods of time, regardless of their education or skill. Whether this is a good thing or not depends upon one’s experiences with immigrants.

I firmly believe little change can come via politics and elections, when it comes to older Americans and their choices for retirement and life after, including long term care. I believe too many people place too much hope in these elections. It’s always a good idea to keep all candidates in our radar on these issues. In the big picture though, it’s also good to recognize what little they can really do.

1 Comment »

Wheel Chair Abuse
Published Jun 26, 2008 By Heather in Nursing Homes, Resources /Print This Post
Copyright © 2008 NursingAssistants.Net


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Wheelchairs. It seems like they are everywhere we go within the walls of so many nursing homes. Many believe they are a needed, if not required, piece of equipment. For some residents, the wheelchair is their ticket to independence. For most though, it’s a one way street to declines in almost every aspect of life. How many residents do we see slumped over in these chairs, belted in, reclined or otherwise forced to stay in them? Do we see the connection between wheelchair use and physical decline?

I can attest to this over dependence on wheelchairs. It starts out innocently enough- the aides are working short (again) and meals are being served. Time is short. Residents walk slowly. It’s easier to just pop them into a wheelchair and push them to the dining room. Or to the bathroom. Or to the activity room…and so on. Soon, the resident begins losing their confidence and desire to walk themselves. Perhaps they’ve had a fall and we are nervous to let them walk again…whatever, it’s insidious and sneaky- this overuse of chairs.

Provider Magazine has an excellent article (PDF) about wheelchair use, or more like, abuse. The article stresses that nursing home culture includes having so many residents sitting in these chairs that it’s almost expected. The article highlights one facility that decided to end the abuse, and how the residents have benefited. The Administrator started this process and walks readers through the steps she took to go “wheelchair free”…

WHEN FOREST AT DUKE, A continuing care retirement community in Durham, N.C., began planning its renovation and expansion, Leslie Jarema, administrator and director of health services, seized the opportunity to dramatically reduce wheelchair use in the community. “My many years in nursing home environments convinced me that wheelchairs created the discomfort that resulted in many negative outcomes and behaviors of residents,” says Jarema.

She has a tough policy:

Jarema instituted a new policy that limits the use of wheelchairs to two purposes: to enable a resident to be independent in ambulation or to transport a resident from point A to point B.

So, even the common “Walk-to-Dine” programs aren’t acceptable here, it seems. This isn’t a bad thing.

And what happened?

For the residents of Forest at Duke, the outcome of the wheelchair policy was nothing but positive, Jarema says. Dignity, comfort, improved skin condition, and residents’ range of motion were improved. “But there are some less obvious, more subtle outcomes,” she says. For example, the feel of the home became quieter, calmer, and more visually appealing. “The new program has totally eliminated the residents who typically sit around the nursing station crying out in discomfort.”

Jarema admits that the new policy meant more work for staff, who at first put up some resistance. “Even families and some residents resisted the initiative,” she says. “But one
must be committed and convinced that this change is for the better. Perseverance, persistence, and patience go a long way in achieving this highest level of functioning for our residents by getting them out of wheelchairs.”

A few reasons to re-consider the over-use of wheelchairs:

Over the years, the image of someone who resides in a nursing facility has become synonymous with an elderly person seated in a wheelchair. According to a study in the Journal of Rehabilitation Research and Development, wheelchairs provided to the elderly are often the wrong size, are in poor repair, are unsafe, and have fixed armrests and foot rests—factors that could lead to “poor posture, pain and discomfort, decreased sitting tolerance and function, decreased mobility, and pressure ulcers.” The authors conclude that psychological factors associated with “inadequate or inappropriate mobility devices” include loss of self-esteem, depression, diminished quality of life, and social isolation.

Does your facility abuse the use of wheelchairs? Are residents transported and then kept in the chairs as a means of convenience? Do you think it could be better to go to a policy such as highlighted in the article? What steps can CNA’s take to prevent this dependence upon wheelchairs? And who is more dependent: The resident or the CNA?

1 Comment »

Safe Transfers Videos: Three and Four
Published Jun 26, 2008 By Patti in Resources, Skills, Training /Print This Post
Copyright © 2008 NursingAssistants.Net

Video 3 and 4 here, from the series.



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Wireless Devices Causing Problems in Hospitals
Published Jun 25, 2008 By Heather in Blog, Hospitals, News /Print This Post
Copyright © 2008 NursingAssistants.Net

Some wireless devices are causing problems with hospital equipment.

CHICAGO (AP) - Wireless systems used by many hospitals to keep track of medical equipment can cause potentially deadly breakdowns in lifesaving devices such as breathing and dialysis machines, researchers reported Tuesday in a study that warned hospitals to conduct safety tests.

Some of the microchip-based “smart” systems are touted as improving patient safety, but a Dutch study of equipment - without the patients - suggests the systems could actually cause harm.

A U.S. patient-safety expert said the study “is of urgent significance” and said hospitals should respond immediately to the “disturbing” results.

The wireless systems send out radio waves that can interfere with equipment such as respirators, external pacemakers and kidney dialysis machines, according to the study.

This is just an FYI post.

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Medication Abuse For Dementia Patients
Published Jun 25, 2008 By Heather in Blog, Dementia/Alzheimer's Disease, News /Print This Post
Copyright © 2008 NursingAssistants.Net

How often do we see our residents acting out? A lot. Do we ever wonder if it’s the drugs they are taking? Perhaps we should.

Ramona Lamascola thought she was losing her 88-year-old mother to dementia. Instead, she was losing her to overmedication.

Last fall her mother, Theresa Lamascola, of the Bronx, suffering from anxiety and confusion, was put on the antipsychotic drug Risperdal. When she had trouble walking, her daughter took her to another doctor — the younger Ms. Lamascola’s own physician — who found that she had unrecognized hypothyroidism, a disorder that can contribute to dementia.

Theresa Lamascola was moved to a nursing home to get these problems under control. But things only got worse. “My mother was screaming and out of it, drooling on herself and twitching,” said Ms. Lamascola, a pediatric nurse. The psychiatrist in the nursing home stopped the Risperdal, which can cause twitching and vocal tics, and prescribed a sedative and two other antipsychotics.

“I knew the drugs were doing this to her,” her daughter said. “I told him to stop the medications and stay away from Mom.”

Not until yet another doctor took Mrs. Lamascola off the drugs did she begin to improve.

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At work, we should ask the nurses if our residents are taking any new meds; if they are, we should ask if there are specific or not-so-specific side effects WE should know of, and report. So many times older people are drugged up and we think this is WHO the person is…I once worked with a woman who was DX with dementia- but she wasn’t demented. It was her meds. It took months to figure things out, but she ended up being discharged from the nursing home. If it weren’t for the excellent nurses who were very aware of drug interactions and side effects, the poor lady most surely would have died in the facility.

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Spot Light: Staying Healthy For & At Work
Published Jun 25, 2008 By Heather in CNA Tips & Advice, Spot Light Series /Print This Post
Copyright © 2008 NursingAssistants.Net

The work we CNA’s do is HARD; some say brutal. The stress we put upon ourselves while performing our duties takes a high toll on our bodies. We have to take care of ourselves. And I mean that- especially at work.

Some of the things I do to make sure I’m ready and physically able to do my job are pretty mainstream, or so I thought. Lately I’ve noticed newer aides not bothering to do simple things that can make such a difference.

1) The usual items we hear about are par for the course: Eat right, exercise and get plenty of sleep! Easier said then done in today’s busy world. Family, friends, commitments, kids’ games and activities all keep us, at times, TOO busy to care for ourselves.

2) We use our legs, arms and backs for the vast majority of the tasks we perform. It makes sense to stretch these muscles before we use them. Before I go to work, each shift, I do some simple little stretches and exercises that really have helped me stay limber, and I believe they help me perform the lifts and other harsh aspects of this work without pain, and without injury. Please seek your doctor’s opinion before attempting these. The links take you to a site that illustrates how to do the stretches.


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SHOULDER STRETCHES

UPPER BACK STRETCH

LOWER BACK STRETCH

SPINE ROTATION

HIP FLEXORS

I do three sets of 10- if you haven’t stretched in a long time, do less.


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3) One thing I always have on my person is my own GAIT BELT. I don’t use the ones work provides; I prefer my own since I take care of it. Actually I have three belts- and it’s important to wash them between shifts. Think of all the germs that come into contact with these things! I have a small can of Lysol spray in my locker and every so often I use it on the belt…to kill the germs.


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4) When I am working, I ALWAYS CARRY a small bottle of hand sanitizer. The stuff comes in sprays and pen form now too. I use it A LOT. I work with an aide who will rub it all over her face every so often- and she never gets sick! I use it every time I touch a door knob, or answer the phone. Some of my peers think I’m a little crazy about this- but I rarely get sick. I use it liberally and purchase several trial size bottles at Wal Mart.


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5) Staying hydrated. A big one for me. Where I work it’s dry and the air is filtered, so little fresh, outdoor air comes in. I used to not bother drinking water cause I didn’t think I had time. I always felt thirsty and my throat hurt due to the dryness. I don’t care for straight water; but I do like Vitamin Water- which comes in many flavors, is very low in calories and tastes good. I get them at Wal Mart for less a dollar each and only buy them for work; I bring two or three bottles with me.


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6) Eating at work can be challenging. We all know that our breaks are often interrupted, or short to begin with. It’s important to bring your own meal with you unless the facility provides them. Even then, I would opt to pack my own lunch. I know a lot of aides who skip meals altogether. That isn’t healthy. I pack a small lunch: A sandwich or pita wrap; some fruit, a granola type bar…keep it simple. Yogurt with nuts is good; a medium size salad can fill me up as well. I try to incorporate the major food groups: Meat, veggie, fruit…protein and the like. Pre made pasta salads are very good as well.


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7) Vitamins. A lot of people take them. Many or a few or even one. We each have our own needs and desires with this stuff. I take a multi vitamin AND lots of extra Vitamin C: We are exposed to a lot of germs and viruses every day. It’s important to stay well nourished and the food we eat should provide us with all the daily requirements…however, there are some vitamins that don’t absorb well due to medications or lifestyle habits. It’s important to seek medical advice before embarking on any vitamin regime.

8) Finally, I always have on my person, a bunch of things that might be needed (and from experience, have indeed BEEN needed!)…A small bottle of Tylenol/Advil/Bufferin or whatever pain reliever works; some TUMS, a little bottle of IMODIUM; band aids…all travel size bottles or packages- that fit neatly in my bag or in the glove compartment. One never knows when the headache from you-know-where will come along; it’s good to have some relief on hand.

What things do you do to stay healthy, as part of your lifestyle or specific things for work only?

2 Comments »

Question of the Week: Falls and Responsibility
Published Jun 24, 2008 By Kim in CNA Tips & Advice, Question of the Week /Print This Post
Copyright © 2008 NursingAssistants.Net


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Question:
At work today I got into trouble because one of my residents’ fell. This man is independent and never needs our help. He can do his own care- showers, dressing, walking, meals, toileting…the works. As far as I know he has never fallen before. I was busy with one of my other residents who requires total cares. I was in the middle of bathing her when the nurse came in to tell me the man fell and why wasn’t I with him? After I finished up with my lady’s care, I was told to fill out a report which wanted to know what I COULD HAVE DONE to prevent the fall; THE LAST TIME RESIDENT WAS TOILETED; THE LAST MEAL consumed- all things that had nothing to do with this fall!!

Later, I was written up for the fall. I told the DON that everyone is responsible for ALL the residents on the hall I was working. Yes, he was assigned to me, but when I am busy with other residents, my co workers should step up and cover for me. What do you think of this?

Answer:
You should not have been written up, in my opinion.

Every resident must be assigned to a CNA. It’s law. No way out of that. Every aide accepts their assignment and therefore responsibility for the residents on it. Each CNA is responsible for her assigned residents and the unit, as a whole, cannot do this.

It’s tough when bad things happen to good aides, though.

Did you read the man’s care plan? Are you absolutely sure he is independent in his cares? If so, did you check in with him to see if he needed any help, with anything? I think sometimes we assume these residents who are able to do their own care never need ANY help- and this isn’t always the case. When doing this check in, it’s always a good to ask when they’re planning to get up; what they’re bathing plans are and the like. This way, you can have some awareness that Mr. Smith is going to be up and about around 9am, and might need someone to just peek at him.

Of course this is where team work comes into the picture. Every time an aide is going to be tied up for awhile with residents, its always a GOOD thing to let as many peers know where you’re at. And include the nurse with this info as well. If you’re so inclined (and I would be) I would ask peers to keep an eye and ear out for your other residents…especially if I was going to be tied up for a longer period than usual with the other resident. A good charge nurse would make sure your other residents are covered as well. It’s a balancing act though: Asking every aide to cover the others’ residents every time personal care is being performed is just not practical.

As for the report: It’s called an Incident Report. The questions asked do indeed have everything to do with the assessment of a fall. By asking you what you could have done to prevent this fall, the answers you provide are supposed to be helpful to prevent a repeat in the future.

Did you know most residents fall because they are trying to get to the bathroom? If they’re hungry they might be trying to rush out to a meal. Usually there are other questions too on these reports- about all sorts of things. Often we don’t know the prior condition of any resident when they have fallen without a witness.

It’s very important for CNA’s to answer these things honestly…however….when we’re written up it takes away the desire for CNA’s to have any respect for these reports. These things should never be used as a means for punishment. When independent residents fall, it is NOT the direct fault of the aides. It was caused by something else. It IS up to management to figure out why the fall occurred- but by placing blame on the aides they are short changing this process. This is another example of autocratic management style- which isn’t helpful. And, I have to wonder if nursing homes with high fall rates have these kinds of managers.

I’m sorry you got written up. Of all the things CNA’s don’t have control over, the FALL tops the list. The work loads alone should tell all that it’s impossible to be everywhere at the same time- or even once an hour. A good fall prevention program begins with a trusting environment where no one is disciplined for falls unseen. Once that is in place, true prevention strategies can be developed AND the CNA’s are the most valuable asset to this process.

3 Comments »

Safe Transfers: Video One and Two
Published Jun 24, 2008 By Patti in Resources, Skills, Training /Print This Post
Copyright © 2008 NursingAssistants.Net

I found these videos at YouTube and thought it would be a good resource. I’m including them here in two posts…

Transfer Techniques p.1 of 4



Video Two from the series.

Transfer Techniques p.2 of 4



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Interview: Donalyn Gross, Death and Dying Expert
Published Jun 23, 2008 By Patti in End Of Life/Hospice, Interviews /Print This Post
Copyright © 2008 NursingAssistants.Net

Recently we highlighted a program offered by death and dying expert Donalyn Gross: She is a thanatologist and has had lots of experience working in nursing homes and hospitals. Her program, “Good Endings” is an excellent resource for all who provide end-of-life care.

I asked Donalyn for an interview here, to get her thoughts and opinions on this issue. Presented here, is the interview which was conducted via email.


1) How long have you been a Thanatologist and what prompted you to get into this profession? What are your perceptions of the death process in institutions such as nursing homes? At your site you offer workshops for staff. I strongly believe this education is needed. How many workshops have you done? Who attends the program? Are CNAs a part of them?


DG: I’ve been a Thanatologist for 30 years now. My dad was a physician, my mother is a nurse, so I was raised in a medical household. I was a Candy Striper at a local hospital in high school, and all the jobs I’ve had since then were in hospitals or nursing homes. I’ve been a medical secretary, transcriptionist, dr’s assistant, nurses aide, Activity director, and a social worker.

In the 1960’s when Elisabeth Kubler-Ross came out with her work with the dying, I decided that’s what I wanted to do. All of my schooling (colleges) was based around medical counseling, etc.

Working in the nursing homes, when someone died, it was like “bag “em and tag “em”. The dead were hidden behind curtains, the roommate was brought into another room if possible, the funeral home was called and the body removed. Many nursing homes put the residents into their rooms, or closed them off when the morticians wheeled the body out. Out of sight, out of mind.

Some more liberal homes now allow residents in to see the person who is dying, or the deceased person. Sort of closure. That’s the way it SHOULD be. Why hide the dying/dead? I also am a Certified Music Practitioner, and play therapeutic bedside harp for the dying. I am on call at local nursing homes and a hospital.
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2) What has been your experiences in nursing homes/long term care facilities with regard to residents’ end of life care? What is the ideal environment for a dignified death within the boundaries of the average nursing facility?

DG: You know how busy nursing homes are= who has time to sit and visit with residents, never mind sit with someone who is dying. That’s why I created the Good Endings Program, with the Vigil Team= we recruited volunteer staff to sit with the dying, around the clock. It is a great program, and many nursing homes around the world are following the program and creating their own programs.

When a resident is “actively” dying, there should be some kind of protocol= the staff should make time to go in and visit/say goodbyes to that person. CNA’s are the ones who work closest to the residents. They’re kind of like extended family. They should be allowed to be with that person if they want.
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3) Is staffing an important factor in EOL care? Many residents do not have family that can be with them during their last hours; some facilities will ask an aide to sit with the dying resident and provide optimal care, while others will not. What are your thoughts on this?

DG: I think every facility should have a specially trained group of volunteer staff, who when a person is dying, should be the ones to provide the last care of that person.

Some residents have family who want to be there all the time, and only need some respite care- example- meals brought in, someone to stay if they need to take a break. For those who have no families/friends, that is a definite focus for someone to be there for them. Some people can’t deal with death and dying, and that’s ok. They can assist in other ways. There’s no shame in it, and a person shouldn’t feel guilty because they don’t want to be there.
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4) Hospice vs Nursing Home Staff: The differences you see

DG: Many nursing homes have outside hospice people coming in to see hospice patients. Nursing home staff are always there, and see the patients constantly. Hospice personnel come in for specific times and visits. They’re not always around. Hospice is a good program- they have volunteers who are a big part of hospice work, but they have their time constraints.
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5) CNA’s: What should their roles be in EOL care?

DG: CNA’s should be allowed to be a part of end of life care, to work along with the nurses, if that’s allowed. Every facility is different. Everyone is so busy and overworked. Our vigil team members will often go in during their breaks, and many will come in before or stay after a shift to sit with people.
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6) Many CNA’s know little to nothing about the religious beliefs of residents; we get basic rundowns on cultures and the like. Should CNA’s have better understanding of religious values in the context of death?

DG: In my Good Endings publications, there is a Teacher Resource packet= it’s 29 pages of everything you wanted to know about death, dying and bereavement, and information on religions/culture. Very important. NEVER push your own religious beliefs on anyone, and ALWAYS know something about a patient’s culture! Lot’s of things to be aware of.
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7) CNA classes don’t do a good job preparing the students for death and dying and all the emotions that come with it. We’re taught signs of impending death and about post-mortem care, but in clinical terms mostly. How could this be improved?

DG: I created the Good Endings program specifically for nursing home staff to provide them with the basics of death education. They should be given information on the physical aspects of dying, as well as the emotional ones.

My Good Endings Guide, a 12 page booklet, is used for this purpose. Facilities should have in service workshops once or twice/year for ALL staff members on death and dying. We’re all going to face it in our lives. It should be mandatory for ALL STAFF. I provide training workshops for healthcare personnel in nursing homes, hospice programs, hospitals, healthcare agencies= anywhere where requested. I speak at conferences for all types of groups (social workers, activity professionals, etc.) I also teach Death, Dying and Bereavement at a local college. We’re ALL going to die and we should know how to deal with it.
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8) CNA’s are often close to their residents. When they pass away, we’re expected to “carry on” and perform our duties with as little interruption as possible. The emotional aspect of losing a favorite resident is hard on the aides. How can management support the aides and nurses, and other staff who are grieving?

DG:When a resident dies, at some of the homes I work with, a sympathy card is passed around for staff to sign and write memories, and then given to the family. Some light a battery lit candle and put a rose up on the nurses station to symbolize there was a loss.

We have memorial services, quarterly at one facility, where we invite the family, staff, other residents to share loving memories of those who died each quarter. (Hospice usually has a big one once/year). It depends on the size of the facility.

Most death occur between September and March due to the cold, winter, and flu seasons. We’ve offered bereavement to the families and staff, but many of the families don’t want to come back to the home, and it’s really hard to get staff members to get together after work hours.

They do know that they can always call me at any time if they want to talk. And talking does help- even if it’s while you’re working, during a break….it’s good to get your feelings out. Working in a nursing home, there’s always going to be another death coming up. Administration should be welcoming of any kind of emotional assistance for their staff. You’re lucky if you get a concerned, involved Administrator/DON.
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Donalyn’s web site is HERE. Make sure you visit it and check out her program. She also offers in house trainings for facilities located in the north east US.

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Nursing Home Star Ratings? Ask the CNA’s to Rate
Published Jun 20, 2008 By Kim in Nursing Homes /Print This Post
Copyright © 2008 NursingAssistants.Net

The latest word from CMS on helping consumers decide which nursing homes are good: Star ratings.

June 18 (Bloomberg) — Nursing homes, like luxury hotels in travel guides, will soon get star ratings for quality and safety, according to Medicare, the federal health insurance program for the elderly and disabled.

Medicare’s new ranking system will help people choose the best nursing homes for relatives and push operators to do better, said Kerry Weems, the program’s acting administrator, on a conference call with reporters today.
[...]
“The public is hungry for information and this is an easy way to evaluate quality,” Weems said. “The new `five-star’ rating system will provide a composite view of the quality and safety information.”

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All I can say is they should have CNA’s be part of this rating system. As in, asking CNA’s to actually rate the facilities based on the special insight and insider info they have. Bet most nursing homes would get two, maybe three stars at most if the aides were doing the rating.

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