Advancing Excellence has announced updates to to their GOALS and several of these give voice to the direct care workforce. AE is now in it’s second year of operation.

Advancing Excellence in America’s Nursing Homes is a coalition-based campaign concerned with how we care for the elderly, chronically ill and disabled, as well as those recuperating in a nursing home environment.

There are over 7300 nursing homes participating on a voluntary basis.

Originally the group listed 8 goals member nursing homes should work on. Those goals are located HERE.

Newly revised and updated, three are of interest to CNA’s- this is a PDF file.

GOAL 6 — STAFF SATISFACTION
NEW
Participants in this goal will have to assess staff satisfaction at least annually and upon separation; plus incorporate results into quality improvement efforts. AE has not yet decided on a target objective for this goal but it will probably be twofold: A) Increasing the number of staff surveyed and B) Raising satisfaction scores by a yet undetermined amount.

GOAL 7 — STAFF TURNOVER
REVISED
AE will ask nursing homes to reduce current levels of staff turnover for each of the following categories of employees: RN, LPN, CNA, DON, and NHA. Turnover will be measured separately for each of those categories. Participants will have to regularly measure and report staff turnover and develop plans to reduce the rate of turnover for each of the staff categories.

GOAL 8 — CONSISTENT ASSIGNMENT
REVISED
AE will increase its efforts to encourage and help nursing homes to adopt “consistent assignment” of front line staff – that is 85% of long stay residents in a nursing home have a maximum of seven (7) CNA caregivers each month AND 85% of short stay residents have a maximum of seven (7) CNA caregivers over two (2) weeks. Participants will be asked to set targets to increase the number of residents being served by a consistent assignment model by a yet undetermined amount.

In another post we will examine, more closely, what some of the AE member nursing homes are doing to promote the goals.

The results from the National Nursing Assistant Survey conducted in 2005 are published:

The NNAS is a nationally representative survey of 3,017 CNAs working in nursing homes, who were interviewed by phone in 2004–2005. Key survey components are recruitment; education; training and licensure; job history; family life; management and supervision; client relations; organizational commitment and job satisfaction; workplace environment; work-related injuries; and demographics.

Not surprising to me:

Results:
One in three CNAs received some kind of means-tested public assistance.

More than half of CNAs incurred at least 1 work-related injury within the past year and almost one quarter were unable to work for at least 1 day due to the injury.

Forty-two percent of uninsured CNAs cite not participating in their employer-sponsored insurance plan because they could not afford the plan.

Years of experience do not translate into higher wages; CNAs with 10 or more years of experience averaged just $2/hr more than aides who started working in the field less than 1 year ago.

There is MUCH more at the linked article. We CNA’s have been screaming these issues for years now so it is nothing new to us. Question is: What will change with all this information? Who reads it? Who has the political and moral courage to fix some of this?

Person centered care. Problems with the culture of this idea, the use and misuse of the principles and, some tough questions to answer. A must read.

Earlier Patti shared an article for nursing home management to pay attention:
Keeping Unions Out: It’s Now or Never

The article she linked to implores management to take action to become more employee-friendly. There are some issues that management might not be able to change. Health insurance for staff is a BIG issue. Affordable and practical insurance is needed.

SEIU’s Andy Stern is calling on US to help him advocate for this important need. He will be testifying before Congress and will be sharing worker stories about health insurance, the lack of or inability to afford.

When I think about what’s wrong with health care, I think of Jacqueline.

It’s one thing to talk about our broken health care system, but Jacqueline lives it every day. For 19 years, she’s worked as a nursing home CNA in Wisconsin. Short staffing in her unit means skipped treatments and longer waits for her patients. And a lack of equipment and supplies puts the strain on the entire facility when things get busy.

Unbelievably, while Jacqueline spends her life providing care for her patients, she can’t afford it for herself or her family. The coverage her employer offers costs too much on her salary.

This has to stop. Congress needs to hear how this crisis is affecting real people. Share your story: http://action.seiu.org/page/s/memberstories

Next week, I’m going to Capitol Hill for a Senate roundtable on fixing health care. It’s one of three roundtables that Senator Max Baucus is holding to hammer out the final details of a health reform bill.

If you’ve got a story to tell, now is the time to do it. Do you have health insurance? If not, why not? Does your employer offer it? Is it too expensive for you to afford? Have you held back on seeing a doctor or other health care needs due to costs? Let Andy know.

It’s a sad day when the use of cell phone cameras to take and share photos of nursing home employees sexually exploiting residents isn’t RECOGNIZED AS ABUSE. By the staff committing these acts.

Bluegrass Care and Rehabilitation Center in Lexington has been cited by state officials who allege that the staff used personal cell phones to “inappropriately photograph and make audio recordings” of residents without their knowledge, according to documents from the Kentucky Cabinet for Health and Family Services.

The staff attached songs with sexual lyrics to the photographs and circulated them to other staffers, Cabinet spokeswoman Beth Fisher said.
[...]
“There was no evidence that the facility had identified or trained staff that using residents’ pictures and/or recordings of a sexually exploitative nature were a form of abuse,” the citation said.

Guess it’s time to update the ABUSE policies folks. And the CELL PHONE policy as well.

At McKnights LTC News, an important and honest article aimed at nursing home management- about unions, the Employee Free Choice Act and keeping unions OUT. The advice offered is simply good management, something that is missing in too many nursing homes.

One of the points that caught my eye as being different:

Gauge employee attitudes through surveys and feedback sessions so that unions cannot take advantage of employee discontent.

Employee surveys should become a “pattern and practice” at the company and should be done on an annual basis. Employee surveys will let management know how employees feel about a host of important factors, such as pay, benefits, supervisors, general work environment issues, fair treatment (or lack thereof), appreciation levels, and even whether the bathrooms are clean.

Initially I would recommend more than once a year…I’d do this every quarter until a pattern is developed and which would show employees a concentrated effort on managements part.

Create a communications strategy for reinforcing the value of maintaining a union-free workplace.

It is important to consistently explain to employees and supervisors the value of working in an environment free of interference from third parties. This means that employers have to “walk the walk” and honor the commitment to treat employees with the dignity and respect they deserve. For example, a company newsletter can be used to honor certain individual accomplishments or those of employee teams. Other communication devices, such as company Web sites, can be used to enhance employee identity with the company, which might alleviate the desires of certain employees to place a value on unionization.

About this “walk the walk” business: Get up from your desks and get out onto the units. Go talk with the aides and others. Catch them doing something good and WRITE THEM UP for it- a positive feedback tool that can work wonders for morale. Join the aides during their lunch breaks. HELP them with their workload when they’re short staffed. No union people will DO THAT.

Most notably:

Create a policy modification (employee handbook) in response to employee survey input, which includes informal and formal dispute resolution procedures and “positive” discipline.

Employees want to know that their input on the survey actually means something and that the company is responsive to their opinions. In addition, a formal grievance procedure should be utilized, which includes a two- to three-step process (e.g., an initial complaint to a supervisor followed by subsequent steps to a plant manager, and then to the company president). The final step could include binding arbitration if the dispute cannot be resolved to the employee’s satisfaction at an earlier stage.

When a company’s policies mirror the typical union perks, unions have less chance of gaining hold. A grievance process is just one perk; almost every policy can be written to union “standards”, and this will be difficult for a union to counter.

Read the entire article nursing home management- DON’s, Adminstrators, Owners…take some action now before you lose control over your staff.

I was over at Advance for LTC and came across this article which I think is timely and important to CNAs. It’s about debt collector practices and the law…in this econmony the author of this article offers some good advice. Advance For LTC is a web site for the LTC industry and they have some excellent articles- most about the industry of course, but every now and again gems like this slip in.

Beware the Collector

The area of “collections” is not something most folks ever get to know, and no one wants to learn about it by living through it. There are three kinds of collection agents: in-house, agency, and distressed debt buyers. Inside every major credit card or credit granting agency (GMAC, Ford Credit, Countrywide Homes, etc.) there is a collections department. These are generally good people who want to work with debtors to help them restructure their debt and avoid foreclosures and repossessions. In many cases they are successful. However, when they are not, they refer the claim out to a company that does business as a collection agency. A collection agency may be part of a law firm, or it may be a stand-alone agency that collects using the phone and letters. The conduct of these folks is closely regulated. The Federal Trade Commission investigates collectors who cross the line and break the Fair Debt Collection Practices Act.

It is the third tier of debt collectors, the “distressed debt buyer” that is the real challenge for consumers. Although it may not be obvious to most people, your account with Mastercard, your home loan, your delinquent phone bill, and your repossessed car note can all be sold to other persons. The legal term for this is the “holder in due course,” and the way it works is through a process called “assignment.”

Read the whole article.

So, keep this in mind if you’re being harassed by bill collectors. I often hear the words, “I can’t afford a lawyer”…but in situations like the ones described in the article, a lawyer would most likely be a lot less expensive than paying an old bill that’s been legally written off.

Will Culture Change be mandated? It appears so. Over at PHI, Aaron has a post about CMS’s new Interpretive Guidelines coming out, which address more homelike environments in nursing homes. We’ve posted often here about the benefits of Culture Change, and it’s about time CMS joined the band wagon on this.

The changes, which go into effect on June 17, 2009, are intended to support efforts underway to transform nursing homes into “homey” environments through both environmental changes and resident-centered caregiving. Whereas in the past, these changes were sometimes stymied by fear that regulators would cite organizations for deficiencies, CMS is now making it clear that the OBRA regulations should be interpreted to support personal choice in the full range of daily activities, including waking, bathing, dining, and sleeping. The new guidance also calls for visitors to have 24-hour access to residents, regardless of familial relationship.

The new interpretive guidelines call on nursing homes to begin or to continue de-institutionalizing their physical environments. Suggestions include: reducing noise such as overhead paging and alarm bells, eliminating nursing stations, taking down institutional signage, and refraining from serving meals on institutional trays.

Get ready for the complaining. Eliminating nursing stations!?! But how can they expect us to do our work…But we can’t…and so on.

Pony up folks. Culture change is much needed process and we’ll all be better off with it. Allowing the residents to control their environment and choices is really a human right. Safety, and all those other excuses we tend to use, are just that: EXCUSES. We don’t want to give up our “power”. It’s not about us. It is about our customers- the residents.

Some Culture Change Sites of Interest:
Pioneer Network

Check out the PN’s vast selection of resource links HERE.

The Direct Care Alliance is seeking a few good people to attend it’s annual Voices Institute Workshop.

The Institute is accepting applications until April 31.

From the VI Brochure: (PDF)

The Voices Institute workshops are intensive, week-long retreats that help direct care workers develop their leadership and advocacy skills.
Attendees learn about advocacy, fundraising, organizational development, message development, and more.
Graduates become bolder and savvier, more confident, and more active in advocating for themselves and their profession. Our 2008 graduates are already changing the world by:

Testifying before lawmakers
Building relationships with legislators to raise their awareness of direct care worker issues
Putting on conferences for their worker associations
Writing letters to government officials to request better wages and working conditions
Raising funds and building membership for their worker associations
Speaking at conferences and other public events
Each year, more Voices Institute graduates will provide their critical perspective to the movement to improve direct care jobs.

More: PDF

This week-long workshop provides an intensive, in-person leadership development experience to a select group of direct care workers from worker associations and coalitions around the country, providing them with the skills and support they need to be effective leaders.

The 2009 National Leadership Training is being held from September 27 to October 3 at a retreat center in Racine Wisconsin, near the Milwaukee airport.

All travel, meal, and lodging expenses will be covered by the DCA. In addition, an $80 daily stipend will be paid to all attendees who qualify. However, attendees will need to contribute a $300 participation fee. We will help the people accepted into the program raise their participation fees.

Candidates must meet the following criteria:
1. Employed as a direct care worker (certified nurse aides (CNAs), home health aides, direct support professionals, personal care attendants, private duty aides, geriatric aides, and other frontline workers).
2. Recommended and/or nominated by their direct care worker association or workforce
coalition. Preference will be given to workers in leadership positions.
3. Demonstrate commitment to active involvement in an advocacy campaign at the state or
national level and coordination with DCA’s National Advocacy Director.
4. Have access to computer and e-mail.

If you’re interested, apply ONLINE HERE, or download this form and mail it to the DCA. I am tentatively planning to attend and would love to meet some of you there! For some ideas about what to expect, a couple Direct Care Workers have posted their experiences HERE and HERE.

As the saying goes: Let’s roll!

Direct care workers- CNA’s and others- have been pushing for better pay, better benefits and working conditions for YEARS now. Direct care worker advocates have also been speaking LOUD on our behalf. We’ve barely made any progress, and many of us hope that the new President will lift us out of the world of low pay, disrespected work…the prospect of the Employee Free Choice Act passing into law will help elevate these dreams.

The LTC industry is getting excited about this as well, but for a more sinister reason.
From McKnights LTC News:

A major development is afoot in the labor movement, and it could have interesting implications for long-term care.

I’m talking about American unions’ recent plans to unify. In case you haven’t heard, the leaders of the two major federations and the nation’s 12 largest unions have formed the National Labor Coordinating Committee. The interim body will help form the federation.

Naturally, the thought of one massive union, 16 million members strong, is enough to send shivers down a long-term care employer’s spine. But let’s think about this a minute.

Clearly, a single union could have an impact on unionization. This is the year of the card check, and if the Employee Free Choice Act passes, nursing homes could be facing a serious increase in union activity.

Sounds good huh? Never trust the LTC industry to do the right thing for YOU.

But there also may be at least one area in which nursing homes can benefit from a unified labor front. That is immigration reform. The AFL-CIO and Change to Win federations recently said they are joining forces to support the effort. That includes a path to citizenship for undocumented workers.

Why worry about immigration reform, in the broader picture here?

Read on:

The American Health Care Association, the largest association of nursing homes, if you will remember, was in favor of a guest worker program that would provide a temporary workforce of skilled and unskilled workers for employers in the future. Given the industry’s reliance on low-wage help, that is not surprising.

Read that last sentence. LOW WAGE HELP. The thinking here is simple: Bring in as many immigrants as possible, allow them to fill our shoes, at lower rates of pay…supported by the Unions of course…And read between the lines: Unskilled workers = low wages is NOT GOOD FOR US. These efforts will drive down our rates of pay. Why would any facility hire an American CNA who will expect a living wage- when hiring an immigrant who will work for cheap hourly rate is a viable option? We need to seriously think this out and speak up on it.

What is your opinion on this?