One of the issues CNA’s deal with on a daily basis is interactions with resident families. Like it or not, they are the most important part of our residents’ lives. I think an admission to a nursing home is not only a shock to the person, but to their family as well.

Families deal with many feelings when they decide to place their loved one into a nursing home: guilt, helplessness, financial worries. They hear the stories about abuse and neglect. They fear these things will happen to their loved ones. Usually families have little experience with how long term care facilities work- the daily pulse and beat. The nursing home becomes HOME to the resident and the second home to many of their families.

CNA’s on the other hand work in nursing homes for a living. We punch in, do our shift and go home. We love most of our residents and do the very best we can with what we have. Often, we work short of staff and this is heartbreaking for many of us. Few of us remember our first days in this work…the shock and dismay we felt at the lack of time to do really good work. We went home feeling guilty and a little shamed of the care we gave. Soon enough, we each realize this is how it is and we also know it could be much worse than it is. I think we become immune to that SHOCK effect.

Families go through the same thing. Some come to know how nursing homes operate. Some don’t bother to learn and others just don’t care. They expect the world to halt to their demands and they could care less about who ends up being neglected because of their demands. They tend to put the heat on management with complaints and needless accusations; and they have expectations that are really not in tune with the typical model most nursing homes follow.

At the message board for this site, a discussion was initiated about this very subject. We got hot handed, a little, because I believe aides can have a huge impact on the families perceptions of who we are and why we do things the way we do.

This one is for the families of nursing home residents
You know who you are, you are the one who likes to show up a few minutes after your family member was looked after but has had an accident and then claim they had been that way for hours. You think you know our jobs, but never had a hour of medical training. You think I am your servant but I serve only god and country. My boss is the nurse, hunt her down with your bitches.

I have a real nice question for you, here it is in little words that I know you can understand:

If you think that you can do a better job then why the f—k don’t you?

Now be honest.

Understand this:

1. I am a CNA, not whipping boy or girl.
2. I am worthy of respect and you will respect me.
3. If you do not do #2 I will talk real bad about you to my co-workers about much of a moron you are.
4. Again, I am a CNA. I take of more patients that just your family member, so if you want extra special care and attention given to Sally or Fred or Ann then you going have to shell out for a private sitter.
5. O if you think I got an attitude, well think no more and now you should know.

The familes are the single worse thing about this job. Nursing homes should have stricter visiting hours.

This is an extreme view, held by more than I would care to know of. I could not work with people who hold this opinion and I can see how negative the work environment could get, surrounded by aides who are seething to the brim with these feelings. Yet I understand where Kevin is coming from…I have had days where I just wanted to toss the towel in literally at a spouse of a resident- who was caught up in the middle of this battle. The demands of one family can have a very negative effect on the other residents we are assigned to care for.

This presents a problem for us. Management always applies grease to the squeakiest wheels, and this bandaid approach never truly heals the wound- instead it makes it worse. I do place blame on management for allowing this to happen. It is up to them to deal with the nitty gritty demands and expectations that truly do take away hours of care from other residents. Dealing with these people might mean telling them how things really are. It might mean letting the families know their petty concerns over missing laundry equate to another resident getting their medications late. It might mean holding a meeting and explaining to these families that they are disruptive and detrimental to overall morale of both staff and residents.

What can a CNA do when caught up in the middle of the family/facility battle?

My best tips:
Smile!

Apologize. It may not be your fault but it is your responsability as an employee.

NEVER say that you are shorthanded!!!! It maybe true but families and patient don’t want to hear it. (I know I don’t want to here it from the bank teller when I have stood in line for 10min.)

If it is something you can’t mend as a CNA then get the RN involved- use your chain of command. Get the risk manager involved if it comes to that.

That about sums it up, nicely. Try to be upbeat and positive, and at the same time acknowledge the families concerns. If there is ever a time to pass the buck, now would be the time.

Hopefully management can do some things to make this issue better for all:
*Before someone is admitted, a good educational session about the workings of the nursing home should take place. Families should always know and understand the aides are responsible for MANY residents, not just one. Timeframes should be disclosed- it should be well known that 20 to 30 minutes is the normal expected amount of time an aide can spend with each resident.

*The family could be asked to come in and watch part of a shift. To see how things work; to learn about how nursing care and treatments; to see the food and meals and laundry service. This is a good time for families to be introduced to the dept. heads

*Get this book, several copies of it…and lend it out to families:
The Eldercare Handbook: Difficult Choices, Compassionate Solutions

*And this book:
Living Well in a Nursing Home: Everything You and Your Folks Need to Know

It wouldn’t hurt to have everyone read these books to be honest- nurses, aides, laundry staff…

I found some really good websites that promote Culture Change within LTC…here’s one I really like:

IDEAS INSTITUTE

The mission of IDEAS Institute is to provide solutions that improve the life of older adults through the conduct of rigorous applied research. Our highly respected staff examine the therapeutic potential of the environment—physical, social and organizational—as it relates to frail and impaired older adults.

Serving older persons, their caregivers, and the community, the IDEAS Institute seeks to be a premier resource of information and environment - behavioral research centered on improving care and quality of life for people with chronic forms of physical and cognitive decline, including, but not limited to, Alzheimer’s disease.

Some of the material here is outstanding:

Home is Where the Heart Is: Designing Home-like Settings

In most homes, different rooms serve different purposes, and are designed to look very different. Seldom does a person have the same chair in the dining room as in their bedroom and their living room. Institutions, on the other hand, are marked by a uniformity of both furniture and design. All wall treatment is the same, or so coordinated that it’s hard to tell one space from the next. When a well designed chair is found, it is used everywhere: in the bedroom, in the dining room, in the activity room. But this approach to interior design will not make a place feel like home.

The Secrect to Happier Meal Times

Long-term care facilities, however, cannot realistically cater to every resident’s complete personal preferences. Group living, almost by definition, requires some level of compromise. It does not, however, suggest care providers should set policies and practices solely to suit their preferred organizational structure. Codes, in nursing homes, and market pressure in independent and assisted living make understanding and catering to your residents preferences related to dining increasingly important. This includes, at a minimum, some choice in meal time and some choice in what is served. More progressive facilities are also offering a choice of meal location, table companions, and a greater array of food options.

These are just a couple of the ideas listed at this site. Go have a look, bring the ideas to work and talk about them. Ask management to look as well. The articles are long but well worth the read.

It’s hard to believe there are still nursing homes out there without sprinkler systems!

Under a new proposal, the Centers for Medicare & Medicaid Services will require nursing homes nationwide to install sprinkler systems or lose their Medicare and Medicaid benefits.

Kansas has more than 350 nursing homes and hospital long-term care units.

“CMS is taking further action to protect the lives of our beneficiaries through a proven effective approach to fire safety,” acting administrator Leslie Norwalk said in a statement. “Automatic sprinkler systems are integral to increasing safety in nursing homes, and we look forward to their installation in all of the nursing homes across the country.”

Officials with Via Christi Senior Services, which operates seven nursing and senior care homes throughout Kansas and Oklahoma, said the ruling won’t have much impact with them — they’ve made a policy of installing sprinklers in all facilities — but smaller, rural centers might feel some financial strain.

“I think it’s important to guarantee the safety of the residents as much as possible,” said Via Christi Senior Services spokeswoman Debbi Elmore. “Our buildings are all sprinkled, but it could hurt some of the smaller, free-standing homes that will have to install them.”

CMS will take public and industry input on an appropriate phase-in time to allow older homes to retrofit their facilities. The comment period will remain open until December 26.

This is absurd.

MORRISVILLE – A nursing home’s failure to assess the impairment of a charge nurse who came to work “smelling very strongly of alcohol” one night last August put it at risk of losing its federal reimbursement, a state report says. The nurse, who failed to respond to patients’ requests for pain medication, was responsible for a unit of 40 residents.

An additional factor contributing to the enforcement action was the nursing home’s lack of policies and procedures directing employees in how to deal with another staff member whom they suspect of being impaired by drugs or alcohol.

Morrisville Center Genesis Healthcare has corrected the conditions that led to a finding of “immediate jeopardy” and won a temporary reprieve from losing its Medicare certification. The 90-bed nursing home is in the process of correcting other problems uncovered in the September investigation, which was triggered by a complaint resulting from the incident.

(The unnamed licensed practical nurse was fired and her conduct reported to the Vermont Board of Nursing.)

Let’s hope she was fired, and let’s also hope she loses her license.

Here’s what happened, according to a report on a three-day investigation by nurse surveyors from Vermont’s Division of Licensing and Protection. (CMS contracts with the state to determine whether facilities are meeting federal standards.)

On Aug. 20, a night charge nurse arrived at work more than an hour late and “smelling very strongly of alcohol.” When the evening charge nurse, who worked the previous shift, asked her whether she been drinking, she replied, “Yes, but I stopped when I found out I was working.”

The evening nurse left, and then, realizing that it was not safe to leave the “potentially impaired night nurse,” returned to the unit. An argument took place between the two, and the night nurse blocked the evening nurse from phoning the unit nurse manager.

After the evening nurse left, the night nurse called the manager and told her she would probably be hearing from the evening nurse because “I was late and she could smell alcohol on my breath.” The nurse manager spoke to the aides and the nurse from the other unit, but never went to the center to evaluate the allegedly impaired nurse herself, although one of the aides said she should come. After the conversation, she turned off her telephone. (She was available by beeper.)

Typical of a nurse manager who doesn’t want to take responsibility for her unit. When an aide feels a charge nurse isn’t able to perform the duties required- the nurse managers should TAKE ACTION immediately.

The nurse manager confirmed that after receiving the call from the night nurse, she made no attempt to contact the evening charge nurse and turned her telephone off. The nursing home reported both the nurse manager and the evening nurse to the Vermont Board of Nursing – the nurse manager for failing to go to the nursing home to evaluate the night nurse’s condition, and the evening nurse for not contacting the nurse manager by telephone or beeper.

So what did she do? Go to bed all safe and snug, not worrying about the residents who were not safe? Bad call, boss. BAD CALL.

When a nurse takes on the responsibility of being in charge of a unit, they MUST accept this with seriousness. It’s not a job for everyone. You have to be willing to come in on a dimes notice and take control of situations that are not safe for residents. It might mean acting as a charge nurse for a shift, or making a lot of phone calls to various agencies. Whatever. Turning off the phone isn’t an option but we see it happen all the time. I feel bad for the aides working that night- they must have felt very taken advantage of. And I’m sure they kept an eye out on all the residents whenever this drunk nurse was around.

A manager needs to do just that: MANAGE. Not pass the buck or let things “go” until the morning.

It sounds like the owner of this place needs a consultant to come in and literally clean house.

DES MOINES, Iowa A Muscatine nursing home with a long history of problems is facing more trouble.
State inspectors visited the Riverbend Nursing and Rehabilitation Center last month and found more than 25 health and safety violations. That’s a large number of violations given that Riverbend has just seven residents.

The alleged violations include the lack of a medical director and no arrangements for a doctor to handle medical emergencies 24 hours a day.

Inspectors also say they found dead crickets throughout the facility, heavy grime in the dining room and urine on the floor.

Richard Angell began running the home in September. He is at risk of losing his nursing home license if problems aren’t corrected before the next inspection.

American Healthcare Associates was Riverbend’s previous owner. It agreed in August to surrender its license after several other violations were cited.

A nursing home owners pleads for mercy.

Pleading for mercy in a shaking voice, Martha F. Bell testified that she was ultimately responsible for conditions at the nursing home she once ran and would accept whatever sentence a federal judge imposed on her.

An hour later, after U.S. District Judge Terrence F. McVerry ordered her to serve five years in prison and pay $50,000 in fines, Mrs. Bell insisted that she’d provided good care to residents and did not deserve jail time.

As she’s done since her conviction for defrauding Medicare and Medicaid and on other charges last year, she contended yesterday that she did not receive a fair trial because the court did not permit her to introduce records and evidence. She said she would appeal.

It’s pretty hard to defend a case against fraud- since those acts are pretty easy to fact check.

She also blamed former employees for providing shoddy care and faking medical records, saying they duped her into believing they were carrying out her dream of operating a model facility for people with Alzheimer’s disease.

“I don’t believe I did anything wrong. I believe I trusted people and asked them to tell me the truth,” said Mrs. Bell, 60, of West Mifflin. “Those people all knew how much I wanted them [to do] for the patients. They have to sleep with their consciences.”

She tries to pass the buck, but it doesn’t stand because she is responsible. That’s what being the boss is all about. She knew what she wanted and had a vision; she should have made sure it was happening instead of depending upon the words of others.

Mrs. Bell was convicted in August 2005 of one count of health care fraud and eight counts of making false statements for her actions as founder and administrator of the defunct Ronald Reagan Atrium I Nursing and Rehabilitation Center in Robinson. The state closed the facility in 2004.
[…]
Weeping on the witness stand, Mrs. Bell told Judge McVerry she never meant to hurt anyone and feared developing Alzheimer’s disease or a reoccurrence of breast cancer in prison. But the judge noted that she’d shown no remorse and denied her request to remain free on bail during her appeal.
[…]
Prosecutors accused Mrs. Bell and Atrium of defrauding Medicare and Medicaid of more than $7 million and making false statements to hide that fraud between 1999 and 2003. They charged that Mrs. Bell and Atrium accepted and spent money from the health care programs, then faked thousands of medical and financial records to conceal failure to provide appropriate care as required.

Mrs. Bell also was accused of diverting funds from Atrium to other nonprofit organizations that she headed to supplement her salary, which reached nearly $1 million between 1999 and 2002.
[…]
“This was a scheme that dramatically impacted people’s lives,” Ms. Buchanan said, noting testimony about how Atrium residents endured injuries, medication errors and lack of adequate food and treatments.

Mrs. Bell ran up thousands of dollars in restaurant meals and personal expenses on corporate credit cards while seeking to cut Atrium’s food budget to less than $3 a person per week, Assistant U.S. Attorney Leo Dillon said. He acknowledged defense attorneys’ arguments that Mrs. Bell had built a “beautiful facility” but said greed destroyed it and harmed vulnerable residents.

“This is not just a typical white-collar case,” he said. “People were hurt.”

We have to many loopholes in the system and although this owner was caught, how many others are doing these same things that no one is aware of? How many residents and patients are still being harmed because of malicious act ivies like this?

An excellent Q & A about C Diff:

Source

What is C. difficile, and why are we hearing so much about it?
C. difficile, or Clostridium difficile, is a kind of bacteria that upsets the normal balance of healthy bacteria in the digestive system, causing diarrhea. It often affects people who have been taking antibiotics, especially “broad spectrum” ones that kill a wide variety of bacteria.

C. difficile has been around for a long time. It’s in the news now because a study of Quebec hospitals reported a dramatically higher rate of death in people with the infection. Instead of the usual death rate of 1.5%, some hospitals had a death rate of 8.5% among those who become infected. Rates at which people become infected have also increased. Researchers are worried that a new, more deadly strain of C. difficile has emerged.

What causes it?
C. difficile doesn’t normally cause trouble for healthy people. However, for people taking antibiotics, it becomes a problem when it takes over from other “healthy” bacteria in your colon or large intestine, causing diarrhea and damaging the colon. Common culprits are amoxicillin, clindamycin, and a group of antibiotics known as the cephalosporins.

Why does it happen in hospitals and nursing homes?
Most of the recent cases of C. difficile have been reported in hospitals and nursing homes. Why? These are both places where patients commonly receive the “broad-spectrum” antibiotics that increase the risk of C. difficile infection. As well, C. difficile is often normally found in hospitals and nursing homes, and is easily spread from person to person through contaminated instruments and dirty hands.

What are the symptoms?
Symptoms of C. difficile infection may include watery diarrhea, diarrhea containing blood or mucus, abdominal pain and cramps, fever, chills, and fast heartbeat. In severe cases, this infection can be fatal.

How is it treated?
For mild cases, the usual treatment is to stop the antibiotics. The balance of healthy bacteria in the colon is usually restored, which gets rid of the problem. For more severe cases, the original antibiotics are stopped and new antibiotics, usually metronidazole or vancomycin, are started. These two antibiotics target C. difficile itself to help the body get rid of the infection. In very severe cases where antibiotics don’t work, surgery may be needed.

How can I protect myself?
One way to avoid C. difficile infection is not to take antibiotics and to stay away from hospitals or nursing homes. However, that’s not always possible or even practical.

Here are a few things you can do to stay safe:

* Wash your hands thoroughly with soap and water after going to the washroom, before and after handling food or medications, before and after visiting people in the hospital, and before eating or taking medications by mouth.

* If you are visiting someone in a hospital or nursing home, follow all precautions that the hospital staff recommends, including visiting restrictions and protective clothing.

* If you think you may have a C. difficile infection, contact your doctor.

Here are the steps that hospitals and nursing homes are taking to reduce the risk of C. difficile:

* Careful antibiotic prescribing practices: This means using antibiotics only when needed and choosing antibiotics that are better targeted to the bugs they are trying to kill.

* Handwashing: Since C. difficile can be spread through contaminated hands, all staff and visitors should wash their hands properly before and after touching patients, going to the washroom, or handling food and medications.

* Room cleaning and disinfection: C. difficile can be spread on dirty surfaces. Rooms and instruments need to be thoroughly cleaned and disinfected between people.

* Isolation: People found to have C. difficile should be placed in isolation so that they do not infect others. Special precautions are taken when entering, leaving, and working in the isolation room.

Since the new strain was first reported, hospitals have taken action to limit the spread of C. difficile and cut down on infections. These steps, plus taking the precautions listed above, will help protect you from C. difficile.

Yesterday we heard about Florida nursing homes that got awards for being SO GOOD. Today I found this:

DAYTONA BEACH, Fla. — Eyewitness News got a copy of a scathing letter sent from the state to a Volusia County nursing home. It details almost 40 violations, thousands of dollars in fines and punishments the nursing home is now facing.

Eyewitness News learned it isn’t the first time the Daytona Beach nursing home has been accused of abusing its residents.

The Horizon Healthcare Center on South Nova Road has 120 residents. Soon, the state could force it to stop admitting any more people.

According to the Agency for Healthcare Administration, the warning is about as stern as it gets. State officials said they rarely have to crack down as hard as they have in this case.

Horizon Healthcare Center has until Monday to make drastic changes, according to the Agency for Healthcare Administration. The 120 be facility came under fire earlier this month, when it failed an in-depth inspection.
[…]
The nursing home is racking up more than $8,000 a day in fines.

The state leveled accusations in five categories, including abuse, accommodation of need, quality of care, accidents and nursing services. The state warned “…conditions at your facility constituted immediate jeopardy to residents’ health and safety…”

Purdham didn’t notice any glaring problems, but said he’ll keep a close watch on his wife.

What inspectors saw could force the facility to stop admitting new residents and they now risk loosing their ability participate in Medicaid/Medicare programs.

Eyewitness News checked and there has been only one lawsuit filed against Horizons, for professional malpractice in 2003.

Daytona Beach police were not able to comment on whether they were a part of the abuse accusations, nor about the nature of the charges.

The parent company of the facility would not comment, except to say that they have already met the state’s requirements, but not so according to state officials.

$8000.00 A day in fines? This is serious stuff going on at this place.

Rewarding hospitals?

WASHINGTON — You tip your waitress for good service. You tip the taxi driver who gets you to the airport on time. Now the federal government is testing the same principle on doctors and hospitals.

The federal government will pay out $8.85 million in bonuses to hospitals this year as part of a pilot program that rewards those that offer the best care. The federal Centers for Medicare and Medicaid Services is launching similar pay-for-performance incentive programs for doctors and physician group practices, with plans to expand into other care areas.

Rewarding the doctors and hospitals that offer the best care — and, possibly, punishing those whose care falls short — is experimental in the United States. But it’s gaining widespread acceptance.

“Pay for performance is a response to nonperformance. It’s a response to health care that is perceived as overpriced and not responsive to patients’ needs,” said Michael Millenson, author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age.”

There is much more in this article. Debate about what standards are going to be used for these rewards; how hospitals feel the current method of collecting data isn’t always accurate, ect.

Great stuff happening in Iowa:

When it comes to caring for our nation’s elderly, there’s a right way - and there’s a better way. Here in Iowa, we are on the better path, transforming everyday quality of life for the more than 30,000 residents who live in our state’s 450-plus nursing homes.

Historically, there’s been a general perception that nursing homes are cold, impersonal buildings that provide institutional care. But nursing homes can and should be good places for our loved ones to live their last years or receive rehabilitation to return home. We really want to make them feel like home.

A coalition has been formed for putting the “home” in nursing homes by the Iowa Foundation for Medical Care, a nonprofit, statewide health-care quality-improvement organization, and members from seven other Iowa organizations. Together, the coalition represents regulators, caregivers and providers, including our own associations, Iowa Health Care Association and Iowa Association of Homes and Services for the Aging.

The Iowa Person Directed Care Coalition is promoting practices and environments that embrace a new future - one where care is resident-centered and offers choice, flexibility and warmth, and where staff, families and residents work as partners to improve the quality of care so that residents have a better quality of life.

The Iowa Person Directed Care Coalition is dedicated to ensuring that elderly Iowans can direct their own care according to their personal preferences and needs.

You’re probably thinking: Sounds nice, but what does it mean in real life?

For nursing-home residents, it means that life is more like real life, the kind of life they led in their own homes, where they had choice; control; meaningful, caring relationships; and comfort and convenience.

Take, for example, the fundamental experience of waking up and getting out of bed every morning. Most of us simply go through the motions without even thinking about them. But that’s not true for many elderly people - and, especially, those who have lived in traditional nursing-home settings.

In the newly transformed person-directed nursing home, you set your own schedule, and staff work around it. Breakfast is served when you want it. Your morning care is tailored to your needs and preferences - and your speed.

In short, it’s a lot more pleasant.

Or what about dinner time? In your own home, that was something to look forward to. In the transformed nursing-home culture, you can eat what you want when you want it, in smaller, more intimate dining areas, where you can interact with staff and with other residents. The food is more interesting and prepared especially for you. And it’s served on china dishes!

You can see how these little things add up quickly, and how they make the difference between life in an institution and a real life.

The Iowa Person Directed Care Coalition is spreading these and many other transformative care practices throughout our state’s long-term care facilities. The coalition recognizes the importance of ensuring that nursing homes and other long-term care providers comply fully with nursing-home regulations.

But we believe that it takes more than regulatory compliance - even full compliance - to provide long-term care residents with the kind of care and the quality of life they deserve. It takes a better way.

CINDY BADDELOO is deputy director of Iowa Health Care Association and MARK TEIGLAND is vice president, member services, of the Iowa Association of Homes and Services for the Aging.

For more information about the Iowa Person Directed Care Coalition, contact coalition member Kim Downs, senior director of quality improvement with the Iowa Foundation for Medical Care, (515) 223.2883, or kdowns@iaqio.sdps.org.

I hope they send out more info and press releases about how this ends up working…we need more people to do these things.