May 6, 2008
By Patti
The New York Times has an article up about whether aggressive medical care is appropriate for elderly people.
HANOVER, N.H. — Edie Gieg, 85, strides ahead of people half her age and plays a fast-paced game of tennis. But when it comes to health care, she is a champion of “slow medicine,” an approach that encourages less aggressive — and less costly — care at the end of life.
Grounded in research at the Dartmouth Medical School, slow medicine encourages physicians to put on the brakes when considering care that may have high risks and limited rewards for the elderly, and it educates patients and families how to push back against emergency room trips and hospitalizations designed for those with treatable illnesses, not the inevitable erosion of advanced age.
Slow medicine, which shares with hospice care the goal of comfort rather than cure, is increasingly available in nursing homes, but for those living at home or in assisted living, a medical scare usually prompts a call to 911, with little opportunity to choose otherwise.
The only issue I have with this is how they have to mention the **costs** factor. All human life is priceless, and to mention costs as a factor in making life and death decisions causes me concern. When we starting going down that road, many lives will be considered not **worth it**.
Posted in End Of Life/Hospice, LTC Politics, Medical Ethics 
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May 1, 2008
By Patti
I read an article over at Long Term Living/Nursing Home Magazine and it brought to light some issues CNA’s have with this work.
At first the article didn’t seem to say much new or different; the issues of low pay and poor benefit packages are discussed as being barriers to attracting good staff. We all know this is the number one problem nursing homes and assisted living facilities face- high turnover.
What disturbed me and caused me to write this post:
The study, which was funded by the National Institute on Aging, also revealed that assisted living workers, who are primarily black, often face racial discrimination from residents, who are primarily white. Nearly half of black employees reported experiencing racism, Ball says, with many of those situations arising from comments made by residents suffering from dementia. Overall, she says, facilities need to make sure their employees feel valued and appreciated.
This is in Georgia. But it happens in every state.
Of all the careers one can chose to work in, nursing is one of the most rewarding. To help another person in need is a good feeling. In no other profession, though, do we see management allowing discrimination to happen, daily, as a matter of routine course. Under the guise of resident/patient rights, aides of color are constantly victims of resident harassment and disrespect. Management bars these aides from caring for said residents- and this leads to resentment and bad morale among all the aides.
No where in any Resident Rights document is the right to ask for or turn down care from nursing staff based on their the race, sex, religion or sexual orientation. Period. Not only is this illegal, it’s immoral. It’s also just poor management when the leaders promise residents and their families only female aides will work with their loved ones. What happens when only male aides show up for work? Don’t say it won’t happen. It has and it will.
In most businesses the customer is always right, no matter what. Business owners and their agents will do most anything to satisfy those who purchase their products or goods. This is, after all, customer service. But what do we do when it’s a patient/resident, demented or not, who overtly displays racism against a nurse or an aide of color?
I’ve seen it at my work. Most of my residents (patients actually) cannot speak for themselves and they are not of age anyway. Some of our best aides, who happen to be black, have been singled out as not being good enough to work with some of our residents, by their families. They insist upon “white aides” for caregivers and that their child never have to have a permanent aide of any other color…and management cowards right down to them. They send out announcements to the nurses (via emails) stating “only so and so CNA’s are allowed to be assigned to Mrs. Smith, per family wish”…and the only names listed are of Caucasian aides. The nurses keep this all quiet of course but we hear them talking about it when they’re making out the assignments. How does it make one feel if you’re an aide of color?
Oftentimes families cite a language barrier as the problem. This is a legitimate concern. We’ve had aides from Haiti, Mexico and other nations, who barely speak any English. How they passed a CNA course and state test baffles us, because they often cannot read and comprehend care plans, assignments and other written directives. Concepts of math are not well understood either- so weights and percentages of meals consumed are huge problems for these aides. I can understand and justify a request for non- English speaking staff not be assigned to certain residents/patients. These staff CAN take charge of this problem themselves and learn to speak English fluently; as well as learn to truly understand this language and work with it. They have a choice here.
But we cannot choose the color of our skin.
In any kind of work the management should never stand for this quasi-discrimination that they excuse or write off as resident rights. While we want our customers to be happy and content, we have to take a stand that’s morally right as well as legal. Discrimination is wrong on every level and for any reason.
How can facilities make sure their staff feel valued and appreciated?
Simple. Tale a stand to this nonsense right from the get-go.
Nursing home administrators and DON’s need to tell residents and their families upon admission that they never ever have a choice or say in which CNA is going to care for their loved one. It doesn’t hurt to mention aides (and all staff) of color, or certain religions or sexual orientations are protected by labor laws. Administrators and DON’s need to make it clear they will not tolerate any form of discrimination.
Demented residents will make comments and sometimes these will be very nasty. Some demented residents will always react poorly to having certain aides care for them, and be fine with other aides. I don’t have an answer for this dilemma. I can say it certainly burdens everyone when this happens. One of the good things about dementia is it causes people to FORGET…usually within minutes of any event or problem or escalation. Sadly this memory deficit can be of help in situations where derogatory remarks are made. Usually these residents are able to become very tolerant of their aide, regardless of race, sex, religion- when the resident realizes on some level that the aide is not out to harm them. This can only happen over time, through consistent assignment.
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