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.

High tech health care doesn’t always mean better lives for our elderly. But we should be careful with the language we use when discussing other “options”. Futile care is an example I would hesitate to speak right now.

LOS ANGELES — A surprising number of frail, elderly Americans in nursing homes are suffering from futile care at the end of their lives, two new federally funded studies reveal.

One found that putting nursing home residents with failing kidneys on dialysis didn’t improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.

Most LTC nurses and aides I know do not support aggressive treatment. We see the frail, dehydrated, malnourished bodies of the very old and know these treatments will not help.

Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible — more like the palliative care given to terminally ill cancer patients.

“We probably need to be offering a palliative care option to many more patients to make the last days of their lives as comfortable as possible,” said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, who was not involved in the studies.

Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life.

Isn’t this what we do with our nursing home residents? Don’t we go out of our way to keep them comfortable and clean? Calling this all “palliative” and using phrases like- “last days of their lives” really isn’t good right now during the fight for health care reform. All this discussion brings many people to believe there really might be “Death Panels” and that turns folks away, especially older people. Who can blame them?

As with all stories, there are two sides. I’m not sure what to make of this.

LOS ANGELES — Amelia Mendoza’s last words to her husband were that she was afraid she would be fired for reporting that she had been assaulted at her hospital nursing job.

Moments later, she had a massive hemorrhagic stroke that has left her in a vegetative state and in a health care limbo because of a dispute over her coverage.

What happened?

Amelia Mendoza, 52, was struck in the face, head and neck by a violent patient while working as a certified nurse assistant at Huntington Memorial Hospital in Pasadena, attorney Russell Glauber said. She is not expected to recover from her April 20 collapse.

Claims for her care have been denied by her insurer, Blue Cross, and by workers’ compensation, Glauber said. He is appealing Mendoza’s workers compensation denial and calling on the state board to expedite its response.

At issue here is whether the assault caused the stroke.

Glauber said Mendoza was attacked on April 14 and 16 but was told to make an appointment at an in-house workers compensation clinic at Huntington hospital on April 20.

Why did she wait so many days before seeking medical help?

An April 20 note in Mendoza’s medical records says she was “in her usual state of health until about a week ago when she was bitten at work and had increased anxiety about her work injury.”

The records also note that Mendoza had developed high blood pressure since the incidents.

Dr. Arthur E. Lipper, who was hired by Glauber, has examined Mendoza’s medical records and said he believes the stroke was a result of Mendoza’s workplace injury.

“Whatever conspired to cause her to have her stroke, clearly at least in part transpired after and because she was bitten, hit in the head and neck,” Lipper said. “She was agitated because of it, and then she stroked.

Not quite true, but it makes for a good headline. I feel terrible for her, but her family, lawyers and others need to be honest and realistic with this. Strokes happen all the time without any “warnings”- and “stress” is not a factor. Read the facts about stroke, HERE, and keep them in mind when forming an opinion on this article.

The main point to this article is the denial of medical care payment- the worker comp people are saying the assault did not cause the stroke; the health insurance people are probably waiting for the worker comp report and will take over the case once it’s released.

As reported:

WILMINGTON– An 82-year-old patient at Governor Bacon Health Center suffered a cut on her forehead and a skull fracture when she was left unattended and fell out of bed, officials said.
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The incident occurred when a certified nursing assistant left the resident to take a personal phone call Monday morning without taking steps to assure the woman’s safety, according to a news release from the state Department of Health and Social Services. The woman’s bed was elevated about two feet above the floor.

Lesson? Don’t accept phone calls while tending to your resident! I suspect the phone involved was a cell phone, and if it was, perhaps we really need to evaluate there use at work. I have seen dozens of co workers texting and talking while working, and sooner than later we will read more stories like this.

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.