A look at hospice oversight:

CHICAGO (AP) — A significant number of Medicare hospice programs were not checked by state inspectors for nine years and were long overdue for certification, according to a federal report released Tuesday.

Three states — California, Illinois and Michigan — were furthest behind, accounting for 41 percent of the past-due certifications, according to the report by the inspector general’s office of the U.S. Department of Health and Human Services.

Of the hospices surveyed, 46 percent were cited for at least one health deficiency, such as missing or inadequate patient-care plans.

There is more to read —>

I found this article about an author of a book about caring for people with dementia and nursing homes.

Through an intensive comparative study of two nursing home units using contrasting approaches to dementia care for elders with severely disturbed behaviors, Central Michigan University professor of anthropology Athena McLean has found that “humanizing” approaches to dementia care may not only extend quality of life for patients, but also their length of life.

In McLean’s recently published book, “The Person in Dementia: A Study of Nursing Home Care in the U.S.,” she discusses the dramatic contrasts in the outcomes of the two approaches to dementia care: a rigid task-oriented maintenance approach emphasizing disease progression and a flexible person-sustaining approach attentive to elders’ communication and individual needs.

McLean found dramatic differences between life quality of the patients at the two nursing units. The patients at the unit that focused on “personhood”, or looking beyond physical and reasoning abilities to a person’s will and relationship with others, were found to be happier, had an overall improved quality of life and even lived longer. Those at the unit emphasizing disability and pathology tended to have their personal needs ignored, were heavily medicated and often failed to thrive.

Does this surprise anyone?

“These findings address issues that medicine can’t answer,” said McLean. “They are valuable not only for improving the general quality of life for these elders, but also for the long-term outcome based on how they are treated and cared for. These elders require attention, time and a lot of caring interaction.”

McLean’s findings also demonstrated how relations among professional and administrative staff within a facility can significantly affect the quality of the dementia care elders receive.

Based in this article I just ordered the book from Amazon.

Here are the details:

# Paperback: 328 pages
# Publisher: Broadview Press; 1 edition (October 31, 2006)
# Language: English
# ISBN-10: 1551116065
# ISBN-13: 978-1551116068

I have created a new private forum for CNA’s to become members of.

Please come register and join, for free.
Nursing Assistant Forum

Here, no topic is off limit and debate and thoughtful exchange of information and views is welcome. Venting, sharing and questions are all welcome. Job seekers and recruitment efforts are not welcome. New and career CNA’s are invited to join; as well as those who are considering working as a CNA. Also, those who are concerned about the work of CNA’s are encouraged to join as well.

Patti plans to keep the Network 54 Forum open, but it is very difficult to keep trolls and troublemakers out of that forum. This is part of the reason for the new forum.

This isn’t news to me, or to most aides I suspect.
We see it. We experience it. We hear all about it.

WHAT? The PANIC mode our DON and Administrators go into when it’s THAT time of the year. The biggest pony show is often put onto the stage during these times.

THE ANNUAL SURVEY.

Weeks before they expect the inspections, the leaders go crazy. Everything is painted and cleaned and polished to a high voltage shine.

Suddenly the food is much better- it’s hot when it’s supposed to be, or cold when it should be. More food is served; it looks better and smells better and….YES….it even tastes better. The nice table linens come out. The dishes are apt to be prettier. The cook is suddenly more responsive to resident requests for an alternative. The servers show some respect once again. And the aides HEAR about IT when they’re not in the dining rooms right exactly on (cue) time. The dietitians suddenly show up more at meals and actually taste the food, check it’s temp and go through the motions they’re supposed to have been doing all along.

The DON changes too at this time of the year. She or he goes on a witch hunt, scouring through employee records to see who needs to be updated for in services and background checks and all that. She might realize the nursing home hasn’t offered enough education hours so we the aides are forced to attend stupid movie in services by the half dozen for several weeks. Then we’re coached as to what to say IF the dreaded SURVEYORS ask us questions. An innocent and idealistic aide might ask why she can’t just tell them the truth? Lo and beho, the SIN this person just committed. The DON goes further into her self imposed bitchdom with the resident care plans. And the nurses are the next target of the scorn and attacks. Care plans are re-written; aides and nurses and others are asked, no TOLD, to re-sign endless pages of flow sheets and similar stuff.

The residents get the most out of SURVEY EXPECTATION ANXIETY TIME. They get brand new towels and sheets and linens. They have new toothbrushes with their names on them…and shampoo and soap and creams and lotions. Things they haven’t always had all year long. Their rooms are suddenly really well cleaned- rugs are washed, walls are re painted, much needed repairs are done. Windows might even get screens placed in them; AND, the bathrooms! The toilets are fixed so they stop clogging up; the showers magically spray hot water again. And residents have an endless supply of needed items like briefs and wipes and the likes. The scents of the home are just wonderful too, at this time of the year. Air fresheners and flowers and the smell of baking food is abundant in every nook, corner and crevice.

THE BEST PART of THAT time of the year is the increase in STAFFING. Yes. Everyone benefits now. Not only are there enough aides scheduled, often we have too many. SO many that a couple might be sent home or better yet- put to work doing special things like restorative nursing stuff, or activities. The nursing home appears to be a well oiled, well run shop. Enough staff; good food, excellent building and yards; a great activity program…and perfect care plans with well written goals and all signed off by the right people, at the right time, for the right resident.

Yep.

Too bad this isn’t how it works ALL THE TIME.

Now go this article. And consider my rant above. It’s all relative and yes, some nursing homes are NOT like this (or shall we say, some nursing home management teams) BUT many are. Hide the truth when IT’S THAT TIME OF THE YEAR. Cover up those things that are cosmetic and can be altered for a few days. And forget about the rest of the year.

The US Supreme Court has made a finding on the case of the CNA who lost her license for allegedly abusing a resident. There was never any actual evidence and the state of Washington took her CNA credentials away anyway.

The U.S. Supreme Court on Monday let stand a Washington state Supreme Court ruling that the state didn’t have enough proof to suspend a woman’s nursing assistant license for the alleged abuse of an Alzheimer’s patient in 2001.

The Supreme Court exonerated Alice Ongom without comment.

In December 2006, the state Supreme Court, in a 5-4 decision, ruled that for professional disciplinary hearings, due process requires “clear, cogent and convincing proof.”

Alice Ongom was a nursing assistant at the Woodmark Retirement Home in Federal Way, Wash. She was accused of throwing a cup or dish at a resident, as well as slapping her on the hands several times and kicking her.

Witnesses gave conflicting statements concerning whether Ongom assaulted the woman, but the Department of Health investigation found that even though there was not “clear and convincing evidence,” a preponderance of evidence existed, as required by the Washington Administrative Code. Ongom’s license was suspended for two years.

The Washington Supreme Court said that section of the code was invalid and that the higher burden of proof must be used in these cases.

I suspect that something bad did happen here- maybe not outright abuse, but something close to it. Whatever it was, it was enough to get the attention of a lot of people in and near that dining room. This case proves to us how important it is to report things we hear and see; to report things our residents tell us; to observe them and their behaviors after such events…and, let this be a lesson for management- a thorough investigation is always very very important. WE DON’T WANT ABUSIVE aides working with us, or our residents. Even though the aide involved with this case appears to have been exonerated, I don’t trust it. None of us should.

Another article about changing nursing homes. These are getting to be pretty common items that pop up in a Google News search for nursing homes.

LONGVIEW – The more nursing homes John Fite visited, the more he became convinced that he wasn’t going to put his sister in one.

Residents of Grace Presbyterian Village in Dallas do water aerobics. Realizing that institutional atmospheres are aunappealing, nursing homes are redesigning their buildings, retraining staff and letting residents determine their own activities and schedules.

“All I saw were people slumped in their wheelchairs,” the Longview dentist said. “And the odor was just as jarring.”

Then he heard about the extreme makeover at Buckner Retirement Services Inc.’s Longview campus.

There are similar themes that are being presented when it comes to culture change:

The first is to make nursing homes’ physical setting less institutional.

“Now is an opportune time to rethink nursing homes,” said Larry Minnix, president and chief executive of the American Association of Homes and Services for the Aging, a trade group for nonprofit care providers.

Many of the nation’s 17,000 nursing homes date from the 1960s and ’70s and are due for replacement or extensive remodeling, he said.

As owners renovate, they’re breaking larger buildings into smaller living units, called “neighborhoods,” each with its own common space.

And:

Like other operators, P&M Health Care has introduced restaurant-style dining in the 37 for-profit nursing homes it manages in Texas. Plastic trays have given way to china, linen napkins, fresh flowers and menus.

“It’s all about giving residents more choices,” said Kenny Owings, regional vice president for the Pennsylvania company.

Other nursing homes have added bread machines, pets, spas and vegetable gardens to make themselves homier. They’ve restyled nurses stations to look like home desks and ripped out public address systems.

Very importantly:

A second objective of culture change is to create a more stable workforce.

The nursing home industry has been beset with turnover rates averaging 70 percent a year. Experts say any nursing home with a constantly changing staff can’t know its residents well.

The answer lies in better pay, better training and better work environments for caregivers, said Robyn Stone, executive director of the Institute for the Future of Aging Services.

One workforce strategy is to assign caregivers to the same residents each day instead of rotating staff members between wings or floors.

“It’s a win-win for residents and staff,” said Gloria Bean, director of nursing home improvement for the TMF Health Quality Institute in Austin.

“The same caregivers can spot subtle changes in residents’ behavior and head off problems. Plus they have the satisfaction of seeing the difference they’re making in seniors’ lives,” she said.

The most important:

The third common characteristic of culture change is to give nursing home residents more control over their lives.

Consumer advocates and others question how far and how deep the culture change movement will go.

“We’re still in the early stages,” said Rose Marie Fagan, co-founder of a culture change group called the Pioneer Network. “It’s easy to do the window-dressing stuff, like put a bird in the lobby. It’s much harder to change routines.”

Nursing homes must throw out their schedules and let residents decide for themselves when to wake up, bathe, eat meals, socialize and go to bed, she said.

It’s all about changing how we view our elderly…how we respect them and value them. One of the biggest problems with culture change is staff attitude. From the top all the way down, we hear about this window dressing stuff and how it really doesn’t change a thing. Management still wants to be in charge- they don’t and won’t allow the lowly CNA to make decisions about resident care and safety issues. Nurses, charge and others, don’t like the idea of being located out of these neighborhoods- in these places nurses stations are no where in sight (usually in one building or section of the main building)…I have found, over and over again that it is the leaders who resist these changes more then the hands on staff and residents. Someday we all hope to see this truly change; and the funding needed must continue. Government oversight must make allowances for modern day change as well.

Matt, the nursing home administrator who maintains a great blog has posted some very informative results from a recent study regarding the use of Paid Feeding Assistants.

How are paid feeding assistants (PFAs) faring in nursing homes? Does quality of care and resident safety suffer when PFAs, with just eight hours of formal training, help out at mealtimes? Are these single-task workers replacing higher-paid certified nurse aides (CNAs)? Are they being asked to perform tasks for which they lack proper training?

Results from a recent federally commissioned study suggest that PFAs are welcome additions to the nursing home staff. In interviews with researchers, administrators and management staff from seven nursing homes in three states were so pleased with the work of the PFAs in their facilities that they planned to train more of these workers. Similarly, nearly all of the 54 CNAs interviewed for the study reported that the PFAs were helpful and that they had no concerns about the work of these assistants.

Read the rest —> of this article.

I found this at the Pioneer Network. They have a GOLD MINE fields’ worth of really good ideas, actual case studies and advice on how to implement culture change in nursing homes.

THIS particular article is about a nursing home in Massachusetts- and the really worthy CNA Career Ladder Program. Very detailed.

Sponsoring Organization

Loomis House is part of Loomis Communities, Inc., a not-for-profit organization that operates three communities in Massachusetts.

Setting

Loomis House, part of a continuing care retirement community, is a 92-bed skilled nursing facility in Holyoke, MA.

Target Group

The culture change effort affects all employees, and career ladders are in place for housekeeping and foodservice employees as well as certified nursing assistants (CNAs). However, this profile focuses on the initiative as it affects CNAs.

Start Date

Loomis House began its initiative by launching a basic CNA career ladder in April 2000.

Here are the details:

Objectives

Primary goals:

* To improve the facility’s ability to retain CNAs.

* To improve care by creating an environment that is responsive to residents’ needs.

* To make the most of each dollar spent on staffing (e.g., spend more on training and less on temporary staffing and recruiting).

Secondary goals:

* To give qualified CNAs more independence, authority, and ability to effect change.

* To increase partnership with families in the care of their loved ones.

* To provide residents with continued opportunities for personal growth.

* To provide outreach to the community, developing or strengthening community ties.

Key Components

The following components affect CNAs most directly:

Continuing education and career advancement. Loomis’s CNA career ladder, which is supported by a curriculum developed specifically to meet the facility’s needs, has three basic levels:

* CNA Level 1 includes the core course of study for state CNA certification plus specialized training in ergonomics. This track is open to Loomis employees who aspire to work as CNAs but joined the staff to work in other departments. Typically, Level 1 graduates secure immediate placement on Loomis’s caregiving team.

* CNA Level 2 provides continuing education with an emphasis on rehabilitation, dementia care, and ’soft skills’ as determined by individual and staffing needs.

* CNA Level 3 covers leadership skills, mentor training, and a 30-hour physical assessment program.

In addition, some higher-level CNAs choose to take specialized coursework to become a neighborhood coordinator or peer mentor, and mentoring is available to CNAs who aspire to become licensed practical nurses.

Finally, diverse specialized training is also available, including Introduction to Computers, American Sign Language, Time and Stress Management, and Communication. Classes are held onsite and offsite at training partner locations (primarily community colleges).

Resident-centered ‘neighborhoods’ led by direct-care workers. As a first step in its shift from a medical model of care to a resident-centered culture, Loomis divided each of its two stories into two neighborhoods, each serving 20 to 25 residents. At the same time, it created a new position for experienced CNAs: neighborhood coordinator.

Currently, four CNAs hold this position, one assigned to each neighborhood on day shift. Each acts as a frontline manager for her neighborhood, handling tasks such as scheduling direct-care workers and fielding questions from family members. Neighborhood coordinators also oversee the weekly review of each resident’s care plan and help ensure that needed documentation has been secured. Neighborhood coordinators report to the Director of Nurses. As of spring 2004, Loomis management was working to add neighborhood coordinators on all shifts.

In effect, this new position is another step on the career ladder. As of early 2004, one nursing assistant in the position had earned her GED with Loomis’ help and was about to begin studying to become an LPN. Staff who want to pursue a GED are offered peer tutoring and preparatory classes on site. They also receive a copy of PLATO, software that supports GED-related training modules and simulates testing.

Flexible scheduling by CNAs. Neighborhood coordinators are responsible for scheduling their fellow direct-care workers. Flexible scheduling done by a peer fosters teamwork and camaraderie as well as a feeling of control.

Flexible scheduling also fosters culture change at Loomis in other important ways.

First, workers see flexible scheduling as a benefit and a sign that management is tuned into their personal needs.

Flexible scheduling also makes it easier for employees to pursue the classes they need to climb the career ladder. Creativity and flexibility in scheduling help assure coverage while workers are attending class.

Open-door policy. All supervisors have an open-door policy designed to invite collaboration and foster communication between direct caregivers, licensed nursing staff, and managers.

Results, Outcomes, Evaluation

Interest in the career ladder program is high. As of early 2004, there were 11 graduates of Level One, more than 50 of Level 2, and 28 of Level 3.

As the culture has shifted and CNAs have received professional training, the facility has begun to achieve its principal goals.

In part, Loomis measures its success by its reduction in expenses related to direct caregiver staffing, including overtime, recruitment, and temporary staffing (agency fees). In 2000, before Loomis began its initiatives, annual expenditures in these categories were $11,600 for recruitment, $96,253 for temporary staffing, and $24,726 for overtime. Overtime costs stayed fairly level in 2001 and 2002 but dropped to $9,470 in 2003, a 62 percent decrease. Recruitment costs rose in 2001 and 2002, reflecting interim costs related to training, before dropping to $9,800 in 2003, the level at which Loomis management expects it to remain. Costs related to temporary staffing dropped steadily and dramatically, totaling just $2,904 in 2003. These decreases amount to savings of $110,000 in 2003 compared with 2000.

In addition, Loomis’s annual turnover rate has dropped 53 percent, from 85 percent in 2000 to 45 percent in 2003.

Finally, Loomis has taken on a leadership role in promoting culture change in other Massachusetts nursing facilities. Ultimately, Loomis hopes to develop a curriculum/career ladder approach that can be replicated at low cost in other facilities in the state.

Lessons Learned

Basic ’soft skills’ training is essential to a career ladder program. At Loomis, leadership-oriented classes are some of the most popular and effective courses. Without such training, direct-care workers are not able to develop essential skills such as conflict resolution and understanding human behavior.

‘Adult learner’ techniques, such as participatory learning and opportunities for discussion and problem solving, have proven to be popular and effective at Loomis.

And finally, the costs:

The initial CNA career ladder was funded by a $5,000 grant from the Holyoke Chamber of Commerce in 2000, which was used to purchase career ladder curriculum and training tapes. Later that year, Loomis received the first of four grants from the Massachusetts Extended Care Career Ladder Initiative (ECCLI), a state-funded program that funds workplace education for direct-care workers in long-term care. The first ECCLI grant was for $25,000.

In 2002, Loomis took on a new role as ECCLI grantee, accepting a charge to lead a consortium including two other nursing facilities in the state. As consortium leader, it was granted $380,860 to be shared by the three facilities and their training partners (i.e., local community colleges and other trainers). Subsequently, the consortium received a supplemental grant of $173,508. Last year, the consortium led by Loomis was awarded an additional $144,590 to be divided by the three facilities.

As outlined above, costs for overtime, recruitment and temporary staffing dropped significantly from their 2000 levels, producing savings of $110,000. Management expects that lower levels of spending in these categories will continue. These savings cover the modest pay raises achieved by workers as they step up the career ladder (30 cents/hour for each rung achieved) and provide funding for additional training.

All costs associated with coursework and curriculum development have been covered by the grant.