Follow the money. Really.

The nursing home industry gave at least $1.8 million to Kentucky politicians over the last decade while lobbying against bills that would require them to hire more direct-care employees, face higher fines for violations and abide by stronger precautions against elder abuse, among others.

While it’s no surprise, I was a little taken aback to learn of the political parties of those involved with this. And I suspect this is very common in every state.

For all the “conversations” this nation has regarding race issues, it seems that this should not be a concern: Residents/patients having the “right” to chose nurses, aides and other caregivers based upon their race. But it happens, often. It’s wrong. It’s discriminatory. And it’s about time something changes to end this. Indiana recognized this and have made it illegal.

INDIANAPOLIS (AP) – Certified nursing assistant Brenda Chaney was on duty in an Indiana nursing home one day when she discovered a patient lying on the floor, unable to stand.

But Chaney couldn’t help the woman up. She had to search for a white aide because the woman had left instructions that she did not want any black caregivers. And the nursing home insisted it was legally bound to honor the request.

As usual, laws are written without legislators thinking of the consequences. It usually takes a few years for the full effect of these consequences to come to light.

Elderly patients, who won more legal control over their quality of life in nursing homes, sometimes want to dictate the race of those who care for them. And some nursing homes enforce those preferences in their staff policies.

The nursing assistant in this case sued the facility:

Documents in Chaney’s lawsuit, filed in 2008, say her daily assignment sheet at Plainfield Healthcare Center always included the reminder that one patient in her unit “Prefers No Black CNAs.”

Chaney, a 49-year-old single mother who at the time was helping to put her only son through college, initially went along with the policy despite her misgivings because she needed the money.

“I always felt like it was wrong,” said Chaney, who has worked in nursing homes since she earned certification in 2006. “I just had to go with the flow.”

The nursing home said it was just following a long-standing interpretation of the patients’ rights law. “The rules say this is their home and everyone else is just a visitor there, including staff,” said McSharar.

We work in a high stress field. No one deserves to be singled out for any reason, rejected and actually written off as a “patient right” issue. I’ve seen the opposite happen as well: Black residents refusing care from white (or Hispanic or Asian) aides.

An aide is an aide. A nurse is a nurse. We all have the same basic training and are fully capable of doing our jobs. It’s about time older people understand this.

“The Best Friends Approach To Alzheimer’s Care” — it is one of the best books out there on caring for people with Alzheimer’s Disease. I have personally read the book many times and continue to read it now and again. It is a set of ideas and practices facilities can adopt to make serious and profound changes in culture. The book is up for review at Provider this month.

Article/PDF

In order to care for their residents, staff members in a dementia wing need to learn and periodically be reminded of the difference between normal aging and dementia-related changes.

Very true, and this book offers lots of educational articles on this subject. In plain language.

One of the things I like most about this book is the chapters on utilizing ALL nursing facility staff to engage residents in activities.

The activity department must be considered a staff group that supplements the activity-focused care provided by other departments.
All team members can be trained in reminiscing techniques using events that happened long ago, sensory stimulation such as massaging the hands or scalp, discussions of smells in their environment, reading a story, or normalization tasks like sorting silverware, folding towels, addressing envelopes, winding yarn, and organizing drawers.

Person centered care is the other hallmark of this book:

The person-centered care approach gives personal attention to the people who live in seniors housing and empowers staff members to be resident advocates. A caregiver’s knowledge of each resident’s pre-dementia story is essential to be able to gain the attention of that resident quickly when his or her behavior needs to be redirected.

Finally, an Alzheimer’s Disease Bill of Rights:

According to “The Best Friends Approach to Alzheimer’s Care,” every person diagnosed with Alzheimer’s disease or a related disorder deserves the following rights:
■ To be informed of one’s diagnosis;
■ To have appropriate, ongoing medical care;
■ To be productive in work and play for as long as possible;
■ To be treated like an adult, not like a child;
■ To have expressed feelings taken seriously;
■ To be free from psychotropic medications, if possible;
■ To live in a safe, structured, and predictable environment;
■ To enjoy meaningful activities that fill each day;
■ To be outdoors on a regular basis;
■ To have physical contact, including hugging, caressing, and hand-holding;
■ To be with individuals who know one’s life story, including cultural and religious traditions; and
■ To be cared for by individuals who are well trained in dementia care.
Source: “The Best Friends Approach To Alzheimer’s Care,” Virginia Bell and David Troxel, Health Profession Press, 1997, www.bestfriendsapproach.com

I highly recommend the book even if it was published several years ago. Get the book HERE.

The New York Times has published an article about investigations of health care facilities pay practices. It rings true for many of us: Do we really get paid for actual time we work?

In St. Louis, the Labor Department has recovered more than $1.7 million in back wages for 4,000 employees of hospitals and clinics operated by SSM Health Care, a Roman Catholic system.

In Boston, the Partners HealthCare System agreed to pay 700 employees more than $2.7 million in overtime back wages to resolve a lawsuit by the department alleging violations of the Fair Labor Standards Act.

And under the proposed settlement of a class-action lawsuit in California, Kaiser Permanente would pay $7.25 million to hundreds of registered nurse coordinators, case managers and other medical workers. The employees said they had been denied overtime pay because they were improperly classified as exempt.

This is when they classify nurses as supervisors. They are, but they usually do not meet the federal standards for being exempt.

Nursing assistants, licensed practical nurses, janitors and cooks “are particularly vulnerable to wage violations,” Mr. Stripling said.

In many cases, employees say they were not paid for work performed during meal breaks.

“Most nurses put the patient first,” said Charles D. Boal, a registered nurse who worked in the critical care unit of The Western Pennsylvania Hospital in Monroeville, near Pittsburgh.

“We often gave up lunch breaks to see that a patient was taken care of properly,” he said. “If you brought your lunch from home or got food in the cafeteria and took it to the nursing unit, you would be interrupted by phone calls, by physicians and family members who wanted to talk to you. We really did not have an uninterrupted meal break.”

How many of us have given up a break, or shortened one, because of patient/resident care demands? I know I have. Multiple times. We need to MAKE sure we are being paid for those minutes given off our breaks. Don’t let the facility management con you into believing they don’t HAVE to pay you because a supervisor/other did not ASK you to give up break times.

Previously here, we posted an article for nursing assistants:
Getting Paid For Every Minute You Work

I’ve always thought nursing homes, and the staff who work at them, place far too much “value” on resident safety issues. I’ve also always believed we use resident “safety” as an excuse to restrict residents movement, diet, preferences and so on. So when I read this article, it resonated with me in a big way.

Our culture values our ability to fix problems — or to think we can. We like to measure things, but happiness and autonomy are hard to measure. We insist that someone must be responsible for everything that goes wrong, which makes everyone obsessive about liability. And, of course, we don’t like to acknowledge that old people have limited life spans, or that some risks to life and limb — in the opinion of those whose life and limbs are at risk — might be worth accepting.

Is safety worth trading over autonomy? I’m not convinced it is.

I’d like to post a reminder of what is here at NursingAssistants.Net

First off, look up to your right. You’ll see a sidebar topic titled: POPULAR CONTENT. The list of articles speak for themselves.

We have many articles full of advice for CNA’s:

Getting Paid. For every minute you work.

Tips & Timesavers for CNA’s

What Not To Wear to Work

Lifts & Transfers: Doing It Right

7 Habits of Highly Effective CNA’s

7 Habits of Highly INeffective CNA’s

And there’s many more HERE.

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We also have an extensive archive of educational articles, that can be used for in services and other trainings. CNA’s are, of course, welcome to read these articles for their own benefit.

The Nursing Process and The CNA

Observation Skills for CNA’s

Legal Issues for CNA’s

CNA’s & Respect

LTC Survey Scope & Severity Scales

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Would you like to connect with other CNA’s? Join the NursingAssistant Yahoo Group- it’s free and you can read the emails or messages on the web.

Need to contact us?

Have questions about the nuts and bolts of Health Care Reform? The New York Times has a blog where you might find answers.

How Soon Will the New Law Help Me?
Will Employer Plans Have to Meet Higher Standards?
Will These Changes Increase My Health Care Premiums?
What to Expect in Next Year’s Health Benefits Offerings

There’s many more- go check it out.

As I read this article at Long Term Care Living, I thought of all the administrators I have known in my 18 yrs working as a LNA (CNA). At one assisted living facility I briefly worked for, I watched three administrators come and go…this was in less than two years.

How prevalent is this?

Research indicates that more than 7,000 administrators will leave their jobs in long-term care each year. Turnover for assisted living is equally as frequent and both are in excess of 40%, and as high as 70% in turnover each year.

What happens to the facility?

The negative impact of high administrator turnover has been demonstrated and includes increased deficiencies, citations, occurrences of resident pressure ulcers, and use of urinary catheters, restraints and psychoactive drugs—all of which become targets for surveyors and are highly recognized indicators of overall quality of resident care.

Usually when the administrator goes, so does the DON among others…

Research indicates that facilities with higher administrator turnover will yield increases in other staff turnover averaging 76% for RNs, 78% for LPNs, and a complete new group of nursing assistants with 107% turnover in a year.

What bothers me about the high turnover among our esteemed leaders is we just get things working, everyone gets used to the management and expectations, when BANG, they’re gone. So, we have to start all over again. No wonder this has such an impact upon staff, residents and families. Make no mistake, this does effect the residents- read this blog post to see why. How many administrators have you gone through?

This is interesting. At the Wyoming State Hospital, CNA’s were given raises to reflect a new job responsibility: Supervising other aides and LPN’s. At issue was the actual hourly rate these aides were earning:

CHEYENNE — Thirteen certified nurse assistant shift supervisors at the Wyoming State Hospital have been notified that their recent pay raise has been rescinded.

They also will no longer be allowed to supervise other CNAs and licensed practical nurses.

The change came after the state reviewed the basis for job classifications and salaries for nurses on the state payroll.

The review was ordered after some nurses at the Evanston institution threatened to quit because the new pay plan increased salaries for CNA supervisors to more than the LPNs earn and only $2.48 an hour less than registered nurses.

Apparently the hospital created these positions without checking the state’s Nurse Practice Act, which forbids CNA’s supervising anyone.

They also questioned whether the CNAs were properly supervising other CNAs and LPNs.

They were not, according to the Wyoming Nurse Practice Act.

The State Board of Nursing determined that the practice of CNA supervisors was contrary to state law, said Dean Fausset, administrator of the Human Resources Division in the Department of Administration and Information.

“So the Department of Health decided to remove the supervisory duty from the CNA shift supervisors,” he said.

I think CNA’s can and should supervise other CNA’s, provided they have training in doing this. Making schedules, assignments, approving time off, observing the work of others are all things a well rounded, experienced CNA can handle. I’d go so far to say CNA’s are capable of evaluating other CNA’s too. But I do not believe aides should EVER supervise nurses.

Remember when they said to the elderly: You won’t lose any benefits?

They lied.

By a vote of 53 to 41, the Senate on Saturday rejected a Republican effort to block cutbacks in payments to home health agencies that provide nursing care and therapy to homebound Medicare beneficiaries.

Republicans voted against the cuts, saying they would hurt some of the nation’s most vulnerable citizens. Most Democrats supported the cutbacks, saying they would eliminate waste and inefficiency in home care.

Who is the elderly’s friend now in Congress? Instead of holding the few bad actors accountable in this waste and inefficiency game, let’s punish EVERYONE by taking away benefits. How many nurses and aides will lose their jobs when these cuts go into effect?

Not to worry though, for there will be jobs, once they move all the former beneficiaries, into nursing homes.

All this, for what?

The Democrats’ health care bill would reduce projected Medicare spending on home care by $43 billion, or 13 percent, over the next 10 years. The savings would help offset the cost of subsidizing coverage for the uninsured.

I sure hope CNA’s get something out of this. I hope they get affordable health insurance. It seems like a very painful trade.

And some every day average people are extremely upset about this:

I am shocked that the Senate slipped such major Home Health Care cuts in on a snowy Saturday night in Washington, when everyone was sitting cozily at home with their family, watching a DVD or reading in front of the fire.

And I am disappointed, hurt, worried, and depressed that the Democrats were the ones who got the cuts passed. I feel sure they wouldn’t have done so if Teddy Kennedy had been there. And Obama, what do you have to say for yourself? Were you sitting cozily in front of the fireplace too, watching a Walt Disney movie with your adorable daughters?

I smell a fox, in fact several. We are in a democracy; I accept that we don’t all agree. But I worked hard to get Obama elected. I have fought hard to encourage others to support health care reform, and to support Obama’s plan, and now I feel betrayed.

And this comment:

I work as a hospice chaplain and every day see how home care keeps people out of hospitals and nursing homes. Curring the services of home health aides who are often paid at or below minimum wage, and often without health insurance themselves seems a particularly nasty and dysfunctional way to cut medicare costs.

One thing to keep in mind: The herd mentality is at work here. It’s cheaper to warehouse people into nursing homes, cut the doctor pay, regulate the cost of medications, supplies, food, CNA pay, nurse pay and the like, than it is to be human about all this.