This is written by Tammie, a CNA who frequents the message board. I asked her for permission to post it here.

What a Nursing Home is really like: By Tammie CNA

A nursing home is a world that used to exist on the outside. It’s the one we often crave in our own world. The people who live there smile at you, know your name, greet you with good mornings. They live in a basic world without computers, cell phones and other gadgets we are used to today. It contains teachers, farmers, doctors, writers, housewives, cooks, well diggers, coal miners, world war vets, and others. They have great grandchildren and great great ones too. They are yesterday behind a set of walls built just for them. Each day, they give a gift of trust to you. How you take that gift is your decision.

They each want you to give them dignity. They will show you their most personal moments and you must maintain a professional and personal touch that makes them feel safe in your care. You will see them using the bathroom and you will see them naked. You will touch parts of their body during daily care that have never been touched by anyone other than themselves and the one they married. And, while doing this you must not snicker, make comments, or show them any negative reactions displayed your face or body posture. Not only does their body need your help, but their tender hearts do as well. When a negative remark is said about their body in any way, they feel as though you have hurt them. You damage any sense of control they have left in the world they now know.

For example, once able to cook for an entire family several times a day, Hazel now needs you to spoon feed her as she lies in the bed alone. Her legs are straight, thin and flat because they are now stuck this way permanantly because of muscle contracture. Her arms do not move above the elbow joint and her fingers are permanantly crossed within each other like her small legs. She has no bladder or bowel control and depends on you to clean her. She weighs eighty to ninety pounds in total. She wears adult diapers and baby powder on her skin. At meal times, you must remind her to open her mouth so you can get the spoon inside.

But, Hazel can hear every word you say to her and she can speak too. You often hear her singing as you walk past her bedroom. She is soft spoken and often says, thank you, please and good morning dear. When you are dressing her, she helps as much as she can by moving her arm this way or that way for you and by lifting her head so the pink gown goes on easily. When you are rolling her to the side to wipe a bowel movement off her skin, she says thank you each time. She likes chocolate and hates peanut butter. If you make a mistake, she is patient with you. She quietly sits in a swing 4 feet above the ground as you transfer her from the bed to a chair in a mechanical lift.

Now, Hazel is a special lady and each person is different. Like many others, she is helpless in your hands. Literally, your hands are her hands now. Your feet are now her feet. And, she is grateful for the use of them. She never yells when you take too much time or don’t give her enough time at all. She politely smiles and forgives you if you accidently scrape her skin with your fingernails while dressing her. And when you walk in the room, she lights up. Hazel trusts you.

Nursing homes are worlds seperate and opposite from the outside. The residents automatically trust instead of judge. They don’t know how to type an email or use a cell phone to keep in touch. Instead, if they are able, they learn your name and remember what you like and what makes you smile during the day. They see the same rooms and the same people day after day, yet every single day is different. They often face difficult times within these walls and your face is the one they look to for comfort.

Every now and then a resident comes along that is not so pleasant but, is combative and violent. These residents require special care and even more patience than the other ones. They can give you a challenge that is unique. And, they too are in your trust.

If you work in a nursing home, you can make the difference between a smile and a tear. You can make an otherwise routine day a special one. Your words can encourage and lift them up or you can disappoint and destroy a spirit. The trust you are given can be held softly in secret or can be broken loudly in an instant. You can share in an accomplishment and offer patience or you can hinder recovery and damage happiness in the future. There are people like Hazel out there right now living their life each day in a nursing home. You are given the gift of trust every single day. How you choose to handle that trust up to you.

If you are looking for an easy job, a place where you can be lazy or even a place where you can be dominating to others a nursing home is not for you. Abuse and neglect are not a joke and it is always revealed eventually. Being a CNA in a nursing home requires special people with compassion who are protectors of the helpless.

A nursing home requires those who are worthy of trust.

What’s in the news recently:::

Oregon nursing home could lose it’s license:

The state of Oregon is threatening to close an east Portland nursing home if the facility doesn’t get its act together. Citing three bad inspection reports in the last two years as well as several complaints that were found to be valid, the state on Jan. 18 informed St. Jude Specialty Care on Southeast 136th Avenue that it’s prepared to strip the home of its license. Such notices are very unusual and “a very big step for us to take, quite frankly,” said Elaine Young, nursing program director for the state Department of Human Services.

Brockton MA nursing home probed:

BROCKTON —The state Department of Public Health and local police are investigating allegations that a worker at a local nursing home abused a patient earlier this month. The DPH launched an investigation into St. Joseph Manor, a Brockton nursing home, after getting a complaint about the facility Feb. 4. Brockton police were called Wednesday to investigate the allegations. Anne Teri, chief executive officer at St. Joseph Manor, confirmed the state was investigating the Thatcher Street nursing home but declined to detail the allegations. “I can’t really comment about the investigation,” she said. “We take any allegations seriously.”

FL nursing home shut down after it failed FIRE safety drill:

PALM HARBOR - Dozens of elderly people are being forced from their homes, but state officials say it’s ultimately not a bad thing. Officials with the state Attorney General’s Office shut down the Long Shadow Inn, an adult living facility in Palm Harbor, because managers there failed a surprise emergency drill Thursday. During the drill, officials said, some residents were left unattended, several were trapped in wheelchairs on the second floor of the building, and at least four residents were never even evacuated.

Man found dead three days after leaving facility:

Searchers found the body of a missing Indiana man in a creek Monday, three days after he wandered from a nearby Rockville health care facility, authorities said. Robert E. Didelot, 62, was discovered just west of Lee Alan Bryant Health Care Facilities Inc., where he lived, said Parke County Sheriff Charles Bollinger. The facility, which includes a nursing home and residential facility, is about 2 1/2 miles east of Rockville. “It appears [he] was trying to cross a log jam and fell off into the water,” near Sanatorium Bridge, Bollinger said. Didelot was up to his neck in water, the sheriff said. An autopsy is scheduled today in Terre Haute Regional Hospital.

British Nurse under investigation:

A nurse alleged to have carried out “unprofessional” practical jokes in hospital put a patient’s glass eye in a cup of Coca-Cola, a disciplinary panel heard today. The accusations came at the start of an inquiry into 12 allegations of misconduct against Christine Mitchelson, including allegations of assault, racism and tasteless practical jokes. The 53-year-old nurse, from Newcastle upon Tyne, has denied all the charges, which are being examined by the conduct and competence committee of the Nursing and Midwifery Council (NMC) in London. She is not attending the hearing, citing ill health. The allegations cover the period between late 2001 and early 2004, when Ms Mitchelson was working at the Royal Victoria Infirmary in Newcastle. Her colleagues - including staff she was supervising - brought the complaints against her.

Legal Issues for CNA’s

Legal Standards
These are guidelines to lawful behavior. When laws are not obeyed you can be prosecuted and found liable (responsible) for injury and damages. Legal guilt can result in fines and imprisonment, as well as loss of certification/license to work as a CNA.

Laws are passed by local, state and federal governments. All citizens are expected to obey these laws…when you disobey a law you are liable for fines and/or imprisonment. CNA’s can avoid this by:
• Knowing and staying within their state’s scope of practice rules.
• Do only those tasks and skills you have been taught; if you’re asked to do tasks you have not been trained to do ask for guidance (and if necessary seek the advice of your supervisor).
• Carry out your tasks and procedures carefully and only as you were taught.
• Keep up to date with your skills and education and in-service requirements.
• In questionable situations, seek the advice of your supervisor.
• Make sure you fully understand your assignment and what is expected of you
• Know your facility policies and procedures and follow them.
• Do no harm to your patients.
• Respect the personal property of your patients

Legal Definitions and Examples
As a CNA the legal issues you might encounter and witness would be negligence, theft, defamation, false imprisonment, assault, battery and abuse. You need to understand what these are.

Negligence:
The failure to provide a degree of care that others would consider reasonable under the circumstances; when injury results to your patient. Negligence is often caused by rushing around to get your work done and by not thinking FIRST.
• YOU give a patient a bath…and don’t check the water temp first. The patient is burned.
• YOU place a tray of food in front of a patient and don’t check the menu; the tray belonged to another patient. The patient who got the tray eats the wrong consistency food and chokes.
• YOU transfer a patient by yourself even though the care plans states two staff should be present for the transfer. You drop the patient.

Theft
One would think this is pretty simple. It should be but often isn’t. Taking ANYTHING that doesn’t belong to you is considered theft. It doesn’t matter how cheap or expensive the item is. When you see another person take something that isn’t their’s, and you fail to report this, you are guilty of aiding and abetting the crime. Keep your standards high. We need all the honest people we can get in this work- don’t be scared or indifferent to report theft you witness. I’ve seen aides take wash clothes, briefs, deodorants, soaps ect from their facility (for their own personal use at home). I’ve also seen aides steal jewelry and clothing from patients. It’s NEVER acceptable to do this. EVER.

Defamation
This means making statements about another person, either verbally (slander) or in writing (libel)
when the character of that person is injured. Examples would be you telling a co-worker wrongful and inaccurate information about patients. I’ve seen this happen: We had an admission coming and the chart was available to all of us. The patient had Crohn’s Disease. One of the aides I worked with at that time went around and told everyone this patient had C-Diff. Not a good thing to do. Unless you know something to be actual fact, (and even then make sure you hear it from a reliable source), keep your mouth SHUT. And never put anything like this in writing.

False Imprisonment
This is an area many nursing staff have trouble understanding. It’s not just about restraints. It’s about a mindset. It is defined as restraining a person’s movements or actions without the proper authorization. Patients have rights and we must respect these rights. In the hospital setting, a patient CAN leave the hospital without a doctor’s permission. They can also leave a nursing home/assisted living home. Under very few circumstances can we interfere with this right. If you do, it’s called false imprisonment.

Physical Restraints
Using them requires a doctor’s order. Threatening to use them is considered false imprisonment.

Physical restraints are defined as any manual or physical device, material, or equipment attached to or near to the patients body, that:
• A patient cannot easily remove
• Restricts movement of ANY and ALL body parts
• Restricts the patient from accessing their own body or parts of their body
Examples of physical restraints:
• Wrist, Arm, Leg and Ankle restraints
• Vests
• Jackets
• Hand Mitts
• Geri chairs, recliners
• Seatbelts, safety belts
• Bed rails and the pads sometimes used on them
• In some populations the use of certain clothing would be considered a restraint: For example, donning a one piece undershirt on a child to prevent him from having access to his body. Or, a long sleeved shirt to prevent access to an IV site.

Also, many practices are considered a restraint. When a patient doesn’t have the physical strength to remove a device it is a restraint.
• When a patient doesn’t have the strength to sit up from a low rise sofa, for example, this practice is considered a restraint.
• Tucking in blankets and sheets so tightly the resident cannot move is considered a restraint. Using Velcro and tape to secure sheets is also a restraint.
• A lap tray being used with a wheelchair is a restraint if the patient cannot remove it.
• Using recliners and Geri chairs, tilted back, is a restraint.
• Moving chairs and beds so close to a wall that it prevents a patient from rising is a restraint.
• Placing a patient up into a table so close they cannot move their chair is a restraint.

In short, any action or device (designed for the sole purpose or something put together by you) that prevents the free movement of body parts is a physical restraint.
Some patients require splints and other appliances to maintain alignment and posture. These are restraints as well, but are often referred to as enablers because they assist the patient with ADL’s.
The patient may not be able to remove the splints, but it’s not an overt restraint. An MD order is always in place for these items.

Many medications are considered restraints. This is called chemical restraining and it is a very different thing than physical restraints. Nurses and doctors must understand the ramifications of using meds to induce sleep, states of relaxation, pain control that could be considered restraining activity.

Assault and Battery
There is some confusion about the meanings of these terms. Assault means purposely attempting to touch the body of another person without their permission, and threatening to do so. Battery is when you actually doing this. These terms are not all about hitting and hurting patients like so many of us have been taught.
Every task we perform is done so with the patient’s informed consent. This means the patient needs to know what it is we want to do, why, the benefits of the task-and they have to agree to it.
Informed consent can be withdrawn at any time and we must honor this. More and more patients are taking their healthcare into their own hands these days, and many will question the value of treatments. In spite of our best efforts to explain the need for treatments, the patient always retain the right to refuse. If you continue with the treatment you are guilty of battery. And threatening to get the nurse or others to assist you with said treatments is battery as well. You must report to the nurse any and all refusals of care by your patients, but do so quietly and not within hearing distance of the patient. Let the nurse handle the situation from this point forward.

To avoid being charged with battery:

• Tell the patient what you plan to do
• Make sure the patient understands what you’re saying
• Asking the patient if they have any questions or concerns
• Allowing the patient some time to think about this
• If the patient refuses, don’t push the issue. Quietly report the refusal to the nurse and document facts only.
• NEVER carry out the refused treatment

In our work we will come across a lot of coercion- which is forcing a patient to do something against their will. Unfortunately, it’s a problem within nursing in general. We always think we know what is best. This happens more with patients who are confused, mentally incapacitated or those with dementia. Almost always, these patients are not their own legal guardian, their family is. This makes it difficult for us to do our job at times because the patient is still refusing the care but we have to do it anyway- because the family has consented on behalf of the patient. It’s ALWAYS best to try to get the patient to cooperate with us vs. a full struggle. It really helps to wait and come back later when a confused patient refuses care. They tell us to always assume the patient would want our care if they were not confused so we have to think of things differently. It’s a hard spot to be in.

Abuse
Abuse: Doing harm to a patient. Abusing a patient is ethically wrong as well as legally wrong. Ethical standards require us to do no harm and legal standards enforce this through laws. There are severe penalties if you’re found guilty.

Abuse is defined as the act (or failure to act) that is non accidental and causes or could cause harm or death to a patient. It’s not just about hitting here. It’s also about mental abuse, verbal abuse and other more subtle forms. Abuse comes in many shapes:
• Physical
• Verbal
• Emotional
• Sexual
• Involuntary seclusion

Physical Abuse:
• Handling the patient roughly
• Hitting, slapping, punching, kicking, pinching a patient
• Performing the wrong treatment on the patient

Verbal Abuse:
• Swearing when you’re dealing with the patient
• Raising your voice, yelling
• Calling the patient unpleasant names
• Teasing the patient
• Embarrassing the patient at anytime
• Using gestures
• Making threats
• Use of inappropriate words/terms to describe a patient’s race or nationality

Sexual Abuse:
Using physical means and verbal threats to force patients to perform sexual acts.
In most states sexual abuse is ANY behavior that is seductive, sexually demeaning, harassing. As with Sexual Harassment policies, this harassment need only be considered as such by the patient without regard to your intentions. Be careful. THINK before your interactions with patients (and everyone else for that matter). Be considerate of your patient’s values and morals.

Emotional/Psychological Abuse:
THIS can be the worst kind of abuse because it’s typically ongoing and subtle.
• Causing a patient to be afraid of you (through threats, actions, attitude, and body language)
• Threatening the patient
• Threatening to withhold treatment
• Threatening to tell others about the patient’s condition
• Making fun of the patient
• Belittling the patient (and this would include all those cute little nicknames we tend to have)
• Calling the attention of others to the patient’s behavior.

Involuntary Seclusion
I see this happen a lot in nursing homes. A resident is being noisy and disruptive so we remove them to another area. This is another one of those hard spots to be in- trying to balance the needs of the larger group of residents without violating the rights of one. A good care plan, communication with everyone, documentation and other interventions should really be in place to prevent the resident from having outbursts in the first place. The nurse should always be the one who directs you to remove a resident. Don’t ever make this decision on your own.

Other forms of involuntary seclusion:
• Closing the door to the patient’s room when they want it kept open
• Placing a patient in a wheelchair away from others
• Leaving a patient without a means to communicate- removing the call bell for example

Abuse by Others
There are times when we will witness another CNA or nurse do harm to a patient, as described above in all the various forms. Often the CNA/nurse will not realize they are doing these things. It doesn’t matter whether she knows better or not. The abuse MUST be reported. As soon as it occurs, not at the end of the shift, the next day or next week. All healthcare workers are required by law to report actual or suspected abuse. When you don’t report, you’re just as guilty.

Sometimes it is a member of the patient’s family who abuses them. This is difficult to see happen, to suspect is happening. Again if you suspect this you are required to report it to the nurse. I’ve seen nursing home residents go out on a day trip with a family member and return to the facility with bruises and cuts; or with complaints of hunger and thirst. These things caused me to suspect some sort of abuse or neglect and I reported the findings to the nurses. I made sure they came down and looked at the bruises and cuts firsthand as well.

Neglect
Neglect is failing to provide the services, care and treatments necessary to avoid physical harm, mental anguish or mental illness. Neglect can be intentional or unintentional. Neglect is against the law no matter what. CNA’s are not expected to decide if neglect has occurred- that is the nurses job. However, you must report signs of neglect. Some examples of neglect we might see on the job:

• Routine hygiene and care not being provided. Patients not being repositioned, bathed, toileted, ROM exercises not being performed according to the care plan.
• Patients not being given enough time to eat
• Patients not being offered water and snacks

Invasion of Privacy
This is an area where every CNA should put themselves in the patients’ shoes. Would you like it if someone went around talking about your medical condition to anyone? How would you feel if you were in a hospital room and the nurse came in, started to do a treatment without closing the privacy curtain? You wouldn’t like these things at all. Most people don’t. Every patient has a right to expect their medical information will be kept confidential and that only those who NEED to know will have access to this information.

~This material can be used freely for educational purposes.

An update about the Charlotte NC nursing home where a resident went “missing” but was actually in a closet the whole time. She died.

CHARLOTTE, N.C. — State nursing home regulators are taking steps to cut off Medicare and Medicaid payments, and fining a Charlotte nursing home $10,000 a day until problems are fixed.

This comes after a resident, Mary Hicks Cole, went missing from the Liberty Nursing and Rehab Center of Mecklenburg County in January and was found four days later in a storage closet at the facility.

According to documents obtained by Eyewitness News after a state investigation, it said “when asked about the missing resident, the nursing assistant stated, ‘We had to check every night’ because the staff on the unit could not understand what had happened to her.”

The report goes on to say a nursing assistant saw two people enter the unlocked closet the night before Cole went missing, but didn’t tell anyone.

The document stated, “She knew the storage room was supposed to be locked but did not tell anyone that night about the residents in the room or the room being locked.”

The document stated that the assistant eventually told someone, but couldn’t remember to whom she spoke.

The North Carolina Division of Facility Services is asking the federal Centers for Medicare and Medicaid Services to deny reimbursement for new admissions effective Wednesday, Feb. 8, and terminate the facility’s Medicare and Medicaid programs effective on Feb. 23.

The daily fine would be effective starting Jan. 23, the date Cole went missing, and run until the conditions found in the home by surveyors from the state division’s Licensure and Certification Section are resolved. Surveyors reported that the home constitutes immediate jeopardy to the residents’ health and safety.

Nurse Gwendlyn Lucas said she still stands behind the nursing home.

“That would hurt the people tremendously because we do have a number of Medicare and Medicaid people and we do give quality nursing care,” she said.

Surveyors said the home was cited for failing to ensure that each resident receives adequate supervision and assistance devices to prevent accidents.

Officials passed on its recommendations to regional decision makers in Atlanta. They said the home is required to submit a plan to the state surveyors by Feb. 19 detailing how it will correct the problem.

Update about the CT nursing home union members, strikes, threats of strikes…THIS needs to stop.

NEW BRITAIN — Workers at Brittany Farms Health Center have authorized a second strike in as many months. However, they are calling on Brittany Farms for more negotiations in an effort to reach a contract and avoid a strike.

“It’s disturbing, to say the least, that Brittany Farms has offered no new proposals in the last two negotiation sessions,” Jerry Brown of District 1199 wrote in a letter sent to Brittany Farms’ attorney Thomas Gibbons. “It would appear that Brittany Farms is not interested in working together to reach a mutual agreement.”

Brown said it is still the union’s hope that disruptions to the nursing home residents and to workers’ own families can be avoided. He added that with continued discussions he believed a resolution could be reached.

In a letter to Brown, Gibbons said management would agree to meet on the union’s suggested date of Feb. 16.

Lynn Ricci, administrator of Brittany Farms Health Center, told The Herald that voting to authorize a strike and setting a strike date “are two very different things.”

“Publicizing their authorization of a strike is another attempt by the union to put pressure on management. Also, they continue to say that Brittany Farms is owned by the Hospital for Special Care. That is not true. Brittany Farms Health Center is a standalone, not-for-profit facility.”

Ricci added that it was “disingenuous” for District 1199 to say that Brittany Farms has offered no new proposals in the latest negotiating sessions.

“That is simply an untrue statement,” Ricci said. “We submitted a proposal to the union on Dec. 21. Seven weeks later, the union has yet to make a counter-offer to the proposal on the table. Brittany Farms management will do everything necessary to ensure that the nursing home continues to operate and provide excellent quality care for our residents.”

Jennifer Smith of District 1199 acknowledged that no strike date has been set. In Brown’s letter, District 1199 offered to negotiate on any of six different dates between Feb. 13 and 22.

The 220 certified nursing assistants, dietary, laundry, housekeeping and other nursing home staff held a one-day strike Jan. 5.

Key issues in the contract talks are job security, health-insurance costs and wage increases. Last August, workers voted to join District 1199.

Smith said she hopes another day or two of negotiations will avoid another strike.She said “dozens of other nursing homes were able to settle contracts with the union in 2005 without striking,” including first contracts like the one being negotiated at Brittany Farms. She pointed out that agreements at Kimberly Hall North and South in Windsor and Kettle Brook in East Windsor included significant reductions in the cost of employees’ health insurance premiums and substantial wage increases totaling at least $2.40 an hour over four years.

“District 1199 may have settled contracts with other nursing homes,” Ricci said. “However, Brittany Farms is a not-for-profit facility that needs to negotiate a contract in keeping with our mission, (one that) is fair to all of our employees. We don’t feel it’s beneficial to compare us to other facilities, particularly for-profit facilities. It’s common knowledge that many facilities represented by District 1199 have experienced significant layoffs or closures as a result of financial demands.”

Brittany Farms Health Center is a 282-bed nursing home managed by Southington-based Athena Health Care.

The New England Health Care Employees Union, District 1199, represents more than 20,000 health care workers in nursing homes, hospitals, state and private agencies, ambulance services and other health care centers in Connecticut and Rhode Island.

Everyone’s healthcare costs are going up. It doesn’t matter what industry you work in. To demand a better deal is asking alot these days. I don’t like it any more than the next person, but these unions will close down nursing homes.

I guess if they keep those with mental illness out of nursing homes it would be safer…BUT- where are they going to find placement for these people? Does the state of CT have the resources to end this practice? I hope so. I hope they don’t just fan the residents out without seriously looking at the alternatives.

HARTFORD, Conn. — More than 200 Connecticut psychiatric patients are forced to live in nursing homes, often in locked wards, when other locations would better suit them and be less costly, advocates for the mentally ill said in a lawsuit filed Monday.

The federal lawsuit, brought by the state’s Office of Protection and Advocacy for Persons with Disabilities and the Bazelon Center for Mental Health Law, accuses Connecticut of violating the Americans with Disabilities Act and other federal laws.

Although the lawsuit focuses on patients at three Connecticut nursing facilities, OPA Executive Director James McGaughey said the implications extend far beyond those individuals and places.

“Institutionalizing people when they want to live in the community, and it is possible for them to live in the community with the proper supports, is a violation of their civil rights,” he said.

About 3,000 of the state’s approximately 27,000 nursing home residents have been diagnosed with serious mental illness, according to a draft version of a state task force report.

That report, due to be finalized and delivered to Gov. M. Jodi Rell and the General Assembly during the upcoming legislative session, estimates that several hundred of those patients could function well outside of the nursing homes _ at group homes or with family, for example _ if they receive the proper community-based services.

The practice of housing psychiatric patients at Connecticut nursing homes has gained attention in recent years, particularly after a 2003 incident in which 16 people died when a mentally ill patient started a fire at the Greenwood Health Center in Hartford. In Manchester in December 2000, a 23-year-old mentally ill man slashed an elderly resident’s throat at a nursing home because he was upset the man had taken a cookie from him.

Advocates for elderly nursing home residents have raised concerns for years about the safety of blending frail, aged residents with younger, stronger people whose mental illnesses may cause unpredictable behavior.

To address those concerns, some nursing facilities have set up separate, locked “behavioral health care” wards _ one of the issues at the crux of the new lawsuit.

State Sen. Edith Prague, a Democrat from Columbia and co-chairwoman of the legislature’s Select Committee on Aging, said Monday that neither group is well served by the current arrangement.

“What we have now is people with psychiatric problems not getting the services they need, mixed in with the elderly population that should be able to live quietly and in peace,” she said.

David Dearborn, a Rell spokesman, said the governor and legislators are concerned about providing the appropriate care to people with mental illnesses, and continue to direct funding and attention toward the issue.

Read the rest of this article —>

If the care has gotten better then I agree, there is no need for more staff. I just find it hard to believe they have enough to begin with!

TALLAHASSEE - Barbara Hengstebeck had worked in nursing homes as an activities director in the 1970s and later had another job taking complaints about nursing home care. But the need for homes to have enough staff hit her when she sat at her mother-in-law’s bedside.

“I can remember sitting in my mother-in-law’s room and her ringing the call bell and waiting for 45 minutes for someone to come help her go to the bathroom,” said Hengstebeck, now the director of the Coalition to Protect America’s Elders. “Finally you just throw up your hands and say, ‘We’ll do it ourselves.’ ”

Advocates for the elderly have been calling on the state for several years to require more nurses’ aides in nursing homes. They’re the people who do the chores that make life there bearable: turning patients to avoid bed sores, helping them go to the bathroom, giving them a bath or a shower.

The Legislature responded in 2001 with a new law that boosted staffing levels. Lawmakers said then that they would increase it a little more each year with the idea that it would eventually get to 2.9 hours of care per resident, per day. After the first two incremental increases, everyone agreed that care got better.

But for the last couple of years, the Legislature has backed off the final increase, and this week Gov. Jeb Bush sent lawmakers a proposed budget that again doesn’t include money to boost the staffing levels.

Bush said Thursday that the number of incidents of poor care and abuse has gone down, making another staff increase unnecessary.

“Before I made that decision, I asked the Agency for Health Care Administration to give me a report on the number of incidents of abuse that had been monitored,” Bush said. “And (the number) declined.”

The AARP, the huge lobby for seniors, which pushed for the changes back in 2001, argues that’s all the more reason to increase staffing even further.

Adverse incidents “have gone down - and that’s the point,” said AARP’s Lori Parham. “But just because things have gotten better doesn’t mean we’re where we need to be.”

Bush did recommend an increase in the part of the state’s Medicaid budget that goes to pay for nursing home care. But even with an increase of about $208 million on top of what it costs to accommodate new patients, it’s just enough to keep up with rising costs, the industry says. The homes say Medicaid already doesn’t pay enough per patient to cover their care.

“I think what the governor has done with the $208 million in price increases is a very important first step, it pays for about a 4 percent inflation rate,” said Tony Marshall, a lobbyist for the Florida Health Care Association, which represents about 500 homes. “It helps us not to lose more money.”

As for the staffing, Marshall said the industry would go along with whatever staffing level is required as long as lawmakers provide the money for it. He thinks the governor’s office isn’t convinced that making the final staffing boost to 2.9 hours would result in as much an improvement as the earlier increases have.

There are also politics involved in the issue. The 2001 measure that included the proposed three-step staffing increase was a broad bill that also gave the nursing home industry some protection from heavy lawsuit losses. AARP supported the lawsuit limits in exchange for the staffing increases, which haven’t been completed.