Archive for January, 2009

Over at Long Term Living, resident blogger Kathleen Mears writes a very timely and important post about the modern training of CNA’s. This article is one that I believe every aide should read. It’s that good.

Just one section, which is VERY pertinent:

I have found that some people are easier to train as aides. Those who are very perceptive do not need to be drilled. But I wonder if nurses’ aide trainers now have realized that some of their trainees do not possess the social skills that most of us learned growing up. With single-parent families and families with two working parents, it is probably more difficult to teach social skills. Also acceptable social behavior has to be taught at home and reinforced in the schools.

Some younger nurses’ aides have not learned these social skills. Today we live in a casual society where we are not required to dress appropriately for very many of life’s events. Schools do not usually have dress codes. Years ago, aides were required to wear specific uniforms usually pressed to perfection. Like nurses, their hair had to be off their collar and their nails had to be kept short. Today’s rules now are not nearly as stringent, or aides reject them soon after training. The common sense rule of a clean and relatively wrinkle free uniform is important. Many aides have nails that are too long. Artificial nails are fine if they are kept at an active or sport length.

A recent article stated that most young people would benefit from reading a Miss Manners’ book. That same idea would be helpful for nurses’ aide trainees. Knowing etiquette and using proper manners make life easier. It is never too late to learn what is proper in order to feel comfortable in most situations.

PLEASE read the whole thing; whether you’re an aide or one who trains them, a DON, a nurse…I know a lot of this will ring some bells! Leave Kathy a comment, too- share your thoughts on this with her.

An article about how high tech is helping older people stay at home vs. living in a nursing home.

The content is striking and amazes me. But what gets me even more is a comment left on this story:

By: Personholecover

This country has just destroyed the future of our children and grandchildren. I, and the rest of my pampered generation who rode on the coat-tails of those great Americans who built this country, have never wanted for anything. In fact, I have lived a life of total narcissism, caring little for how my actions were dooming future generations. Now I have the audacity to demand my children to continue to support me in old age to the level I’ve become accustomed?

My generation, the baby-boomers (a.k.a., the churlish-consumers), should be ashamed. After bankrupting the country, both financially and morally, after promoting the slaughter of millions of the unborn for our own convenience, we’re not finished. Let’s spend trillions more keeping our useless, bovine carcasses alive and comfortable in our “Golden Years” … years of sitting in front of the effluent box formulating our next bowel movement while complaining about all the pills we have to take and how our rotten children don’t spend every second of their “free time” basking in the glow of our esteemed presence.

A word to Progeny … “it’s a choice!” Remember that mind-numbing mantra of the churlish-consumers. It worked for them with abortions, why not for euthanasia? It’s your life, what little we’ve left of it. Why should you have to be further bankrupted by individuals who are totally responsible for the economic conditions in which you find yourselves? What do you owe parents who were so concerned about their own happiness, careers, sexuality, bank accounts, television shows that they let strangers raise you? Do you ever think to yourself, “Why did they bring me into this world in the first place?” Well now you know. Get to work, drones!

I’d like to say this person has PROBLEMS. I think he or she does.

What do you think of this?

The Alliance for Quality Nursing Home Care is lobbying the Obama administration to consider adding direct care jobs to the stimulus package, among other things.

Washington, DC — Commenting on the legislative year ahead as well as the Medicare Payment Advisory Commission’s (MedPAC) initial comments today that skilled nursing facilities (SNFs) should not receive a market basket cost of living update for FY 2010, the nation’s leading long term care advocacy organizations today said the sector supports and is well-positioned to help President-elect Obama and the incoming 111th Congress advance broad-based health care reforms, in addition to serving as a cornerstone in the effort to bolster the new Administration’s economic stimulus initiatives.

Regarding the MedPAC recommendation, the leaders of the American Health Care Association (AHCA) and Alliance for Quality Nursing Home Care warned strongly that failure to adequately fund Medicare – coupled with looming threats to Medicaid funding due to the national recession and worsening state budget crisis – threatens seniors’ continued access to quality care, jeopardizes the very jobs that are a critical factor in ensuring quality of care, and undermines the overall capacity of the long term care system itself as demographic trends portend greater utilization.

“While we recognize that all Americans will be called upon to sacrifice and support our national priorities, we must be careful not to jeopardize a sector that cares for many low and moderate-income seniors, and is a source of job creation given the current 100,000 employee vacancies in the long term care sector — especially in direct care giving positions,” stated Bruce Yarwood, President and CEO of AHCA.

The problem with this, as I see it, is making this work attracktive. It’s not. It’s hard, dirty work. It takes a special person to do it…and one who is willing to sacrifice the perks of just about any other profession. Nursing itself is good work. Nurse Aiding, however, is not. Nevermind the pay and benefits and respect issues.

It will be interesting to see how Obama reacts to this. He has a chance to really improve the economy AND help solve the nursing shortage AND start the process to overhaul healthcare. Construction jobs are important and so is the updating of our nations’ infrastructure. However, the real and present danger of not having enough direct care givers is more humane, more important, in my opinion.

For those of us who have worked in nursing homes, we know many residents who are given drugs to help them with agitation, depression and other “behaviors”. But do we know how dangerous these drugs can be?

An article explores how the use of meds can cut short the life of a person with Alzheimers.

LONDON (AP) – Anti-psychotic drugs commonly used to treat Alzheimer’s disease may double a patient’s chance of dying within a few years, suggests a new study that adds to concerns already known about such medications.

“For the vast majority of Alzheimer’s patients, taking these drugs is probably not a worthwhile risk,” said Clive Ballard, the paper’s lead author, of the Wolfson Centre for Age-Related Diseases at King’s College London.

“Would I want to take a drug that slightly reduced my aggression but doubled my risk of dying? I’m not sure I would,” Ballard said.

I’m sure if they asked a CNA who has to deal with an agitated and acting out person with Alzheimers, the answer would be YES. Aggression takes many forms…some harmless and others not so. CNA’s get the brunt of these aggressions: We get hit, kicked, bitten, pulled, punched and so on. The violence a person with Alzheimers can produce and aim towards us is quite amazing.

Alzheimer’s disease is the most common cause of dementia and causes symptoms including aggression, delusions and hallucinations. Previous studies have shown anti-psychotic drugs, which can help control the aggression and hallucinations for a few months raise the risk of death in older patients with dementia. There are other side effects, including respiratory problems and stroke.

The violence isn’t always aimed at the aides. Other residents and families are often targets. Most of us do realize the person with AD cannot control their behaviors. We know they would not do these things in their “right” mind. The reality is clear though: An aggressive resident is a threat to all, in the nursing home setting.

Ballard and colleagues followed 165 patients aged 67 to 100 years with moderate to severe Alzheimer’s disease from 2001 to 2004 in Britain. Half continued taking their anti-psychotic drugs, which included Risperdal, Thorazine and Stelazine. The other half got placebos.

Of the 83 receiving drugs, 39 were dead after a year. Of the 82 taking fake pills, 27 were dead after a year. Most deaths in both groups were due to pneumonia.

After two years, 46 percent of Alzheimer’s patients taking the anti-psychotics were alive, versus 71 percent of those not on the drugs. After three years, only 30 percent of patients on the drugs were alive, versus 59 percent of those not taking drugs.

I wonder if they kept track of behaviors of the people who were given the placebos? THAT would be interesting data to see. It’s pretty clear that these drugs somehow hasten the death of Alzheimer victims. In the end, they all die- a sad fact. Alzheimer’s is an awful and brutal disease and one I do not wish upon anyone.

Experts aren’t sure how the anti-psychotics increase patients’ risk of dying. But they think the drugs could be damaging to the brain and their sedative effects make patients less able to exercise and more susceptible to deadly infections.

I agree. I’ve seen many a resident start taking these meds – and the meds DO work. They “calm” the resident down to a level of “safety” that works for the environment. The person is able to stay still longer, so we see less wandering and unsafe movements.

However, I’ve also seen how this turns into a mobility problem: Due to “time restraints” aides tend to push the resident around in a wheelchair vs assist them with ambulating…Legs get stiff, contractures settle in, ambulation is no longer possible. So the resident becomes wheelchair and bed bound, and totally dependent upon us for all care.

We see other outcomes every day: They no longer have control of their bladders and bowels. Skin issues become more pronounced. Sitting in one position for hours on end results in red areas, open areas and everyone knows what this means.

Residents gradually require more and more assistance with eating and drinking. Meds change the appetite, the desire to eat and drink. Meds also alter the ability to smell and taste food. Since there aren’t enough of US to do it all in a timely manner, the food goes in cold and gross; drinks are forced down (and let’s not forget how the disease process screws up the ability to swallow correctly); oral care isn’t the top priority and infection is likely present. The resident loses weight, becomes dehydrated and the vicious cycle continues.

Exactly how much of this is caused by the meds isn’t known, yet. But I think we can all say the decline starts when the meds start. Are they worth it?

The decline will happen no matter what. That’s a given. Those months, even years- of Alzheimer’s induced behaviors are a turning point. Most families will seek a nursing home admission when these things happen. They can’t manage it. Nursing homes “manage” it with drugs.

Is there a better way? Would a really good and targeted Activities Program help? I think so. There are a great many people who believe that all “behavior” is a form of communication, even coming from those whose brains are literally deteriorating. I have seen how well planned yet spontaneous activity programs work WONDERS with people with all forms of dementia. It takes everyone to make these programs work though- aides, housekeepers, the DON, the administrator…everyone. I’d like to see some research done on this. The costs savings alone should make sense: Meds are expensive! Activities are cheap in comparison.

Did you know your scrubs probably harbor more germs than you’re hands???

You see them everywhere — nurses, doctors and medical technicians in scrubs or lab coats. They shop in them, take buses and trains in them, go to restaurants in them, and wear them home. What you can’t see on these garments are the bacteria that could kill you.

Dirty scrubs spread bacteria to patients in the hospital and allow hospital superbugs to escape into public places such as restaurants. Some hospitals now prohibit wearing scrubs outside the building, partly in response to the rapid increase in an infection called “C. diff.” A national hospital survey released last November warns that Clostridium difficile (C. diff) infections are sickening nearly half a million people a year in the U.S., more than six times previous estimates.

Ewww. I wear my scrubs to work, ONLY. I go directly home after my shifts, and remove them, shower, and re-dress.

The problem is that some medical personnel wear the same unlaundered uniforms to work day after day. They start their shift already carrying germs such as C.diff, drug-resistant enterococcus or staphylococcus.

Really? I don’t know anyone who wears dirty uniforms to work…at least I don’t THINK I know anyone.

Do unclean uniforms endanger patients? Absolutely. Health-care workers habitually touch their own uniforms. Studies confirm that the more bacteria found on surfaces touched often by doctors and nurses, the higher the risk that these bacteria will be carried to the patient and cause infection.

That’s a no brainer.

So what to do??

Until about 20 years ago, nearly all hospitals laundered scrubs for their staff. A few hospitals are returning to that policy. St. Mary’s Health Center in St. Louis, Mo., reduced infections after cesarean births by more than 50% by giving all caregivers hospital-laundered scrubs, as well as requiring them to wear two layers of gloves. Monroe Hospital in Bloomington, Ind., which has a near-zero rate of hospital-acquired infections, provides laundered scrubs for all staff and prohibits them from wearing scrubs outside the building. Stamford Hospital in Connecticut recently banned wearing scrubs outside the hospital.

When I first began working in healthcare, I remember the hospital DID indeed wash the SCRUBS- but not the required white UNIFORMS- which we all purchased and maintained on our own. This was 18 years ago.

Across the pond, a British study found that one-third of medical personnel did not launder their uniforms before coming to work. One British surgeon who specializes in hip and knee replacements reduced postoperative infections by two-thirds at her hospital by protecting patients from contaminated uniforms. Before approaching any patient’s bed, nurses put on disposable, clear plastic aprons that were pulled off rolls like dry cleaning bags. Each one costs a nickel.

A nickel is certainly a small price to pay to prevent an infection.

And that old standby- washing our hands- would most likely curb the spread of infection 95% of the time- if we complied 100% of the time.

Does your employer launder your scrubs? Or offer gowns to wear at each patient-care session?

Has Obama said “NO” to improving the health care workforce?

The Obama administration’s economic recovery team is under increasing pressure to create and improve jobs for those most in need: low-income workers, particularly women. To that end, PHI and others have proposed targeted increases in Medicaid to create and strengthen the eldercare/disability services workforce–the millions of jobs held by home health aides, certified nurse aides, and personal care workers. But so far, the response from the Obama team has been a flat “no.”

The proposal isn’t included in Obama’s first stimulus plan. There, he plans to create jobs rebuilding infrastructure and public school buildings. I think the “NO” comes from adding health care workers to this plan…right now or in the not-to-distant future.

I don’t believe Obama means “NO” for good.

Obama has to pick and chose the issues to work on, and prioritize them. There are millions and millions of people out of work right now- and the first priority should be getting them BACK to work ASAP. For the incoming President, priorities will be based upon the economic realities this country faces.

In the future, I bet we will see health care workers day of reckoning arrive: I’m thinking the needed changes will come when they overhaul health care in general.

For us, we are working. The conditions we work under are not good. There’s a lot of room for improvement. And yes- our skills will be needed when the baby boomers grow old and need care. For now though, we have jobs.

Obama will be focusing on those who do not, or who are working in industries that are less likely to survive the future. All the lobbying and prodding in the world will not change this reality. Groups like PHI and others should give the incoming President some time, to get this country moving in the right direction again. Going negative now will not win any brownie points in the future…