When The Standards Are Low to Begin With
Posted by Patti on February 18th, 2008 / 
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When we read about and hear people discussing nursing homes, remember this very important point:
I was thinking about this last night and realized something quite obvious. JCAHO, the organization that accredits virtually every hospital in this county, has established standards for hospitals to go by. These standards are considered optimally achievable outcomes — what a facility should aspire to be. CMS standards, the ones that nursing homes are required to comply with, are minimum standards — the absolute bare minimum you can do to get by with. Literally every single nursing home I have worked with has regarded the CMS minimum standards as optimal achievable outcomes.
So true…all these stories about CMS releasing it’s list of worst nursing homes should tell us how bad things really are. CNA’s know this- and have known it for years. We work in the bowels of this industry and every one of us can attest to the truth of this. When the standards are low to begin with the care isn’t going to be much better.
February 18th, 2008 at 10:00 am
yes, i do agree that every agengy should follow the rules or go out of business, but what i have experienced lately, that it is all about the p’s & q;s, that the person (pt) and the pt care gets lost somewhere. there should be someone besides government agencies watchdogging, like a person who cares and knows. i find so many situations morally and legally irresponsible, that all i can see is room for improvement, in all areas, starting with us. kim
February 18th, 2008 at 5:47 pm
The whole survey process is a joke. Administrators know when it’s coming; they beef up staffing, paint the walls and spray the halls with deoderizer. They harp and hoot and carry on like the stupid monkeys they can be- deamnding everyone be prefect and telling us what to do, how to act and what to say (and not say!)
Ask an aide and we’ll tell them: The truth is nursng homes suck. They are, as Kim has written here, borderline concentration camps where the resident is the very last person who is truly honored and cared about. Oh sure it’s bragged about- we passed the survery with 0 deficiencies! But that means nothing. 0 means poor care still happens; weight loss is still a factor; falls and bed sores still occur…resident to resident abuse can still be a problem. And of course staff to resident abuse can always be a factor with the best inspectiion results.
February 18th, 2008 at 10:32 pm
Yep…Cheryl you’re quite on target. The survey process is supposed to work to the resident’s benefit. But instead it’s not working for anyone. The industry wants it to be a collaborative effort where fines and other enforcement don’t happen; resident advocates want more punitive actions; and so on.
We just want to give good care. If they all would shut up and ask US, and listen to our answers, problems would be solved!
As for the standards: The LTC industry is the second most regulated in the US. We have more rules and laws and what not…and yet the care still sucks on a good day let’s not even mention the bad days. To me, this is proof that MORE regulation isn’t needed. Some simple rules need to be applied though: Making too much profit should end government payment. Period. Because poor care IS ALWAYS happening at any facility where profit is made with an exception to private pay places…
ALL the billions of dollars being fed into the LTC system should be redirected to keeping/sending the residents back HOME or to an alternative home. Do away with nursing homes altogether. BILLIONS of dollars being spent on less than 8% of our elderly population…imagine how many BILLIONS if not TRILLIONS will be needed in the next 30 yrs…no thanks. Alternatives must come into the show soon.
February 19th, 2008 at 3:10 pm
CMS minimum standards represent the least a facility can do in order to provide an acceptable level of care. The standards themselves are quite stringent because nursing homes have a long history of inadequate care. This problem is compounded by requiring administrators to be licensed. In my state, the training is required under state law to be conducted by the state nursing home association (which is a private lobbying organization/this is probably illegal but a topic for another discussion). The required textbook is James E Allen’s “Nursing Home Administration” which literally says the best way to manage CNAs is to keep them in their place. Administrators have never been taught anything else and no incentive to change their ways. Hospital administrators are not licensed and are hired on the basis of graduate education, membership/fellowship in the American College of Healthcare Executives, and their previous management experience. Nursing home administrators are hired on the basis of whether or not they have a license, which requires a 6 month internship after either a bachelors degree or an equivalent amount of time as a department head. If a hospital has a bad JCAHO survey, the administrator gets fired. If a nursing home has a bad survey, the administrator stays because the industry intentionally restricts the number of licensed administrators.
February 27th, 2008 at 9:14 am
Thanks Matt for your thoughtful comment.
“Keep CNA’s in their place” sounds about right. No wonder these facilities have such high turnover and low morale…and probably extremely poor care.
They reap what they sow…