Archive for August, 2010

Follow the money. Really.

The nursing home industry gave at least $1.8 million to Kentucky politicians over the last decade while lobbying against bills that would require them to hire more direct-care employees, face higher fines for violations and abide by stronger precautions against elder abuse, among others.

While it’s no surprise, I was a little taken aback to learn of the political parties of those involved with this. And I suspect this is very common in every state.

For all the “conversations” this nation has regarding race issues, it seems that this should not be a concern: Residents/patients having the “right” to chose nurses, aides and other caregivers based upon their race. But it happens, often. It’s wrong. It’s discriminatory. And it’s about time something changes to end this. Indiana recognized this and have made it illegal.

INDIANAPOLIS (AP) – Certified nursing assistant Brenda Chaney was on duty in an Indiana nursing home one day when she discovered a patient lying on the floor, unable to stand.

But Chaney couldn’t help the woman up. She had to search for a white aide because the woman had left instructions that she did not want any black caregivers. And the nursing home insisted it was legally bound to honor the request.

As usual, laws are written without legislators thinking of the consequences. It usually takes a few years for the full effect of these consequences to come to light.

Elderly patients, who won more legal control over their quality of life in nursing homes, sometimes want to dictate the race of those who care for them. And some nursing homes enforce those preferences in their staff policies.

The nursing assistant in this case sued the facility:

Documents in Chaney’s lawsuit, filed in 2008, say her daily assignment sheet at Plainfield Healthcare Center always included the reminder that one patient in her unit “Prefers No Black CNAs.”

Chaney, a 49-year-old single mother who at the time was helping to put her only son through college, initially went along with the policy despite her misgivings because she needed the money.

“I always felt like it was wrong,” said Chaney, who has worked in nursing homes since she earned certification in 2006. “I just had to go with the flow.”

The nursing home said it was just following a long-standing interpretation of the patients’ rights law. “The rules say this is their home and everyone else is just a visitor there, including staff,” said McSharar.

We work in a high stress field. No one deserves to be singled out for any reason, rejected and actually written off as a “patient right” issue. I’ve seen the opposite happen as well: Black residents refusing care from white (or Hispanic or Asian) aides.

An aide is an aide. A nurse is a nurse. We all have the same basic training and are fully capable of doing our jobs. It’s about time older people understand this.

“The Best Friends Approach To Alzheimer’s Care” — it is one of the best books out there on caring for people with Alzheimer’s Disease. I have personally read the book many times and continue to read it now and again. It is a set of ideas and practices facilities can adopt to make serious and profound changes in culture. The book is up for review at Provider this month.

Article/PDF

In order to care for their residents, staff members in a dementia wing need to learn and periodically be reminded of the difference between normal aging and dementia-related changes.

Very true, and this book offers lots of educational articles on this subject. In plain language.

One of the things I like most about this book is the chapters on utilizing ALL nursing facility staff to engage residents in activities.

The activity department must be considered a staff group that supplements the activity-focused care provided by other departments.
All team members can be trained in reminiscing techniques using events that happened long ago, sensory stimulation such as massaging the hands or scalp, discussions of smells in their environment, reading a story, or normalization tasks like sorting silverware, folding towels, addressing envelopes, winding yarn, and organizing drawers.

Person centered care is the other hallmark of this book:

The person-centered care approach gives personal attention to the people who live in seniors housing and empowers staff members to be resident advocates. A caregiver’s knowledge of each resident’s pre-dementia story is essential to be able to gain the attention of that resident quickly when his or her behavior needs to be redirected.

Finally, an Alzheimer’s Disease Bill of Rights:

According to “The Best Friends Approach to Alzheimer’s Care,” every person diagnosed with Alzheimer’s disease or a related disorder deserves the following rights:
■ To be informed of one’s diagnosis;
■ To have appropriate, ongoing medical care;
■ To be productive in work and play for as long as possible;
■ To be treated like an adult, not like a child;
■ To have expressed feelings taken seriously;
■ To be free from psychotropic medications, if possible;
■ To live in a safe, structured, and predictable environment;
■ To enjoy meaningful activities that fill each day;
■ To be outdoors on a regular basis;
■ To have physical contact, including hugging, caressing, and hand-holding;
■ To be with individuals who know one’s life story, including cultural and religious traditions; and
■ To be cared for by individuals who are well trained in dementia care.
Source: “The Best Friends Approach To Alzheimer’s Care,” Virginia Bell and David Troxel, Health Profession Press, 1997, www.bestfriendsapproach.com

I highly recommend the book even if it was published several years ago. Get the book HERE.

The New York Times has published an article about investigations of health care facilities pay practices. It rings true for many of us: Do we really get paid for actual time we work?

In St. Louis, the Labor Department has recovered more than $1.7 million in back wages for 4,000 employees of hospitals and clinics operated by SSM Health Care, a Roman Catholic system.

In Boston, the Partners HealthCare System agreed to pay 700 employees more than $2.7 million in overtime back wages to resolve a lawsuit by the department alleging violations of the Fair Labor Standards Act.

And under the proposed settlement of a class-action lawsuit in California, Kaiser Permanente would pay $7.25 million to hundreds of registered nurse coordinators, case managers and other medical workers. The employees said they had been denied overtime pay because they were improperly classified as exempt.

This is when they classify nurses as supervisors. They are, but they usually do not meet the federal standards for being exempt.

Nursing assistants, licensed practical nurses, janitors and cooks “are particularly vulnerable to wage violations,” Mr. Stripling said.

In many cases, employees say they were not paid for work performed during meal breaks.

“Most nurses put the patient first,” said Charles D. Boal, a registered nurse who worked in the critical care unit of The Western Pennsylvania Hospital in Monroeville, near Pittsburgh.

“We often gave up lunch breaks to see that a patient was taken care of properly,” he said. “If you brought your lunch from home or got food in the cafeteria and took it to the nursing unit, you would be interrupted by phone calls, by physicians and family members who wanted to talk to you. We really did not have an uninterrupted meal break.”

How many of us have given up a break, or shortened one, because of patient/resident care demands? I know I have. Multiple times. We need to MAKE sure we are being paid for those minutes given off our breaks. Don’t let the facility management con you into believing they don’t HAVE to pay you because a supervisor/other did not ASK you to give up break times.

Previously here, we posted an article for nursing assistants:
Getting Paid For Every Minute You Work