This isn’t news to me, or to most aides I suspect.
We see it. We experience it. We hear all about it.
WHAT? The PANIC mode our DON and Administrators go into when it’s THAT time of the year. The biggest pony show is often put onto the stage during these times.

THE ANNUAL SURVEY.
Weeks before they expect the inspections, the leaders go crazy. Everything is painted and cleaned and polished to a high voltage shine.
Suddenly the food is much better- it’s hot when it’s supposed to be, or cold when it should be. More food is served; it looks better and smells better and….YES….it even tastes better. The nice table linens come out. The dishes are apt to be prettier. The cook is suddenly more responsive to resident requests for an alternative. The servers show some respect once again. And the aides HEAR about IT when they’re not in the dining rooms right exactly on (cue) time. The dietitians suddenly show up more at meals and actually taste the food, check it’s temp and go through the motions they’re supposed to have been doing all along.

The DON changes too at this time of the year. She or he goes on a witch hunt, scouring through employee records to see who needs to be updated for in services and background checks and all that. She might realize the nursing home hasn’t offered enough education hours so we the aides are forced to attend stupid movie in services by the half dozen for several weeks. Then we’re coached as to what to say IF the dreaded SURVEYORS ask us questions. An innocent and idealistic aide might ask why she can’t just tell them the truth? Lo and beho, the SIN this person just committed. The DON goes further into herself imposed bitchdom with the resident care plans. And the nurses are the next target of the scorn and attacks. Care plans are re-written; aides and nurses and others are asked, no TOLD, to re-sign endless pages of flow sheets and similar stuff.
The residents get the most out of SURVEY EXPECTATION ANXIETY TIME. They get brand new towels and sheets and linens. They have new toothbrushes with their names on them…and shampoo and soap and creams and lotions. Things they haven’t always had all year long. Their rooms are suddenly really well cleaned- rugs are washed, walls are re painted, much needed repairs are done. Windows might even get screens placed in them; AND, the bathrooms! The toilets are fixed so they stop clogging up; the showers magically spray hot water again. And residents have an endless supply of needed items like briefs and wipes and the likes. The scents of the home are just wonderful too, at this time of the year. Air fresheners and flowers and the smell of baking food is abundant in every nook, corner and crevice.

THE BEST PART of THAT time of the year is the increase in STAFFING. Yes. Everyone benefits now. Not only are there enough aides scheduled, often we have too many. SO many that a couple might be sent home or better yet- put to work doing special things like restorative nursing stuff, or activities. The nursing home appears to be a well oiled, well run shop. Enough staff; good food, excellent building and yards; a great activity program…and perfect care plans with well written goals and all signed off by the right people, at the right time, for the right resident.
Yep.
Too bad this isn’t how it works ALL THE TIME.

Now go this article. And consider my rant above. It’s all relative and yes, some nursing homes are NOT like this (or shall we say, some nursing home management teams) BUT many are. Hide the truth when IT’S THAT TIME OF THE YEAR. Cover up those things that are cosmetic and can be altered for a few days. And forget about the rest of the year.

Related posts:

1. THAT time of the YEAR
2. Taking Time To Find Time

Yet another study has come out about nursing homes not being prepared for disasters- natural and otherwise. After Katrina, where many residents at one nursing home died due to poor planning, the government decided to do a large scale study.

WASHINGTON (AP) – Tornado, hurricane or flood, nursing homes are woefully unprepared to protect frail residents in a natural disaster, government investigators say.

Emergency plans required by the government often lack specific steps such as coordinating with local authorities, notifying relatives or even pinning name tags and medication lists to residents in an evacuation, according to the findings.

Pinning name tags and med lists to actual residents? That’s a novel idea.

“We identified many of the same gaps in nursing home preparedness and response,” investigators from the inspector general’s office of the Health and Human Services Department wrote in the report being released Monday. “Emergency plans lacked relevant information. … Nursing homes faced challenges with unreliable transportation contracts, lack of collaboration with local emergency management, and residents who developed health problems.”

The devil is always in the details: The more detail the better the plan. I recall a nursing home calling for buses to come get the residents during the Katrina event; the buses could not enter the city because the governor blocked access into New Orleans. Then as the levies broke, flooding became a logistical problem for bus companies. So the problems may not have all been the nursing homes’ fault.

The vulnerability of nursing home patients became a national issue when 35 residents of St. Rita’s Nursing Home just outside New Orleans perished during Katrina. Some drowned in their beds.

Prosecutors charged the owners of the facility with negligent homicide, saying they should have evacuated the home. But a jury acquitted them of all charges. Some jurors said afterward that Louisiana authorities should have taken responsibility for the safety of nursing home residents ahead of the monster storm.

I believe most disasters cannot be adequately planned for. There are too many variables that could destroy one important aspect of such plans.

If transportation can’t happen because the flooding is making the roads unsafe to drive on, there isn’t much to be done. No amount of planning, drills or government mandate will change this.

Having 10 days of a water supply isn’t unreasonable in my view- storing it safely is though. This could be a whole lot of water to be stored somewhere…

How about meds? What happens when they’re gone? And the streets are too flooded? And the government says we can only have so many days supply of meds in the first place? There are too many different scenarios that can occur during a disaster. It doesn’t hurt to prepare. It does hurt to assume all will go according to some neatly written, well practiced plan.

No related posts.

An interesting article came to my attention today. In it, a study has shown that when the ecomony is strong and jobs are plentiful, nursing home residents have much higher death rates than any other time. The study shows that staffing is directly related to resident mortality.

Loss of caregiving help is literally deadly for older folks, according to a study from the Center for Retirement Research at Boston College. Perhaps surprisingly, death rates actually rise when the economy is stronger. In researching why this happens, the Center found that when employment rises, nursing homes lose staffers who prefer other jobs.

I’ve seen this happen for sure. People who not otherwise consider working in a nursing home, will do so during tight times. A job is a job. Money is money. It’s fairly easy to become a CNA, let’s face it. The promise of a secure job, even in tough economies is a motivator for people. There’s always a need for nurses and aides. When times lighten up and better jobs are available, many people do run, as fast as they can, from this work.

Why is that? Don’t the joys of the work keep people interested in staying in the profession? Maybe. But the pay, weekend requirements, unforgiving management style so typical to nursing homes, and the HARD PHYSICAL work are huge turn offs.

What can be done to rectify this? Not much. Pay rates are determined by funding sources; when the government is the chief source of money, pay rates are low. Working every other weekend is the norm is this line of work although some forward thinking facilities do offer a M-F option and an weekend option (2 back to back double shifts Saturday and Sunday). As far as the management style- well this CAN change IF those in charge are willing to give up some of their power to the front line staff. Few health care facilities are willing to do this though. And finally, the work itself just isn’t appealing to so many. Personal care- bathing, feeding, lifting, changing briefs– it’s a lot to do and you’re not into it, you never will be.
So all these laid off teachers and money management professionals really don’t have what it takes to work in nursing.

And who suffers? As always it’s the residents.

Related posts:

1. Nursing Home Worker Injury Rates High

A headline caught my attention this evening. This is about a hospital going to an all RN staffing model, eliminating CNAs.

In a move that defies conventional wisdom, Hahnemann University Hospital is replacing less expensive workers with people who are paid more.

Michael Halter, the hospital’s chief executive officer, believes that ultimately the change will earn Hahnemann more money and customers, and create a more loyal staff when the labor market becomes competitive again.

Halter said a pilot study done on one nursing unit found that using all registered nurses to care for patients instead of a combination of nurses and nursing assistants led to higher-quality care, and greater patient and nurse satisfaction. As a result, the entire hospital is transforming to the all-RN model. Halter thinks the move will pay off financially as insurance companies change reimbursement policies to reward quality.

“I believe it’ll help us grow,” Halter said. The idea, he said, originated with nurses. It has been tried on two units and will begin on a third next week. He expects the entire transition to take six months to a year. Until now, it has been possible to move certified nursing assistants (CNAs) on those units to other jobs, but Halter said layoffs will soon be required.

I’ve seen this happen before and for some hospitals, this staffing model works. Patients with very high acuity needs, who are very sick, need the skills of an RN to take total care of them. I’ve also seen these hospitals start off with this, but end up hiring “advanced skilled” aides to assist the nurses with the personal care portions of the job. There are many studies that do indicate all RN nursing teams provide better care with less incidents. However, it’s a costly model and most people, insurances and other payers are not willing to allow costs to go up based on a staffing model.

No related posts.

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No related posts.

I’ve been doing this work for over 20 years now and had my unfair share of injuries while performing my duties. I have often heard bosses moan and groan about worker comp rates and cost loss problems. Those of us who work in this field KNOW getting hurt on the job is almost…part of the job at times.

An article here validates this:

We’ve seen reality shows featuring dirty jobs, cops and coal miners. I wonder if it’s time for one showing a day-in-the-life of nursing home workers. Most of us don’t give much thought to what goes on inside of nursing homes, that is until a friend or family member needs to reside in one. What might appear as a quiet, slow-paced, restful setting is usually a stress-filled, physically-demanding environment for the people who work in them. Lifting and moving patients from beds, toilets, recliners, showers, and wheelchairs can cause all sorts of injuries, but then throw on top of that, the body fluids and infectious agents, staffing shortages, and violent patients and family members. On second thought, it’s probably not a tv show that would attract many viewers.

I think it would be good to have a reality show on Life in The Nursing Home. A Day In The Life of a Nursing Home Worker.

Related posts:

1. Nursing Home Scope & Severity Rules
2. Nursing Home Industry Heading for Crisis- Job Losses Will Happen

Articles like this leave me speechless. A man volunteered at a nursing home for years without any problem. One day he witnessed an abusive occurrence. He reported this. He started seeing more abuse and continued to report.

His story is here.

For the first time, he was told he couldn’t visit the nursing home, that it constituted trespassing. Feeling that the residents had the right to have visitors, on January 26, 2011, Edmund disobeyed those orders, and found himself arrested. He spent time in jail at taxpayer expense. He had never been arrested before.

It’s too bad this gentleman had to experience all of this. Doing the right thing can be difficult when you’re up against big corporations and especially nursing home chains. We need to support those who have the guts to speak up. Support can mean cheering them on, assisting with paying for legal help, etc.

No related posts.

This is an age old question: Should CNA’s pass meds? What if we had more training? What if the states mandated that the practice of CNAs include passing routine medications as delegated by the nurse?

Forbes has an article up about this very subject:

Frail seniors, as well as adults with disabilities, often need help with routine medical care such as taking pills, receiving injections, getting oxygen, or managing catheters. Traditionally, this assistance has been provided only by nurses. But, especially for people living at home or even in assisted living facilities, having a nurse provide this routine care is prohibitively expensive and can lead to long delays in getting assistance. As a result, states are increasingly permitting home health aides or certified nursing assistants to take on these responsibilities.

Personally I don’t see where I would have the time to collect meds and pass them. If a system could be set up that made this process very simple and involve very little time, I think it could work.

No related posts.

In the March edition of Long Term Living Magazine, an article was written about nursing home and assisted living residents hiring their own staff. This is a unique development in our line of work, and one that could have wonderful implications for the next generation of people who need LTC services.

You would expect the DON to be involved in every aspect of recruiting a CNA, and Judson is indeed involved. But, at the hour of decision, she silently steps aside and the residents take over.

A team of four to six residents, their homework done and ready to meet the applicant, stroll into the conference room. It is a meeting of the ages. On one side is arrayed the accumulated wisdom of the seniors who look benignly across the table at the eager young aspirant, Angelica Riviera, 19, idealistic but nervous. The dialogue across generations goes on for 45 minutes, with storytelling, jokes, and much laughter, as each side wonders how the other side will affect its future.

Isn’t this great? Imagine being a resident, and having some power in who is hired to work with you, to take of you, help you?

The DON is instrumental in this process:

“Seeing residents hire their caregivers is rewarding enough,” says Judson. “It has also elevated my understanding of what matters most to the residents. It has made me a better leader and a better person. It is an empowering and uniting experience for us all. Sitting on the sidelines, I listen to residents tell a budding caregiver what living in a facility is all about; at each session I learn something new.”

Read the whole article HERE.

No related posts.

Why I haven’t seen links to this article at other nursing home blogs is beyond me.

HARTFORD, Conn. (AP) – The nation’s nursing homes are perilously close to laying off workers, cutting services – possibly even closing – because of a perfect storm wallop from the recession and deep federal and state government spending cuts, industry experts say.

The spending cuts are only just beginning. Wait until this health care reform really gets going. It’s all in the details, which hopefully we will all have a chance to read and comment on. It appears that some of our elected officials are not even reading the devilish details.

A Medicare rate adjustment that cuts an estimated $16 billion in nursing home funding over the next 10 years was enacted at week’s end by the federal Centers for Medicare and Medicaid Services – on top of state-level cuts or flat-funding that already had the industry reeling.

And Congress is debating slashing billions more in Medicare funding as part of health care reform.

Add it all up, and the nursing home industry is headed for a crisis, industry officials say.

“We can foresee the possibility of nursing homes having to close their doors,” said David Hebert, a senior vice president at the American Health Care Association. “I certainly foresee that we’ll have to let staff go.”

So in order to fix one part of health care, we have to sacrifice another part? Seems so. A saving grace here might be that home care would be the most cost effective “choice”- which is far better for the elderly person than a nursing home admission.

Related posts:

1. Nursing Home Scope & Severity Rules