Sometimes articles like this just ANNOY me. It didn’t take any research…or studies…or other forms of wasted money to come to the conclusion: More nursing staff equals less staff injury rates=better care. Did it really take a rocket scientist to figure this out? They should have asked the aides. We would have told them this and saved them a lot of money. I love the second subject line to this story:
Quality of nursing home care may suffer No duh!!

The more hours of nursing care provided per nursing home patient, the fewer the workplace caregiver injuries, which leads to better quality of care, say researchers from the University of Toronto and the University of Maryland.
The study, which appears in the July 1 issue of the American Journal of Public Health, is authored by University of Maryland School of Nursing professors Alison Trinkoff (Department of Family and Community Health) and Meg Johantgen (Department of Organizational Systems and Adult Health) and Carlos Muntaner, currently a University of Toronto professor and a scientist at Toronto’s Centre for Addiction and Mental Health.

The researchers examined injury and staffing data for three U.S. states: Maryland, West Virginia and Ohio. For each additional hour of nursing care provided, injury rates for nurses and nurses’ aides fell by nearly 16 per cent. In other words, for every unit increase in staffing, worker injury rates decrease by two injuries per 100 full time workers.

“Our findings were consistent across states, despite differences in data collection, classification of injuries and reporting procedure,” says Trinkoff. “This information is valuable, because as health-care institutions have been asked to perform more efficiently, changes have led to lower staffing and higher patient loads, which lead to worker injury.”

The researchers controlled the data to examine differences between for-profit and not-for-profit homes. Profit status was not significantly related to worker injury, once they accounted for state, facility size and staffing levels. However, for-profit homes generally have higher nursing turnover and lower staffing levels, which correlate with injuries, says Muntaner.

With more than 1.5 million elderly Americans residing in nursing homes and a population that is aging, nursing injuries take on an increasing importance, adds Muntaner. They can be viewed as a warning sign. “If residents are treated by workers who are injured, the quality of care suffers, and there is also the problem of high turnover rates,” Muntaner says.

Muntaner believes the data have implications for Canadian health care, too.

“As we move toward the further privatization of health care, we will see more of this,” he says. “Reductions in staffing ratios and numbers of staff hours lead to lower quality of care. At the end of the day, it’s a policy option, but the consequences are clear. If you try to squeeze the budget to maximize profits, it creates the dangerous situation we see in the United States.”

I worked at a hospital with Patti for about a year, a long time ago. It was a great experience-we learned a lot and got certified to do many more things than we were allowed to do at the nursing homes. The one thing we both really hated was the accredidation process for JCAHO. What a waste of time I thought that was. Management would go insane for a couple months before an inspection (the dates of which were well known ahead of time).

They focused on the paperwork and nothing else. It’s no different today, except that now they use computers to send along information ahead of an inspection. It’s still all about the paper though, and as far as I am concerned, the actual patient care issues mean nothing to the people at JCAHO. So long as the records look good, a hospital will get it’s accreditation.

By the way, this group does not FORCE itself onto any hospital. Rather, the hospitals beg and plead to get inspected…so they can have the coveted and esteemed seal of approval.

A powerful national organization that enforces quality standards for hospitals said yesterday that it had found a flaw in software that it had sold to more than 1,000 hospitals, which use the program to help them qualify for accreditation and payments from Medicare.

Joint Commission Resources, a unit of the Joint Commission on Accreditation of Healthcare Organizations, disclosed the defect in a note on its Web site.

Many hospital officials across the country said they were reluctant to publicly criticize the commission, which sends auditors to check whether hospitals are meeting more than 1,300 criteria.

Robert Curran, director of clinical excellence at the O’Connor Hospital in San Jose, Calif., said many hospitals were concerned that they might have lost quality- control data already entered into their systems.

The software, which costs members several thousand dollars a year for hospital groups, and $495 to $1,095 for small hospitals, is used to help create files showing, for example, that a hospital has fully informed patients of their rights.

The problem was a missing identification marker that alerts a hospital to the 250 standards among the 1,300 that the commission and its auditors regard as essential. Without the marker, a hospital might overlook essential categories in which it must verify its compliance.

Hospitals failing to meet the essential standards must come into compliance within 90 days and demonstrate to auditors that they remain in compliance during the following four months, a commission spokesman said.

Diane Martin, the executive director of Joint Commission Resources, said in a telephone interview yesterday that the error was minor and would be fixed today. On its Web site, the joint commission said the error was “a production glitch.”

Mr. Curran, however, described the problem as much more serious. “How about calling it an earthquake,” he said.

Karen H. Timmons, chief executive of Joint Commission Resources, said it placed the notice of the error on its Web site “as soon as we learned of it.” She said hospitals seeking accreditation were not required to use the Joint Commission Resources software.

Jeff Cleary, a spokesman for Xpediate Consulting, said his computer specialists found the omission a few days ago and warned hospital clients of possible problems. Xpediate sells software to assist hospitals with the Joint Commission requirements.

When administrators at several hospitals began asking Joint Commission Resources about the omitted markers, according to Xpediate officials, they were initially told that the markers would not be restored until the next update in August.

When I read this I got to thining about a couple other things they should do when looking at quality care in nursing homes. Like yes, ask the residents more questions. But what about the aides? Don’t ask the administrator, DON or nurses. They all have things they want to hide. But the aides will tell it like it is. If you look for a home to place your loved one in, I would ask the aides who work there…before I would ask anyone else. When the aides say the place is good, then you know you have found a really decent home.

FRIDAY, June 24 (HealthDay News) – Asking nursing home residents the right questions may be crucial to really understanding if quality-improvement measures are working, a new study finds.

Nursing homes often distribute “assessment surveys” quizzing residents on their satisfaction at the center. In the study, researchers at the Borun Center for Gerontological Research in Los Angeles asked 45 residents at two nursing homes a series of questions after improvements had been made at the residences.

They found that some types of questions drew sensitive responses while others did not. Resident responses to direct satisfaction-oriented questions — for example, ‘Are you satisfied with how often a staff member helps you walk?’ — didn’t change even after improvements to that particular service.

On the other hand, “discrepancy questions” — for example, ‘How many times during the day did a staff member help you walk?’ — were sensitive to improvements in care, the study authors said.

The findings should help nursing home residents better assess whether or not specific innovations are improving care. “If nursing home staff improve services to better meet residents’ needs and preferences, then resident satisfaction with care should also increase. If it doesn’t, then the right questions are probably not being asked,” study lead author Dr. Sandra Simmons, assistant professor at the Borun Center, said in a prepared statement.

The study was published in the June issue of the journal The Gerontologist.

Another CNA has been charged with abuse…this time out in MICHIGAN. They are making a very big deal about this as they should…It appears to me that this is just the beginning of a widespread investigation into the lack of criminal background checks for nursing home employees.

LANSING, Mich., June 21 /PRNewswire/ — Attorney General Mike Cox announced today the arrest of a Certified Nurse’s Aide, or CNA, for physical abuse against an 85-year-old wheelchair-bound Muskegon nursing home resident.
“Michigan’s most vulnerable citizens deserve the highest standard of care and anyone who violates that standard will be prosecuted,” said Cox. “This case highlights the need for the Legislature to pass the criminal background check bills being introduced today to prevent this kind of risk to nursing home residents in the future.”

Laticia Schevette Brown, 30, of Muskegon, was arrested by Attorney General investigators on Tuesday. She was arraigned before Judge Wierengo in Muskegon’s 60 Judicial District Court on one count of Patient Abuse, which carries a maximum penalty of one year in jail and $10,000 in fines. Brown, who was released on a $1,000 personal bond, will be back in court July 26 at 8:30 a.m. for a preliminary examination.

Read the rest of this article—>

William Thomas, of The Eden Alternative fame, has written another book about transforming nursing homes into real homes.

Many people think of nursing homes as grim places where residents often seem bored, lonely and sad. But now some reformers are experimenting with a new kind of nursing home. Instead of an institutional setting, they want to provide a homelike atmosphere for residents.

Among the leading proponents of this kind of nursing home reform is Dr. William Thomas, who calls his vision the Green House Project. It’s based on a simple idea: Older people will thrive in a nursing home if it’s built to resemble living in one’s own house. Others have tried to make existing nursing homes more homelike. The Green House Project makes the nursing home over from scratch, the goal being to give residents more privacy and more control over their lives.

The first such nursing home is currently being built in Tupelo, Miss., by Mississippi Methodist Senior Services. The brand new houses with driveways, barbeque grills and green lawns look like a housing community, but they are nursing homes, with just 10 people in each house. Residents sleep in private bedrooms, share family-style meals and have more freedom of movement than in traditional nursing homes, where staff usually decide most aspects of residents’ schedules, including when they eat, sleep and shower.

This is a powerful quote from Thomas, that I happen to agree with 100%:

“I believe that in [nursing homes] in America, really every year, thousands and thousands of people die of a broken heart,” Thomas says. “They die not so much because their organs fail, but because their grip on life has failed.”

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I’m surprised that CO is considering handing over the management of it’s state run homes to a for profit corp. I guess the private sector does have a better record at keeping the homes in good shape and they can offer better wages and benefits for staff. Not too many of them do offer these things though. CO has had some pretty hefty issues with all the nursing homes…I have access to the data that comes from surveys…WOW.

A key panel this week recommended that Colorado get out of the nursing home business and transfer management of its six homes to the private sector.

If Gov. Bill Owens agrees, it will mean military veterans homes in Aurora, Florence, Rifle and Monte Vista would be run by nursing home specialists from private firms, rather than by the Colorado Department of Human Services. Walsenburg is already being run by a hospital authority in the area. The state nursing home in Trinidad, not exclusively for veterans, also would be run by a private firm.

The recommendations came from the accountability committee for the State Veterans Home at Fitzsimons in Aurora.

The panel was given oversight of the Fitzsimons home in 2003 after a report found fiscal problems, substandard care and patient-safety issues. Piñon Management was appointed to manage Fitzsimons temporarily. Panel members were supposed to oversee the transition from Piñon back to the department.

Instead, the panel said Piñon had done such a good job that it was rethinking the management of all state homes.

Panelists have recommended that Piñon, which runs 15 homes in Colorado, continue to manage Fitzsimons in the short term, with the hope that the Lakewood-based company would be a candidate to run all the homes in the future.

Colorado veterans support Piñon’s work at Fitzsimons.

Human Services oversees dozens of programs but isn’t necessarily an expert in any.

“Running a nursing home does take a very special expertise today,” said Arlene Miles, executive director of the Colorado Health Care Association.

Twelve states have at least one of their veterans nursing homes managed under private contract, according to a recent survey by the Mackinac Center for Public Policy, a research institute based in Michigan.

In all, there are about 17,000 people living in 220 nursing homes in Colorado.

The $25.3 million state-of-the-art Fitzsimons home opened in October 2002, but was closed to new admissions a little more than a year later after scathing health and financial audits. State and federal reports said residents were being abused by staff, assaulted by other residents, chemically restrained with drugs and not being given adequate pain control.

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It’s not just administrators and nurses who get into trouble at work…As we all know some CNA’s can do things that are just awful. They make all of us look bad.

A nurse assistant has been indicted on charges that she assaulted a patient at an Absecon nursing home last year, the Attorney General’s Office announced Wednesday.

Chanel McRae, 27, of the Richland section of Buena Vista Township, is accused of striking patient Mary Walters several times on April 10, 2004, at Absecon Manor Nursing and Rehabilitation. It is unclear how severe Walters’ injuries were.

The grand jury indictment, which was handed down June 8, does not give Walters’ age, except to say she is older than 60.

McRae has been charged with aggravated assault, a fourth-degree crime, and faces as many as 18 months in state prison and a fine of as much as $10,000. A court date has not yet been set for McRae to face the charges. Bail will be set at that time.

The indictment will be referred to the state Department of Health and Senior Services, which certifies nurses’ assistants, to determine any action necessary in regard to McRae’s certification.

The department investigates abuse allegations, but would not comment until the case is complete, a spokeswoman said.

An Absecon Manor representative would not comment on the case, even about how long McRae was an employee or whether she still works at the home.

It is unclear who reported the incident.

A spokeswoman with the Attorney General’s Office did not know if there were any other allegations against McRae or Absecon Manor.

Nursing Home administrators are lisensed and they are where the BUCK stops…when it comes to issues about abuse, neglect and other problems within their assigned homes. This means that they can be held accountable as in this case:

PROVIDENCE — The former administrator of Hillside Health Center in Providence has been charged with 11 counts of felony patient neglect in connection with problems at the now-closed nursing home, the state attorney general said Thursday.

Attorney General Patrick Lynch announced that James Janetakos, 64, has been charged with intentionally failing to provide appropriate care and services to 11 patients, following a probe into allegations of substandard treatment at the home.

The Providence nursing home closed its doors in May 2004 after going into receivership. Soon after, reports surfaced of poor patient care.

The state alleges that the 11 victims’ health and safety suffered because of a lack of basic humane care and treatment at the facility while Janetakos administered it.

Patient neglect is a felony punishable by up to three years in prison and a $3,000 fine.

The attorney general’s office said there were other patients who suffered due to poor care, but they selected for prosecution the 11 cases in which they had the best evidence of neglect.

The charges against Janetakos conclude only part of the investigation into the former nursing home’s problems, the attorney general’s office said. Thursday’s announcement did not include any charges against Antonio Giordano, the former home’s owner. It was not immediately clear if he will face charges.

According to the attorney general’s office, its Medicaid Fraud and Patient Abuse Unit began investigating Hillside in September 2003 when it received a complaint from the spouse of one of the patients named in Thursday’s charges.

Janetakos is scheduled to appear in Providence Superior Court on July 11 for a pre-arraignment conference.

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Some questions from comments, answered here in a post:

1) Is it O.K. to copy articles for clinical group?
Yes. If you are copying something we have LINKED too, you would need to give full credit to the source.

2) Lots of questions about how to become a CNA. Go to a local nursing home and ask if they are holding training classes. Call your local chapter of the Red Cross-they have an excellent program. Also, try local votech colleges.

3) Online CNA Courses
STAY AWAY from these. While you might gain good info, most states will not accept this for hands on, clinical training. Anyone who wants to become a CNA SHOULD want to have the hands on stuff. Much of what we do in our work revolves around caregiving skills that require our hands…trust me.

4) Hello, I am getting ready to enter my CNA training. I need to interview somoeone who is already a CNA and unfortunately I do not know anyone. If someone would please be willing to answer a few questions for me I would greatly appreciate it!
Ask away! Go to the discussion forum as well.

Another strike….a walkout…who is taking care of the residents? I want to know the outcome of this action. Will the strikers get what they want? Without forcing the facility to make cut backs in other areas? I doubt it.

(June 14, 2005) — Workers at two nursing homes plan a one-day walkout today to protest stalled contract negotiations.

About 200 unionized staff members at Arbor Hill Care Center and Jennifer Matthew Nursing Center are taking part in the walkout, joining workers at seven other nursing homes in the Oswego, Watertown, Albany and Buffalo areas.

The workers are staging walkouts this week to highlight their fight for a contract that they say will give them adequate pay and health care benefits, among other things, said Bruce Popper, vice president of Service Employees International Union Local 1199 Upstate.

The following “reason” given for this walk out is absurd. It doesn’t take this extreme action to get answers about potential funds marked for staffing programs. Did they try a letter writing campaign? Or a petition? Did they go and visit their elected officials first? I bet not.

The union is also using the walkouts to call upon the state Legislature to free up $80 million that has been earmarked for upstate nursing homes, money that would help the facilities improve staff retention and recruitment, he said. Although the money was included in the state budget, it has not been released because legislators never decided how to distribute it.

Read the rest of this sad story—->