Archive for April, 2009

Will Culture Change be mandated? It appears so. Over at PHI, Aaron has a post about CMS’s new Interpretive Guidelines coming out, which address more homelike environments in nursing homes. We’ve posted often here about the benefits of Culture Change, and it’s about time CMS joined the band wagon on this.

The changes, which go into effect on June 17, 2009, are intended to support efforts underway to transform nursing homes into “homey” environments through both environmental changes and resident-centered caregiving. Whereas in the past, these changes were sometimes stymied by fear that regulators would cite organizations for deficiencies, CMS is now making it clear that the OBRA regulations should be interpreted to support personal choice in the full range of daily activities, including waking, bathing, dining, and sleeping. The new guidance also calls for visitors to have 24-hour access to residents, regardless of familial relationship.

The new interpretive guidelines call on nursing homes to begin or to continue de-institutionalizing their physical environments. Suggestions include: reducing noise such as overhead paging and alarm bells, eliminating nursing stations, taking down institutional signage, and refraining from serving meals on institutional trays.

Get ready for the complaining. Eliminating nursing stations!?! But how can they expect us to do our work…But we can’t…and so on.

Pony up folks. Culture change is much needed process and we’ll all be better off with it. Allowing the residents to control their environment and choices is really a human right. Safety, and all those other excuses we tend to use, are just that: EXCUSES. We don’t want to give up our “power”. It’s not about us. It is about our customers- the residents.

Some Culture Change Sites of Interest:
Pioneer Network

Check out the PN’s vast selection of resource links HERE.

The Direct Care Alliance is seeking a few good people to attend it’s annual Voices Institute Workshop.

The Institute is accepting applications until April 31.

From the VI Brochure: (PDF)

The Voices Institute workshops are intensive, week-long retreats that help direct care workers develop their leadership and advocacy skills.
Attendees learn about advocacy, fundraising, organizational development, message development, and more.
Graduates become bolder and savvier, more confident, and more active in advocating for themselves and their profession. Our 2008 graduates are already changing the world by:

Testifying before lawmakers
Building relationships with legislators to raise their awareness of direct care worker issues
Putting on conferences for their worker associations
Writing letters to government officials to request better wages and working conditions
Raising funds and building membership for their worker associations
Speaking at conferences and other public events
Each year, more Voices Institute graduates will provide their critical perspective to the movement to improve direct care jobs.

More: PDF

This week-long workshop provides an intensive, in-person leadership development experience to a select group of direct care workers from worker associations and coalitions around the country, providing them with the skills and support they need to be effective leaders.

The 2009 National Leadership Training is being held from September 27 to October 3 at a retreat center in Racine Wisconsin, near the Milwaukee airport.

All travel, meal, and lodging expenses will be covered by the DCA. In addition, an $80 daily stipend will be paid to all attendees who qualify. However, attendees will need to contribute a $300 participation fee. We will help the people accepted into the program raise their participation fees.

Candidates must meet the following criteria:
1. Employed as a direct care worker (certified nurse aides (CNAs), home health aides, direct support professionals, personal care attendants, private duty aides, geriatric aides, and other frontline workers).
2. Recommended and/or nominated by their direct care worker association or workforce
coalition. Preference will be given to workers in leadership positions.
3. Demonstrate commitment to active involvement in an advocacy campaign at the state or
national level and coordination with DCA’s National Advocacy Director.
4. Have access to computer and e-mail.

If you’re interested, apply ONLINE HERE, or download this form and mail it to the DCA. I am tentatively planning to attend and would love to meet some of you there! For some ideas about what to expect, a couple Direct Care Workers have posted their experiences HERE and HERE.

As the saying goes: Let’s roll!

Direct care workers- CNA’s and others- have been pushing for better pay, better benefits and working conditions for YEARS now. Direct care worker advocates have also been speaking LOUD on our behalf. We’ve barely made any progress, and many of us hope that the new President will lift us out of the world of low pay, disrespected work…the prospect of the Employee Free Choice Act passing into law will help elevate these dreams.

The LTC industry is getting excited about this as well, but for a more sinister reason.
From McKnights LTC News:

A major development is afoot in the labor movement, and it could have interesting implications for long-term care.

I’m talking about American unions’ recent plans to unify. In case you haven’t heard, the leaders of the two major federations and the nation’s 12 largest unions have formed the National Labor Coordinating Committee. The interim body will help form the federation.

Naturally, the thought of one massive union, 16 million members strong, is enough to send shivers down a long-term care employer’s spine. But let’s think about this a minute.

Clearly, a single union could have an impact on unionization. This is the year of the card check, and if the Employee Free Choice Act passes, nursing homes could be facing a serious increase in union activity.

Sounds good huh? Never trust the LTC industry to do the right thing for YOU.

But there also may be at least one area in which nursing homes can benefit from a unified labor front. That is immigration reform. The AFL-CIO and Change to Win federations recently said they are joining forces to support the effort. That includes a path to citizenship for undocumented workers.

Why worry about immigration reform, in the broader picture here?

Read on:

The American Health Care Association, the largest association of nursing homes, if you will remember, was in favor of a guest worker program that would provide a temporary workforce of skilled and unskilled workers for employers in the future. Given the industry’s reliance on low-wage help, that is not surprising.

Read that last sentence. LOW WAGE HELP. The thinking here is simple: Bring in as many immigrants as possible, allow them to fill our shoes, at lower rates of pay…supported by the Unions of course…And read between the lines: Unskilled workers = low wages is NOT GOOD FOR US. These efforts will drive down our rates of pay. Why would any facility hire an American CNA who will expect a living wage- when hiring an immigrant who will work for cheap hourly rate is a viable option? We need to seriously think this out and speak up on it.

What is your opinion on this?

Provider Magazine features an article (PDF) about how an assisted living facility in Nebraska has made good use of the Nebraska Health Care Association’s Learning Center. This is an innovative program.

From Provider: PDF

Attracting and retaining well-trained long term care professionals can be particularly difficult for nursing facilities in rural settings, but that hasn’t kept Good Samaritan at Pineview from luring staff to its remote community of Valentine, Neb.—just nine miles from the South Dakota border and nearly 300 miles from Lincoln.
[...]
The learning center was created in 2003 by the Long Term Care Workforce Institute in an effort to attract better candidates and offer standardized education for Nebraska long term care professionals.

One of the driving forces behind the center was Nebraska Health Care Association (NHCA) Executive Director Pat Snyder, who worked with September Stone, RN, to get the center off the ground.
“Ms. Snyder identified a significant need for educational excellence in long term care and believes standardized high-level education can have a major impact on the residents served in long term care,” says Stone, who is administrator of the learning center.

The goal of the learning center, which is now considered a post-secondary career school licensed and accredited by the state’s department of education, is to promote growth and leadership through education for the long term care setting. In addition to offering classes in Lincoln, the center contracts
with nursing facilities and assisted living communities throughout the state so they can hire instructors and offer courses. With seven training sites across Nebraska offering classes periodically, the center has graduated more than 800 students to work in long term care.

From the LTCWIN site:

Mission Statement
The goal of the Nebraska Health Care Learning Center is to promote growth and leadership through education for the long term care setting. Nebraska Health Care Association/Nebraska Assisted Living Association (NHCA /NALA) and Long Term Care Workforce Institute of Nebraska (LTCWIN) work closely together to provide essential educational opportunities throughout Nebraska in long term care fields.

Of specific interest to Nebraska CNA’s:

Basic Nursing Assistant
6.5 Quarter credit hours
This program is designed to train the beginning nursing assistant (NA) to provide safe, effective, and caring services to the patients of any health care setting. It is designed to meet the training requirements of both federal and Nebraska laws for nursing assistants working in a licensed nursing facility. The skills and knowledge contained in this material can be adapted for any health care or residential setting.
Employment settings: nursing facilities; assisted living, home health, hospitals, ICF-MR.

And:

Medication Aide
4.0 Quarter credit hours
This program is designed to prepare the participant to meet the requirements of the Medication Aide Act and to assume the role and responsibilities of a Medication Aide. The training is intended for the Medication Aide in an assisted living facility, nursing facility, or intermediate care facility for the mentally retarded. It may also be used to train Medication Aides in other settings.

Excellent! Now if we could only have such programs available in ALL states.

Some states are using Federal Stimulus/Medicaid funds to fill gaps in budgets that have nothing to do with Medicaid- the program some of these funds is supposed to go to.

RI:

PROVIDENCE – Dozens of nurses and other caretakers could lose their jobs at nursing homes across Rhode Island – one of the state’s few growth industries – as funding is cut to close ballooning state budget deficits.

A plan enacted this month trims about $5 million in Medicaid payments for nursing homes – roughly 2 percent of what officials originally planned to spend on nursing care for the fiscal year ending in June. Governor Don Carcieri, a Republican, and state lawmakers made the cut to help close a massive budget deficit brought on by 10.5 percent unemployment, a plummeting housing market, and slumping tax revenues.

Meanwhile, eight other states might divert stimulus Medicaid funds to fill budget holes as well:

WASHINGTON, D.C.— Some states may be diverting Medicaid funds from the economic stimulus package to projects unrelated to caring for seniors, according to a report from Rep. Darrell Issa (R-Calif.), House Committee on Oversight and government reform ranking member. Issa is calling for broader federal oversight to ensure monies are being used appropriately.

In a recent statement, the American Health Care Association has pointed out that stimulus resource diversion could force state Medicaid programs into decreasing reimbursements to healthcare providers.

Issa’s study, “De-Targeting the Stimulus: States Diverting Medicaid Funds Away from Helping Poor, Protecting Health Care Jobs,” cites eight states—New York, Michigan, Virginia, West Virginia, Kansas, Indiana, Florida, and Nevada—that are likely to use Medicaid stimulus funding to fill budget gaps.

Report HERE…PDF
This all means no raises; it also means potential lay offs at nursing homes. Just when we think this profession is recession-proof…

According to this report, Hispanic nursing home residents receive poor nursing home care.

Nursing homes serving primarily Hispanic residents provided poorer quality care compared to facilities whose patients were mostly white, according to Brown University research.

Details were published recently in the Journal of the American Medical Directors Association .

Researchers reached their conclusions after looking at the rate of bed sores at nursing homes with high concentrations of Hispanic patients, compared to others with low concentrations. Hispanics at nursing homes with a high rate of Hispanic residents were more likely to have bed sores, compared to Hispanics living in nursing homes with fewer Hispanic residents.

I wish they gave more reason in this article; I fail to understand WHY this happens. Is there a difference in the way staff are trained? Are nursing standards different? What could be the reason (s) for this disparity?

A week or so ago I wrote an endorsement for Just4CNA’s- an online CE web site for CNA’s. Since then, I received a sample of hard copy Inservices (as a “thank you”) and I AM IMPRESSED.

The materials came in a binder, all labeled and ready for use. I got 3 inservice packages neatly organized into plastic separators. Instructor pages which include handouts, quizzes and more are included. This is a quality product. Upon further exploration, I found that Just4CNA’s parent company, In The Know, has a blog about the different topics and offerings. A couple relevant postings MUST be read by Staff Educators, DON’s and CNA Instructors.

7 Tips for Giving Great Inservices to Your Nursing Assistants

Have you ever gathered your nursing assistants for an inservice meeting and found yourself staring at a bunch of tired, dull-eyed and disinterested people? Wouldn’t you rather be greeted by excited, eager to learn employees? Try implementing these 7 tips to freshen up your CNA inservice training…

Please go read the article to find out what these 7 tips are! This is very useful information…and trust me, as I working CNA, I know what it’s like to sit through a boring and dull “meeting”…even when it’s about something important, even though I really like to learn.

Another great post:
Rewarding Positive Behavior

One way to empower your nursing assistants is to reward positive behavior. Obviously, positive behavior is more than just getting to work on time and performing an assignment. As you go through your day, look for all the little ways in which your aides are growing–both as employees and as people. For example, be sure to praise your employees when they:

Set a good example for others.

Ask to join committees.

Ask for help when they need it.

Share their knowledge with others.

Approach their work creatively.

Come to work/meetings on time.

Are willing to stay late.

Set goals for themselves.

Listen to others.

Give help to others when asked.

Other articles include topics such as CNA of The Quarter, Tips for Picking a CNA Inservice Provider, and right now there’s an offering of a FREE INSERVICE about Domestic Violence (in reaction to the recent nursing home shooting where a CNA was a victim of DV and her estranged husband went on the killing rampage).

I highly recommend In The Know and Just4CNA’s for all your inservice needs- whether facility based or individual CNAs. THIS IS NOT A PAID ENDORSEMENT. IT IS A PERSONAL one!

Contact Linda Leekly with questions and thoughts.

An update about the NC Nursing Home shooting suspect. (Is he a suspect at this point?)

Raleigh, N.C. — A Moore County man accused of going on a deadly shooting spree at a Carthage nursing home last month was indicted Monday on a number of charges, including eight counts of murder.

A grand jury also indicted Robert Kenneth Stewart on two counts of assault with a deadly weapon with intent to kill inflicting serious injury, one count of assault with a firearm on a law enforcement officer, two counts of assault by pointing a gun and one count of discharging a weapon into occupied property.

Seven patients and a nurse died in the March 29 attacks at Pinelake Health and Rehab in Carthage; and three other people, including Carthage police officer Justin Garner, were injured.

I hope the staff and families are able to heal. What a horrible event to live through.