The perils of Assisted Living.

Peer into the files of Pennsylvania’s assisted-living industry and confront a catalog of horrors.

Betty Trainer, 81 and suffering from dementia, died of heat exhaustion in 2005 after wandering off from her Bucks County care home during a fire drill. They found her body near her husband’s grave.

June Loth, 74, who raised her family in Levittown, succumbed to complications from when she was raped in 2004, authorities say, by a live-in handyman in a home outside Pittsburgh.

In December, John Lambert, 95, tumbled down an unsecured basement stairwell at a sparkling Main Line complex and broke his neck. At the same home a few years before, a resident killed another resident.

I suspect one could reasonably say this is true of every state.

Quick growth,

looser oversight

The personal-care industry mushroomed after state mental institutions began closing in the 1970s. Small homes sprung up as housing of last resort for many with mental illness.

Then, after scandals beset nursing homes in the 1980s, corporate-run assisted living came to be seen as a more humane alternative.

Assisted-living residents tend to be elderly, disabled, mentally ill, or some combination of the three - a population extremely vulnerable to abuse, neglect and exploitation.

These residents live in a gray area: They are infirm enough to need help with daily living, but legally they are not supposed to be sick enough to qualify for more elaborate and expensive nursing-home care.

Unlike nursing homes, which are subject to federal regulations, assisted living operates under less stringent state-by-state rules. For years, Pennsylvania had some of the country’s weakest regulations. A recent update put the state in the middle of the pack, experts say.

In 1999, a federal study of assisted living in four other states - California, Florida, Ohio and Oregon - found that state regulators had cited more than a quarter of the facilities for five or more serious deficiencies, including poor care, understaffing and medication errors.

Some thoughts and ideas about nursing homes and Unions and how to avoid them.

To avoid unionization, management must act like a union when employee grievances arise

The number of unionized workers in the private sector continues to diminish; it is estimated that no more than a small fraction of the nongovernmental workforce is currently unionized. To maintain a productive nonunion workforce, however, the management of nursing homes and assisted living facilities needs to assume the role that unions played at an earlier time in corporate America.

Nursing homes are typically managed in a very autocratic manner. Staff are given little to no leeway in the day to day tasks they are assigned to do. CNA’s are paid poorly and the work is very hard on them. Many aides seek union representation based upon these things: Better pay and benefits; less forced overtime, a voice in policy and procedure planning. These are the nut and bolt reasons aides want to join unions.

But another set of reasons is very clear as well. For whatever reason, the nursing home environment is very degrading to so many. Staff disagreements, disrespect, poor treatment from charge nurses and others; family who make demands that are often superficial and often leave other residents with less time for care. The workplace culture of the typical nursing home is a sad sight. Aides are left feeling they have no recourse for their concerns and issues. They feel helpless and devalued.

Unfortunately, not many nursing homes and assisted living facilities have managers trained to “supplant” unions, and that lack of training can be a significant detriment to a company’s overall well-being.

This is very true…the lack of sound and basic management experience we see in so many who lead is evident…the administrators try hard to be fair, to be honest, to do the right things…but MANY of them have no real MANAGEMENT experience. Sure, they are college educated with business degrees. Yes, they are licensed to do their job. But to actually manage staff— I don’t think so.

Some ideas to make a nursing home UNION FREE:

Alternative Dispute Resolution Programs

Human resources (HR) executives must be expert in administering alternative dispute resolution (ADR) programs, of which there are many types. ADR programs are generally welcomed by both management and employees, because they are cost-effective and swiftly arrive at fair resolutions. One obstacle that I frequently encounter, unfortunately, is management’s fear of giving up its traditional power. Yet by involving employees in the process, management will not be perceived as arbitrary or capricious. I always try to explain to administrators and managers that by being proactive rather than reactive, they create a general feeling among employees of inclusion, and that goes a long way toward increasing productivity and morale.

While there are many ADR programs that I recommend as part of an overall proactive program, the three most common types are:

* Arbitration. This is an adjudication process during which a third party hears both sides of a dispute, weighs the evidence, and renders a decision. Both sides may agree prior to the commencement of arbitration that the arbitrator’s decision will be binding, or they may agree that there could be an appeal to another body to reach a mutually acceptable decision.

* Mediation. In this case, the third party does not render a decision but facilitates open and ongoing communication designed to lead to a mutually acceptable settlement. In most cases, the mediator is an outside professional without the authority to render a decision.

* Peer review. This is a representative adjudication process that relies upon a selected panel of managers and employees. A majority of the panel is required to render a binding decision. Peer review should not threaten management’s perquisites, because in most cases employees will side with management.

These programs give all employees a voice in every aspect of their work. Usually the issues that would be addressed by these programs would be disciplinary actions, evaluations and pay raises (or lack of). Most times, the employee filing a concern is found to be correct with their issue. Management has to agree to accept the terms of the agreements made and so do the employees.

Focus Groups

When management successfully supplants the role of a union, it also undertakes one of unions’ traditional roles: listening closely to what employees think and feel about their jobs, their futures, and their company and its policies.

One of the best means of doing this is through focus groups, which provide management with significant opportunities to gather reliable and representative information about its workforce and their attitudes. Focus groups also permit management to communicate real issues through ongoing employee involvement.

Not just with employee attitudes, these groups can render extremely valuable information about procedures, risks, quality of nursing care, safety and budgetary issues. CNA’s, housekeepers and dietary workers have a lot of really good insight into the ways and hows and means of their jobs. They also have ideas for improvement and innovation. Listen to them!

Team Building

Focus groups lead to team building. While focus groups are exploratory, teams are the instruments that implement strategic plans designed to accomplish specific goals.

Historically, unions have created a sense of employees playing on the same team, a sense of employee solidarity. In today’s complex work environment, management can create that same spirit of solidarity to accomplish commonly shared productivity goals and to solve important problems.

Teams can serve such purposes as enhancing communication and resolving conflicts, but teams are most effective as a means of increasing productivity and enhancing employee morale. When it comes to meeting certain productivity criteria, for example, the entire team is mutually responsible for reaching those goals. One need only look at various sports teams to see how valuable mutual cooperation is to winning. In successful corporations, no one is an individual sprinter, although individual initiative is extremely important to the overall success of a team and the achievement of its goals.

I have two thoughts about team building. I think there are two different types of teams to be spoken for…the actual teams that work together each shift…in each unit and department. And then there are other teams- groups brought together to address problems and issues. BOTH groups need to learn to work together to accomplish anything.

1) Unit based teams can and should be given some autonomy as to how they work together. Group norms, expectations and problems can be dealt with by the members of the team, without management involvement. Scheduling, assignments and activities can be planned by the staff who regularly work these units. In order to achieve a well run team it’s leader MUST be well versed in leadership skills…and most charge nurses have no real management experience. So this is risky.

2) Teams pulled together to address broader company wide issues need to be educated on how real teams work. Ideas about building consensus, debate, and all those other skills are not naturally learned.

Coaching
An essential spur for a team’s success is having an effective coach. A coach is a counselor, not a disciplinarian. The coach encourages employees to do better, to accomplish more; the coach works to rehabilitate negative employee attitudes, emphasizing what’s positive; the coach is not a punitive taskmaster.

Team leaders, focus group leaders ALL must get out of the BOSS mode and get into the “We’re working together to make it better” mode. Management has to drop it’s hat and allow others to help them MANAGE.

Of all the advice offered up through this article I have linked to here, this is one of the best:

Employee Advocate Representative

As unions have shop stewards who represent the interests of the union members by reporting back to union officials, so nonunionized companies can have what is known as an Employee Advocate Representative (EAR). The EAR position is usually a trial assignment aimed at improving morale by involving employees in a broad spectrum of management activities and decisions. When employees want to make their concerns known to management, the EAR listens and then voices those concerns to management. The EAR is both the ears and voice for employees. This position may or may not be salaried and is held for a limited time. Once a term expires, another employee is either chosen or volunteers to be the EAR. To enhance a sense of employee inclusion, the EAR position should be filled by as many employees as possible. Such rotation ensures the greatest amount of employee inclusion and further guarantees that no employee is perceived as a being a tool of management. In small companies, the EAR can work in that position for an hour or two each week.

An in house mediator…someone who is trusted to speak up for those who don’t want to speak for themselves. Someone who is respected and fair; someone who has the ability to see ALL sides of issues YET someone who works on the units. The person who accepts this role must be emotionally strong as well. Management must allow this person the time to perform the very important tasks needed. This might mean a shift a week of being assigned to NON NURSING duties.

This happens FAR too often. It’s preventable. A simple head count does the trick. Often. Like every hour.

MARION, Ind. — An Alzheimer’s disease patient froze to death after he wandered away unnoticed from a nursing home, authorities said.

Staffers at Bradner Village Health Care found Clarence B. Elliott, 76, dead about 3 a.m. Thursday outside a locked door, Grant County Coroner Stephen Dorsey said.

“He had a history of walking outdoors,” Dorsey said. “It looks as if he possibly fell and tried to crawl back to one of the doors to gain entry.”

An autopsy determined that the preliminary cause of death was hypothermia and that it was accidental. Temperatures fell below zero overnight in the area.

Elliott had lived at the nursing home’s Alzheimer’s unit since May 2003, Bradner said in a statement.

“Bradner Village is fully cooperating with local law enforcement authorities and Indiana State Department of Health personnel. We ask the community to please join us in prayer for the Elliott family,” the statement said.

A nurse noticed about 2:30 a.m. that Elliott was not in his bed, Marion Deputy Police Chief Cliff Sessoms said. Investigators were working to determine why a bed check normally done about four hours early was not conducted and why no one heard the alarm on the door by which Elliott was believed to have left, Sessoms said.

What a way to die.

A newer blog is up and running, celebrating the work of CNA’s, particularly those who work in Hospice and Nursing Homes.

They go by several names. During my hospice volunteer rounds in Detroit, I tend to say “nurse aide,” maybe because it’s older and easier to pronounce. But no matter what they are called, they are called often, sometimes too often when there’s a staff shortage. They are generally first responders meeting patients’ needs. Patients frequently think of them first when they evaluate their nursing home experience.

These are two comments I have heard nurse aides express to me about their jobs:

1) “I love working here. It’s not perfect, but we try to work as a team. I treat my patients like they are my family. For some of them, I’m the only one they can really talk to about their true feelings. I know what I do matters.”

2) “This place is depressing. I usually have more patients than I’m supposed to, and nothing I do is enough. It’s low pay with high pressure, but I need the job. It’s not right the way nurse aides and patients are treated here. When I try to make suggestions, nobody listens. I’m really frustrated.”

Well spoken points- each representing an attitude many CNA’s hold. Whether your glass is half empty or half full, there is something for everyone at Frances Shani Parker’s site. Go check it out.

This is the first in a series of articles we will be writing on topics related to nursing home staff turnover, keeping the aides happy and keeping the UNIONS out.

About nursing staff turnover, in nursing homes.

Nurses are at a premium throughout California, but high nursing home employee turnover is leaving some facilities scrambling just to fill ranks.

Nursing homes are not an attractive post for certified nursing assistants because they work extremely hard for minimal wages, said Tippy Irwin, coordinator of the Long-Term Care Ombudsman Program for San Mateo County.

As a result, the industry turnover rate is 8 percent. Nurses who are employed at nursing homes often have to work two jobs and come to work under enormous stress, which hurts the residents for which they care, Irwin said.

“The system needs to change,” Irwin said. “They need to recognize that (CNAs) are the pivotal people because that’s where the care is all happening. CNAs need to be paid what they’re worth. They’re lowest on the economic ladder, and yet they are the ones doing the heavy hands-on work.”

Even when given comparable wages, however, some nursing home administrators say they still can’t attract enough nurses. The reasons why nurses avoid long-term care facilities — and why they are sometimes attracted to them — appear to be a mystery.

Let’s list some reasons why this work is unattractive, to CNA’s:

1) The obvious- very low pay

2) The work itself…physically brutal, demanding, hard, non stop…

3) Poor Management
* Good aides are not recognized via pay raises, special bonuses, a write up based on their GOOD traits ect.
* Bad aides are given too much slack and leeway, and they are often the ass kissers to management
* Managers/DON types don’t come out to the units often to see who is working hard and who is not
* New CNA’s are not given adequate training/orientation periods. Who mentors the new aides?
* Families: Some are very rude, abusive and have too many expectations. Management needs to be supportive of staff!
* Aides who abuse policies are allowed to continue employment. Call out queens, those who are late or leave early…
* The other side- being TOO strict with policies can lower morale and cause turnover (POINT SYSTEM anyone?)
* A DON who disrespects CNA’s- where there is high turnover there should be a BIG question as to the worthiness of the DON
* Charge nurses with BIG HEADS and little anything else- they ruin the atmosphere and morale
* Schedules- no creativity. It’s always every other weekend; every other holiday…CNA’s are given little leeway in this
* The work we do is often over supervised or under supervised- there is little middle ground (AKA trust)
* Assignments are not always fair, spread out evenly; aides get stuck working with the same residents and it can get OLD

4) Lack of autonomy
* CNA’s are given little voice in the work they are asked to perform. Their input is rarely asked for when decisions are being made about policies, procedures, ratios, new admissions and budgetary issues. How many CNA’s are invited to join safety committees and daily rounds? How many CNA’s are asked to give feedback when a care plan is being written? (and not just the ass kissers; aides from all 3 shifts)

* CNA’s are not trusted in the work they are asked to perform. Nurses, especially those with big heads and egos, are always out to make aides look bad or to “catch” them doing something wrong. Why not catch them doing things RIGHT and being positive about it?

* Ratios make this work difficult to manage. Resident demands vs. real needs are lost in the daily shuffle and it makes the shift very difficult to work. Expectations of overzealous families, catering nurses dictate which residents are priorities, vs. real and true medically needy residents.

These are things management can think about. What can be controlled and what can’t? How can these issues be addressed? Culture change is hard work. The mindset of so many who work in the nursing home, from the Administrator to the aide to the housekeeper to the dietary worker can and should change.

NY Governor Spitzer’s budget calls for cuts in nursing homes. While many people tend to blame President Bush, I think the people of NY state just got SPIT on by their Democrat governor.

ALBANY — The average nursing home will lose $700,000 a year in taxpayers funds under Gov. Eliot Spitzer’s proposed budget, and the homes would probably have to cut staff as a result, the head of an industry organization said Monday.

“The only place homes really have flexibility is staffing, so that is what would be affected,’’ said Carl Young, head of New York Homes and Services for the Aging.

Spitzer has proposed reducing the normal increase in state money flowing to the state’s 660 nursing homes by $460 million next year. The Legislature, which is supposed to decide on a spending plan by April 1, has scheduled a hearing on the health-care portion of the proposal on Tuesday.

Taxpayers spend about $7 billion on nursing homes in New York annually through the Medicaid program, with half of that money coming from the federal government. The state pays 40 percent and counties the remaining 10 percent.

From time to time this site is going to enter the political fray when it comes to funding issues. Because we believe it’s not all one side being better than the other. Financial realities have hit nursing homes hard and it really has little to do with federal, state and local politics. Nor does it have much to do with political parties. It has everything to do with citizens who pay taxes.

Somehow this doesn’t seem right.

Martha F. Bell, the nursing home operator found guilty last week of trying to cover up the death of a client, was sentenced this morning to nearly four years in state prison.

Common Pleas Judge David R. Cashman orderd Mrs. Bell, 60, of West Mifflin, to serve 22 to 44 months in state prison. A jury last week convicted her and the nursing home of neglect of a care-dependent person, involuntary manslaughter and reckless endangerment.

The charges stem from the Oct. 26, 2001, death of Mabel Taylor, 88, who had been a client at the defunct Ronald Reagan Atrium I Nursing and Rehabilitation Center in Robinson.

Mrs. Taylor, formerly of Crafton, died after she was locked outside in a courtyard where she succumbed to heart disease and exposure to cold.

Mrs. Bell’s sentence is to be served consecutive to a federal prison term.

In October, U.S. District Judge Terrence F. McVerry sentenced Mrs. Bell to serve five years in prison and pay $50,000 in fines following her conviction on one count of health care fraud and eight counts of making false statements on health care matters.

She is to report to a federal prison in West Virginia on Monday to begin that sentence.

Once completed, she will serve the state sentence, which also includes a fine of $25,000, Judge Cashman said.

It doesn’t seem right when one considers that Mrs. Bell ordered the cover up of the events surrounding the death of Mabel Taylor. The jury convicted Bell, and justice has been served. I don’t agree with the sentence, but it sends loud message to other nursing home operators who are of questionable ethics.