Nursing homes are accepting more and more short term rehab patients, and designing special units just for this population.

With billions of dollars at stake, nursing homes across the nation are rushing to reinvent themselves to compete with hospitals and affiliated rehabilitation facilities for short-term, higher-paying patients like Smyth. They are spending hundreds of millions of dollars on renovations and additions and new features like aromatherapy, brightly colored decor, spacious therapy gyms and Internet cafes to try to create a new, warmer, less institutional image.

Most often, they are providing postoperative rehabilitation for knee- and hip-joint patients, but heart attack and stroke victims are also coming in for therapy. Though many are retirees, others are still in the work force and some patients are as young as their 20s.

Offering treatment at lower costs, nursing homes are undeterred by criticism that they do not have the expertise that hospitals do, and that some data show a decline in the quality of their rehab care.

Too bad they can’t put this effort into the section where the elderly live. Too bad the elderly don’t rate this kind of service.
I understand the need to have a good design for short term stays, but this bothers me a lot- the very people who so deserve well designed and appointed surroundings aren’t getting this.

Excellent article about how Minnesota nursing homes are embracing culture change.

Coaching families to help nursing homes create that type of care is the focus of a free state-sponsored conference today at the RiverCentre in St. Paul.

The conference comes at a time when state agencies and the nursing home industry are struggling to guide the long-term-care system into a future of fewer and better nursing homes, with many more home-based alternatives.

“We’re already in the midst of nursing home culture change,” said Rosalie Kane, a researcher at the University of Minnesota and national expert on nursing home care. “There’s a lot of momentum for change, and families can be a powerful force to keep it up.”

Make sure you read all of it.

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The other day I posted about a nursing home that got sued for DOING TOO much to save a life…for not following the DNR of a resident; who ended up going to a local ER and was subjected to the usual array of life saving tools…Today we see just the opposite in this article:

Albany County has paid a $75,050 fine, levied by the federal government, after its nursing home was cited for jeopardizing the health and safety of residents last year, officials said.

The state Health Department, after an inspection late last year, notified the federal government that the Albany County Nursing Home was not in compliance with requirements for nursing homes participating in the Medicare/Medicaid programs.

Around the same time, the state placed the facility in “immediate jeopardy” status after two people died when the staff failed to resuscitate them.

Question:
What does your facility do to ensure ALL staff KNOW the DNR status of residents? Even non staff, such as agency, must know these things- what exact orders are in place, where these documents are located and facility policy and protocol for such events.

Our friends over at the National Clearinghouse on the Direct Care Workforce have linked to a PDF article that is WELL worth your time. Print it out and plan on a good half hour or so to read this. This article is about leadership skills among the front line workers- CNA’s, dietary staff, ect.

Highlights:
Page 3

Some facilities look at CNAs and see shining stars. One such organization took some of these heavenly lights and put them in
charge of a special club for assisted living residents who had some memory impairments but weren’t ready for the special Alzheimer’s unit. The new group leaders received training in recreation and activities and ways to socialize with and support residents. “These caregivers take great pride in the fact that they are now coordinators and in the deep connection and
involvement they have with these residents,” said the administrator.

Page 4:

One of the easiest and most popular means of building leadership from the ground up in long term care facilities is to give staff opportunities to mentor new hires and subordinates. “You can have a position that says senior aides are able to teach and model best practices of organizations. They can assist in orientations and help identify and address barriers to keeping employees,” says Powell. Some companies are going online. “We started nurturing our medication aides by providing monthly online training that includes leadership skills,” says Sandi Flores, RN, head of Community Education, a provider of assisted living and residential care education in San Marcos, Calif. “We found that when we give them leadership skills, retention rates just
soar,” she says. “You can take this to the bank. I say, ‘Give me a little money for staff training, and I can save you
thousands on staff turnover.’”

A creative and impressive idea for Assisted Living:

The program starts with a three month orientation period, during which caregivers take classes about dealing with dementia, assisting people who need physical assistance, and related topics. If they complete all the requirements by the end of this period,
caregivers become a PCA 1 and get a monetary bonus. They then can go on to become a PCA 2, which requires additional training and a minimum of nine months employment at the facility. At the completion of this phase, caregivers get a pay raise, a certificate of achievement, and formal in-house recognition. At level PCA 3, caregivers become certified care associates. “These are specially selected people,” says Kanaskie. “They have to demonstrate exceptional performance, express interest in customer performance, and demonstrate leadership skills.” Candidates at this phase must interview facility leaders and complete a project—something that improves resident care or makes life easier for staff.Past projects have included organizing a resident choir and leading group validation services for patients with dementia.
“This program enables motivated caregivers to become highly competent —if not experts—in their role. They feel good about their ability to do their jobs. They put extra work into it, and we recognize their efforts,” Kanaskie says.

Like I said, this is in PDF format. It should be printed out and read in hand. I found it to be extremely motivating and plan to bring it to work and show my DON. If they did these types of things at my work I GUARANTEE the turnover would decrease. We don’t get paid much. We don’t get recognition for the HARD work we do. THESE things would improve morale and would show that management CARES and wants to see everyone do better. AND I daresay having a program or two like some of these would help keep unions OUT too.

The push to keep elderly people out of nursing homes IS ON. But what happens when the state decides a person is TOO healthy to receive in home help…yet without that help the person will have to move into a nursing home? Balance. We need to find balance.

Evelyn Gray no longer drives and needs a walker to cross her living room. She’s had 16 operations to treat arthritis and skin cancer and has no family left to care for her. For four years, state-subsidized housekeepers, nurses and social workers visited her Lebanon apartment, but last summer the state deemed her too healthy to qualify for help.

Now Gray, 86, might lose her emergency call button, weekly grocery deliveries and other services that allow her to live alone instead of in a nursing home. Gray, like many seniors, cherishes her independence and wonders why she’s being penalized for trying to maintain it.

“I have my mind about me,” she said, sunlight flooding the windows of her studio apartment. “I do not want to go to a nursing home and live.”

Gray’s social workers are equally perplexed. Her troubles come at a time when state health officials want to reduce nursing home populations - and state spending - by steering seniors away from institutions and into community-based support programs. But elder-care experts and some lawmakers worry that the state is pushing too many, too quickly into an already overburdened system. Gray’s struggles, they say, are indicative of problems that must be solved before New Hampshire’s rapidly aging population overwhelms the state’s home health care providers.

Read the rest of this article —>

Nurses and CNA’s claim that low pay effects quality of care.

It does. Nurses and aides who work in LTC are the lowest paid nurses and aides, and this leads to high turnover. Which costs the nursing homes a lot of money when they either have to call in agency help or hire new staff and train them.

Nurses and aides at the troubled Minneapolis Veterans Home complained for years that their pay was too low and their hours too long, and that those conditions have contributed to repeated health and safety violations.
[...]
During years when a shortage of nurses boosted their value in the Twin Cities job market, nurses at the Veterans Home earned substantially less than they would at metro hospitals. Today, a top-scale registered nurse at a Twin Cities hospital can make $14,600 more in a year than one working at the Veterans Home.

And there is this:

Margaret Skoy, a Veterans Home RN, testified at a legislative hearing in 2005 that administrators had cut staffing a few years earlier on each skilled care unit — from four RNs to three, and from eight nurses aides to four — and that an aide’s workload “dramatically increased.”

She also testified that nurses and aides were being required to work double shifts, sometimes 16-hour days two or three times in a 10-day period.

“It causes increased stress and exhaustion,” Skoy told legislators. “It negatively impacts their ability to give quality care to our veterans.”

It IS about pay. And those forced overtime shifts…which are HARD to work. Hard on our bodies and families. No wonder we have such a difficult time getting enough staff. WHO wants to work with these conditions?