I’m forever finding little known to CNA’s –web sites that offer excellent advice and tips. I found this site through some searches and then an entire series of articles that we can all relate to.

Advance For Long Term Care Management

Career Articles

Employee Ethics: Do our staff know right from wrong?

The following incidents make the case for ethics training classes in our nation’s nursing facilities. (Names have been changed, but the situations did occur). Brenda, a registered nurse, clocked out after her 8-hour shift and walked down the nursing home hallway towards the parking lot. She was stopped on the way by a frightened CNA who said a resident was choking and needed help. Brenda looked at her watch, tapped it, and told the CNA she was “off the clock” and left the building. Fortunately, the CNA was able to quickly get support from another nurse and the resident was assisted.

Lisa, a certified nursing assistant, observed a resident under her care spilling cranberry juice on the floor of her room. Lisa left the spill without concern for the resident or staff falling, or the staining of the floor. A housekeeper, hours later, found the spill and cleaned it up. Hundreds of dollars were spent to replace the tile.

Rhonda, a certified nursing assistant, alleged mistreatment of three residents by a fellow CNA. She reported that the aide “body slammed” three residents into their wheelchairs. Upon investigation by the administrator, there was absolutely no proof of the wrongdoing. A personality difference between the two aides was the only possible explanation. Following State law, this incident and the name of the accused was reported to the CNA and Nurse Registry.

A common thread can be found linking these incidents. Brenda, Lisa and Rhonda failed to consider how their actions affected others’ health and wellbeing. In most health care facilities, there are regularly scheduled inservices. Fire safety, activities, abuse reporting and other topics are addressed. The questions remain are we effectively educating our workforce, or do we need to first lay a foundation for learning? I believe the latter is the case.

Do you ever attend an in service that talks about the ethics and rights and wrongs?

There are MANY more excellent articles located at this site. Check it all out.

Lately as I surf the net seeking out articles and links pertinent to the work of CNA’s, I find SO many things that are vital to Long Term Care in general. Many articles, web sites, stories, online magazines are geared for industry leaders and others and not for CNA’s. I often post stuff here that is more relevant to DON’s and Administrators than to anyone else.

The target audience for this site has always been CNA’s and those who have a direct concern for the work we do. I want to keep it this way.

In that light I have started a new blog for all things LONG TERM CARE. Kim and I will find interesting things and post them there. The targeted audience will be Long Term Care professionals: Administrators, DON’s, nurses, dietitians, activity staff…and of course CNA’s!!

So please check out our latest offering:

LONG TERM CARE DIRECTIONS

For now the site is at Blogger; if it proves to be valuable and as well visited as THIS site we will get private hosting for it.

This post is going to stay on top through the weekend. Look below for newer content. Thanks.

I am appalled. Just appalled. After being away for two weeks on vacation, I come back here only to read how one nursing home administrator decides to bash those CNA’s who chose to do what is best for their own personal situations. He invokes the age old guilt trip bulloney tactic upon us. And he implores us to stay put for the sake of resident dignity. No matter HOW bad the damn job is, and the lack of management that creates almost ALL the reasons AIDES QUIT in the first place. We are allowed to hold ourselves to a certain standard. WE HAVE SOME DIGNITY TOO.

He asks, and Patti quotes:
Why then, caregivers, do you continue to move from job to job, facility to facility?

Well let’s count the reasons. While YOU sit at your desk, making executive decisions and doing all those very difficult and exhausting tasks with your Cross pen, we the aides are:

Barely getting enough information from our nurses during shift report and therefore placing our residents at risk.
ADMINISTRATOR: When is the last time you came in at 6 or 7am to listen to a shift report? Better yet, how about 10 or 11pm?

Getting assignments that are often unfair and depending upon whose ass we each kiss, downright brutal.
ADMINISTRATOR: When is the last time you worked as an aide? Surely you can remember getting the assignments from hell, day in and day out?

Going out to the units to do our work, which includes getting kicked, hit, slapped, yelled at, having items thrown at us. We report these incidents to your management team (AKA the DON) and we’re told there is nothing to be done about it.
ADMINISTRATOR: When is the last time YOU got bruised three or four times a shift, at work? Or had wads of your hair pulled OUT?

Struggling to get it all done and done right..those of us who care anyway. There are some aides who don’t care, who powder and perfume up their residents so they smell good yet who haven’t been washed with soap and water in days…who sit in feces and urine for hours and hours; somehow THESE aides manage to get the good raises and reviews. They get their “work” done by skimping. DO YOU know which aides actually do it right and those who don’t ADMINISTRATOR? Bet not.

Aides bathe, shower, lift, turn, reposition, pull up and transfer many, 8, 9, 10 or more totally dependent heavy human beings every day, several times a day. We clean up endless accidents and wipe up vomit, blood and bile. We change messy briefs all shift, and then some. We fight to do much of this too- because so many of our residents are demented or otherwise combative towards our efforts. Depending upon where some of us work, we also make the beds, do the dishes, sweep the floors and wash and dry the linen. We put away supplies. We’re expected to do repetitive documentation only to see the written record of our care ignored. We write out incident reports and rarely see action taken to make the situations YOU demand we report get better.

Do you know how it feels to keep a special resident clean, dry and comfy all shift? Only to come in tomorrow and find out the next two shifts neglected their duty to this resident who now has an open area or two? Are these minor little issues dealt with or are they just swept under some rug in someone’s nicely decorated office?

Some of us never get a break. We bust our asses all shift, running around answering call bells, dealing with irate families, dealing with panicking nurses AND taking the phones with us in case a call comes in. Some of us feel like we run the show because there is no real management. ADMINISTRATOR: When was the last time you worked a day in our shoes?

When you finally go home after a long day at work, are your back and leg muscles sore? How do your arms feel? Or being so thirsty you feel sick, cause you didn’t have time to take in an adequate amount of fluids to drink? (No I don’t think you know because you posted about your higher concern for keeping the refrigerators clean). Do you know how it feels to be dehydrated? AIDES DO.

Speaking of that, how do you think aides feel when they KNOW they haven’t given their residents enough to drink because there wasn’t enough time? When we’re expected to feed four and five residents who cannot do this for themselves? How do you think we feel when we know you and the other bosses are off in the cafeteria or break rooms or sitting at your desks, stuffing your faces with food, guzzling down fluids and we don’t have time to offer this very basic need to our residents? Do you assist during mealtimes? How many residents have lost weight at your facility? WHO IS DEDICATED here?

Did you know that we have days where all the above listed “items” occur within an 8 hour shift? In fact, do you realize most of our days are like that? DO you care? If so, what are you going to do about it?

Would you put up with this environment for 9.00/hr, or maybe even 10.00?
I didn’t think so. Enough said on pay. We are SAINTS for doing this work for these wages and don’t you ever forget THAT.

Did you thank the aides working for you today? And the nurses? Or are you one of those managers who doesn’t think any employee deserves to be thanked for coming to work?

Now I have some questions for the ADMINISTRATOR:

WHY do YOU work?

What factors are absolutely necessary in order for you to accept a job? Do salary, benefit packages, hours, travel distances from home, growth potential have an impact? When you have choices, as we each do, do you make a list of pros and cons for each job “opportunity”?

Have you ever gone home after a hard mean day at work, feeling GUILTY that you couldn’t provide even substandard care or even a little less than that? Do you wake up in the mornings dreading going to work? Simply because you know NO matter how much effort you put into your work, it makes so little difference to those you’re charged with doing just that?
Or, do you ever experience such days? DO you ALWAYS feel satisfied when you go home? AIDES DON’T.

We all chose nursing because we want to help people. When the workplace takes away the tools, resources and TIME needed to do this work, we feel dissatisfaction, ADMINISTRATOR. So yes, we move on. We hope the next nursing home is better managed and when it is so, we are content to stay. We want to be associated with a win-win situation in our work: Happy, relatively healthy residents AND HAPPY and content AND YES– decently compensated aides (and nurses). You get what you pay for in this work. When a facility experiences high turnover, look at the working conditions. Don’t blame the aides for leaving. Blame yourself.

A couple articles about Nursing Assistant Week:

VistaCare’s Terre Haute office includes more than 17 CNAs. “We are so fortunate to have such a dedicated team of CNAs caring for our patients,” said Kerry Wilson. “They have the privilege and responsibility of working directly with our patients and their families on a daily basis. The services they provide truly make a difference in the quality of life of the patient and his/her family. We are pleased to give them special recognition and a pat on the back during this annual observance.”

CNAs work side by side with physicians, nurses, social workers, chaplains and others. They not only provide personal care to the patient – baths, back rubs, oral hygiene, shampoos and changing bed linen – they also prepare meals, feed the patient, and watch over the patients’ well-being by making sure they are turned and positioned appropriately and that they use any adaptive equipment such as foot stools and rails properly.

VistaCare CNAs also perform patient care activities such as taking and recording temperatures and pulse and respiration and assisting the patient with ambulation and range-of-motion exercises. They also support family members by performing light housekeeping duties and doing the patient’s laundry when it is a part of the plan of care. In addition, all CNAs are certified in cardiopulmonary resuscitation.

AND:

For one local family, going to work is a labor of love

At first glance, the scene in the hallway of the Good Samaritan Health Center seems quite commonplace: two young women in medical scrubs are bringing an elderly resident in a wheelchair into the center’s dining room.

But their situation is far from ordinary: the women are sisters. And the resident is their great-grandfather.

This week is National Certified Nursing Assistant Week, which honors those who work in this caring, demanding profession. For CNA Jeena Bradburn and her sister JoJean, coming to work each day is now even more special. Their great-grandfather, John Bradburn, whom they lovingly call “Grandpa John,” lives at the care center in International Falls.

“It’s great” Jeena says. “I get to see him more now than I did before he moved here.”

“I was excited” says JoJean, of when she learned her great-grandpa would be moving to the care center.

JoJean, the eldest of the two sisters, works as a dietary aide in the kitchen. Both women have been with the Good Samaritan Health Center for several years. It seems a natural fit. Their grandmother and mother were both in nursing care.
“Grandma was a nursing assistant and mom was a volunteer candy striper” says Jeena.

Sitting with the three of them in the center’s dining room, it’s easy to see why Shawnda Shofer, the center’s marketing coordinator, called their situation a touching story.

The Arkansas state Supreme Court has ruled that class action lawsuits can go forward against chain nursing homes.

LITTLE ROCK - A lawsuit against a Fort Smith-based nursing home company can proceed as a class-action suit, the state Supreme Court ruled Thursday.

The court affirmed a decision by Independence County Circuit Judge John Harkey to grant class-action certification to a suit alleging Batesville Nursing and Rehabilitation Center failed to live up to contractual and statutory obligations to take care of the basic daily needs of hundreds of residents.

The suit, filed in 2005 by Annette Thomas, names the nursing home and its parent company, which was known in 2005 as Beverly Enterprises, as defendants. Beverly changed its name to Golden Horizons last year following its purchase by Golden Gate National Senior Care.

The suit alleges that between Sept. 13, 2000, and June 30, 2004, the nursing home failed to care properly for 489 residents by, among other things, failing to provide adequate staffing and failing to provide a clean, safe living environment.

On May 1, 2006, Harkey granted class-action certification to the suit with respect to claims of statutory and contractual violations only, not claims of malpractice or personal injury. The defendants appealed that ruling.

In oral arguments before the Supreme Court last week, Little Rock attorney Sam Jones argued against class-action certification, saying it would be impossible to examine the issues in the case and, if necessary, determine appropriate damages without considering each plaintiff separately.

“You’re not going to have uniformity,” Jones told the justices. “You’re not going to have homogeneity. You’re going to have a mixed bag.”

Attorney Philip Bohrer of Baton Rouge, La., argued that the case did not include personal injury claims, but rather claims involving issues such as understaffing which would have affected all residents of the facility. Granting class-action status was preferable to “having 400 individual trials on the same issue and the same evidence,” he said.

Bohrer also said many of the plaintiffs are elderly and unaware of their rights and would not be able to file individual claims against the company.

In some situations, examining 400 individual cases would never end- a verdict or settle would not happen. Going after the chain for many nursing homes could be an alternative worth pursuing. It will be years before we see how this works out. Both sides will defend staffing, safe and clean homes and what not…unless there are clear standards, neither side should expect to “win” this.
It’s so sad. When we think about the fact this is all based upon human lives and nursing care, there should be no doubts or questions that lead to legal action.

This doesn’t surprise me at all.

ROCHESTER, N.Y. /PRNewswire-USNewswire/ — A new study introduced today supports the nursing home culture change movement, spearheaded nationally by The Pioneer Network. Dr. Bonnie Kantor, Executive Director, delivered findings at the Second Annual Medicaid Congress. The study suggests that culture change potentially affects quality without a detrimental effect on cost.

So why aren’t more nursing homes embracing this? I suspect its all about power and control. And the fear of letting these things go.

The study used participation in the network as the treatment variable to assess any differences in quality of care and financial outcomes between network participants and non-participant nursing homes. Examples of key findings include:

— Early adopter homes participating in the network experienced fewer
survey citations than the Centers for Medicare and Medicaid Service
dataset of the national sample of homes in 2003.

— Early adopter homes participating in the network achieved better
differences in quality of care outcomes (as measured by survey
citations) than comparable non-participant homes from the 1996 to 2003
timeframe.

— Early adopter homes participating in the network achieved better
differences in per bed net income and operating margins than comparable
non-participant homes from the 1996 to 2003 timeframe.

If it makes sense in every aspect that it should be done. Again, it’s the power thing at work here. Some day maybe we can hope to see every nursing home become a HOME.

A book for people who are considering placing their loved one into a nursing home, the finances involved and other topics.

The Senior Solution

Discover important concepts that allow seniors to “age in place”- giving them the ability to afford long-term care at home with or without long-term care insurance!

Discover important information that seniors and their family members should be armed with when making decisions about financial and health care issues.

In today’s world families need help finding the answers to questions about long-term care and cash flow planning. “The Senior Solution” is a fast, effective guide to the long-term care universe. Only when we are educated about all of the tools available to us can we make informed decisions. “The Senior Solution” can open your eyes to new programs and opportunities for seniors, as well as educate the family about long-term care. This guide book is designed to point you in the right direction regardless of your current situation.

And:

* Learn how to keep seniors home for life.

* Understand the REAL cost of long-term care.

* Learn about programs and services for seniors that very few people truly understand!

* Know the right questions to ask a health care provider.

* Understand the importance of cash flow planning.

* Read about seniors who are living safely at home for life, and how they achieved financial security.

The book will be available at Amazon here.

What are the implications of this?

Julia McCauley , a resident at Life Care Center in Acton since 1996, tended to roam the nursing home in her wheelchair. Worried about her safety, doctors fitted her with a tan plastic bracelet that set off an alarm and locked the doors if she got too close to the exits.

But one morning in April 2004 the woman described as a “loved and welcomed resident” at the home by her family and care providers was found dead at the bottom of the center’s front stairs. The 74-year-old had a 3-inch gash in her forehead, her wheelchair overturned. McCauley’s bracelet was nowhere to be found, and several nurses and aides told state investigators they did not know she was supposed to wear it at all times.

Yesterday, a Middlesex grand jury indicted the Tennessee-based Life Care Centers of America Inc. on charges of manslaughter and abuse and neglect of a long-term facility resident. It is the first time in Massachusetts that a national corporation has faced criminal manslaughter charges, said Attorney General Martha Coakley .

Good. I hate lawsuits. But when we have for profit facilities not ensuring that good care is given, we have a problem. Resident safety should come before profits and I have heard many horror stories about Life Care Centers all over the country. Further in this article there are some examples.

Matt, The Nursing Home Administrator has a question for us:

Why then, caregivers, do you continue to move from job to job, facility to facility? If you truly believe in resident privacy, comfort, and dignity, why don’t you want that continuity for your residents? Are you a caregiver for yourself or for others? When faced with a difficult situation on the job, do you find yourself thinking about how it will affect you or your residents? How many issues that people quit over could be resolved if ours goals were better aligned?

Go over and tell him why…or why not. Let’s start a conversation about this topic. There’s no need to be rude about this either; honesty and being forthright, yes…but rude and defensive- no…

Wow.

“Absence of bedsores, absence of depression, absence of malnutrition – these are hardly evidence of a good quality of life or goals to inspire generations of caregivers.”

Read the article where I found this quote.