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Has Obama said “NO” to improving the health care workforce?

The Obama administration’s economic recovery team is under increasing pressure to create and improve jobs for those most in need: low-income workers, particularly women. To that end, PHI and others have proposed targeted increases in Medicaid to create and strengthen the eldercare/disability services workforce–the millions of jobs held by home health aides, certified nurse aides, and personal care workers. But so far, the response from the Obama team has been a flat “no.”

The proposal isn’t included in Obama’s first stimulus plan. There, he plans to create jobs rebuilding infrastructure and public school buildings. I think the “NO” comes from adding health care workers to this plan…right now or in the not-to-distant future.

I don’t believe Obama means “NO” for good.

Obama has to pick and chose the issues to work on, and prioritize them. There are millions and millions of people out of work right now- and the first priority should be getting them BACK to work ASAP. For the incoming President, priorities will be based upon the economic realities this country faces.

In the future, I bet we will see health care workers day of reckoning arrive: I’m thinking the needed changes will come when they overhaul health care in general.

For us, we are working. The conditions we work under are not good. There’s a lot of room for improvement. And yes- our skills will be needed when the baby boomers grow old and need care. For now though, we have jobs.

Obama will be focusing on those who do not, or who are working in industries that are less likely to survive the future. All the lobbying and prodding in the world will not change this reality. Groups like PHI and others should give the incoming President some time, to get this country moving in the right direction again. Going negative now will not win any brownie points in the future…

A while back I wrote an article about discrimination in nursing homes. Not about worker-to-worker discrimination, but resident/family-to-worker discrimination…namely CNA’s.

I see again Long Term Living Magazine is asking about how facilities are handling this issue. A poll asks,
“Has any of the in-service training you provide direct care workers taught them how to deal with racist attitudes in your facility?”

The vast majority of answers are a resounding NO.

CNA ABUSE: Not just discrimination

I think it’s a huge problem. And it’s not just residents-to-CNA’s- it is, sadly, families-to-CNA’s (and nurses). Where I work, it’s allowed to continue. Management gives the excuses, and tells the aides to toughen up and to be more understanding of the stresses the families face. Management also picks and chooses which aides should be assigned to which residents, in an effort to dilute the confrontations.

I’d like to think this is all just discrimination. But it’s not. In the bigger picture, this is a reason why so many aides come and go. Who would stay in a work place that allows people, even customers, to verbally abuse it’s employees?

I think management of nursing homes should be educated on how the pandering to residents and families effects employee morale.

Over the weekend at work, a resident/patient’s Mother was demeaning the aides. Nothing they did was right; she loudly complained and repositioned and redressed her daughter. She refused to look at the aides. She pushed one of them out of her way. Later, when her daughter was crying, her Mother yelled at the aide- telling her to, and I quote, “Get your fingers out of your ass and do this right!” She actually grabbed the aides arm and shook it while making this comment.

The aide walked out of the room, her eyes welling up with tears. She’s been an aide for over 10 years. She has never seen anything quite this bad before.

Frankly neither had I. What shocked me even more, was the charge nurses’ reaction. She told the aide to go back into the room, and do her job and ask the Mother to show her how she wants things done. The patient has been on the unit for several months now so it’s not like no one knew her or her needs.

The nurse didn’t blink an eye when she heard those words the Mother said. The exchange was not documented in the chart, in spite of threats from the Mother to report the aide for being a “stupid POS”— exact words.

The aide gave her notice today- she’s done in two weeks. Not good…another hard working, experienced CNA is leaving because she was targeted by a vicious family member who is allowed to be rude, obnoxious and really, out of control. The yelling and physical shaking was enough. This aide is moving on to another career.

What to do? Management needs to STAND UP to this nonsense. Call it what it is: VERBAL ABUSE. How about having a ZERO TOLERANCE POLICY for this stuff?

Give the resident and or their family some counseling on the matter. A warning, if you will. If the behavior continues, kick the resident/family out! Evict them! Make it part of the contract!

Be tough. Be up front, and give them a chance to improve. Give them three chances. If they can’t stop, they need to find another facility that accepts this crap.

I knew this would happen. The Nursing Home Industry is all atwitter over the new Star Rating Program put into action a couple weeks ago.

The industry is upset, naturally, because they believe the ratings are biased, based on survey info only and so on. Personally I think it’s a great idea. It gives consumers, who happen to be OUR customers, an easy way to weed out problem nursing homes. Ofcourse, the problem facilities always have an excuse and never view themselves as “problematic”. We posted here, before, about having CNA’s rate nursing homes. Literally.

Anyway here is some reaction, from McKnights Long Term Care News:

The five-star rating system for nursing homes officially begins tomorrow. But it is already off to a rocky start.

Today the normally easygoing Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging, sent a scathing e-mail to members about the new system and the way it is being handled.

The title, “A Five-Star Travesty of Justice, Poorly Implemented,” sums up his message. Incensing Minnix was the discovery that CMS handed over its entire database of five-star ratings to the national media and state survey agencies in advance of providers receiving their facility data.

Ouch!

We know something is RIGHT about these ratings, when we see this sort of reaction.

One of the more telling comments about this came through in words that caused me to cringe, again from McKnights:

I don’t know about you, but the first thought that came to my mind when I heard about the plan was hotels. After all, when most of us choose accommodations we go to a Web site like Expedia.com or Travelocity.com to see first-hand visitors’ opinions. Will it be any different for nursing homes? You could either be a first-class, chocolate-on-the pillow type of joint, or a lowly two-star, where the pool is more of a pond?

But the comparison only goes so far. The reason is, and I hate to break it to everyone, but nursing homes aren’t hotels. They aren’t washing machines or any other kind of commodity that consumers judge by scores either.

Whoa. If nursing homes aren’t hotels, then stop marketing them as such. Stop it with the fancy adverts and other dishonest promotions. I think people KNOW the differences between a nursing home and a hotel.

People expect their loved ones to be well cared for, by compassionate and knowledgeable staff. People also expect a clean, safe environment, good food and fun activities. Nursing homes that provide these things will get a good rating. Those that don’t - well- they need to get their heads out of the sand and take an hard, honest look at WHY a low rating was assigned.

From the Government’s Medicaid web site:

Five-Star Quality Rating

The Five-Star Quality Rating System was created to help consumers, their families, and caregivers compare nursing homes more easily and help identify areas about which you may want to ask questions. This rating system is based on continued efforts as a result of the Omnibus Reconciliation Act of 1987 (OBRA ‘87), a nursing home reform law, and more recent quality improvement campaigns such as the Advancing Excellence in America’s Nursing Homes, a coalition of consumers, health care providers, and nursing home professionals.

Nursing home ratings are taken from the following three sources of data:

* Health Inspections
* Staffing
* Quality Measures

What are Quality Measures?? It’s important to know.

How would you rate the nursing home you work at, or one you previously worked at?

Happy Holidays Folks!

After a three month blogging vacation, we are back. I want to thank all the readers who emailed Patti and me, asking what is up, where we’re at, why no new posts….we’ve been busy with new jobs, new shifts, a family emergency and of course, the holidays. It’s hard to believe 2008 is almost over.

With that, 2009 promises to be an exciting AND scary year.

We are in the midst of a terrible economy, although CNA’s probably have the most secure jobs in America right now. We don’t earn enough money, though, to pay for the things we need- and it’s hitting many of us very hard. The cost of food alone eats up a big chunk of our pithy paychecks. Gasoline prices have dropped dramatically, yet we can’t afford to make car payments on our income. We’re lucky if we qualify for a loan!

State governments are slashing budgets left and right- and nursing homes are feeling the brunt of this. There isn’t going to be money for raises, or new equipment, or much else. In my area, we’re seeing entire nursing units close down due to lack of adequate funding- and with this comes actual lay offs of nurses and aides.

We have a new President, who many of us are looking forward to working with. Obama has an opportunity to really make a difference in the work CNA’s do- and for the residents, patients, clients we care for. Wages, health insurance and working conditions should improve under Obama’s watch. Let’s all hope!

One of the areas Obama has promised to move on, and quickly, is the Employee Free Choice Act. This is the legislation that, if passed, will make it much easier for workers to unionize. I have made a 180 degree turn on unions: WE NEED THEM now. Because we get screwed over too often. After reading endless articles about all these bail outs, and how the money is being wasted on retreats and jet planes and the like, it’s time to stand up and get what we deserve. In the long run, unions probably aren’t going to help us in our big picture goals. But for right now, these next few years, we need a voice.

The nursing home industry will see major changes in the next several years as well. Hospitals and other agencies will be changing too- in a big way. A national health care initiative will force the changes and we might not like all parts of it. But it will better than what we have right now.

We are about to witness history- although it’s wise not to place much faith in political leadership, somehow I believe this time is different.

What are your hopes for the next few years?

Another article from Huffington Post, about nursing homes. This reflects a sad state of affairs that I’m afraid is true.

Philip Cohen:

Even as the poor quality of nursing home care has become a cliché, nursing home care costs have been rising faster than those for services in general. According to economist Nancy Folbre, writing in Science, this has to do with increasing demand for paid care as women enter the workforce, and as they get better job opportunities. But the other “problem” is that care workers actually care about their clients, which makes them behave inefficiently. In response, employers create bureaucracy to keep the care workers in line. Because good care work requires hard-to-measure skills and behavior, this defensive action by employers may actually increase costs and reduce the quality of care. Folbre writes: “Unlike the idealized consumers of standard economic theory, care recipients may not know themselves what they need, and they don’t enjoy a menu of many alternative choices. Their very lack of consumer sovereignty makes them vulnerable to institutional pressures to cut costs by lowering aspects of quality that are difficult to measure.”

The elephant in the room of the care quality crisis is gender. The bedrock of nursing home care is the staff of nursing aides, orderlies and attendants. There are 589,000 of them, with average annual wages are $23,000 - and 89% of them are women.

So, by setting low standards to begin with, we see how this happens. Also, counting on residents being uneducated about their rights as well as what good care really is, the industry takes advantage. Add to this the lack of respect given to CNA’s, as evidenced by low pay and bad benefits, we see a pattern of institutional pressure for sure.

When will this change? CNA’s must become their own advocates before they can do so for their residents. Luckily we have many family groups and other resident advocacy organizations standing up. But how effective is their work when they push the very buttons that created this mess in the first place? Political action and trust in certain groups and parties is close minded. Everyone who really cares must think outside the box and come up with other solutions.

Les Weisbrod shares his thoughts on two recent news events that will effect nursing home residents.

Two notable events occurred this week that should be of concern to seniors and families who will have to make the tough decision of placing a loved one in a nursing home.

Number 1. The Inspector General of the Department of Health and Human Services released a report showing that 94 percent of nursing homes around the country have violations.

Number 2. A New York Times article highlights, as of Wednesday this week, Medicare, the nation’s largest senior insurer will no longer pay for preventable mistakes that occur in hospitals including serious bed sores, injuries from falls, and infections caused by prolonged use of catheters.

Les further notes:

For different reasons both of these news revelations affect seniors and their families but they also shed a revealing light on the industry that cares for our nation’s older citizens.

According to the Inspector General, for-profit nursing homes are the worst offenders when it comes to violations in nursing homes. These troubling numbers reflect a dangerous trend in nursing home care of placing profits over patient safety, charging Medicare and Medicaid for errors and using a little known practice called binding mandatory arbitration to avoid the scrutiny of the judicial system.

Nursing home residents and their families sign agreements that eliminate any legal action against the facility in case of negligence or error.

A possible consequence of the No-Pay-For-Errors ruling:

What is not known is how this proposal will affect nursing homes that are highly prone to committing preventable medical mistakes. Currently nursing homes receive more than $75 billion from government programs like Medicare and Medicaid. Medicare pays higher rates for those who are sicker. According to the Inspector General report, nursing homes were found to be overstating patients’ injuries in order to get additional money from Medicare. Essentially, Medicare’s practice of increased payments for frailer seniors results in nursing homes profiting from their bad actions.

Will it pay to plan for the decline of residents? It looks that way to me. We see here, perhaps, reasons for staff and supply cuts in facilities owned by these nursing home corporations who hide themselves behind layers of front companies. This all goes together in the name of profit over care.