This is surprising. Long Term Living (formerly Nursing Homes Magazine) recently wrote an article about Barack Obama’s plans for health care reform. A poll was also done. A whopping 73% don’t believe Obama’s ideas will make any difference. Also, several comments indicate that people don’t trust Obama has enough experience to do the job.

We tallied the votes and compiled your comments, discovering a striking display of distrust from you, our readers, in Obama’s healthcare reform. A week after posting “Questioning Obama’s Healthcare Reform…,” 17% who read the article decided to vote in the poll that accompanies it, resulting in 73% of that group expressing their doubt of the presidential candidate.

A while back we posted on the (at the time) three major candidates positions regarding health and long term care. Obama, McCain and Clinton each had their plans up at their web sites. Senator Clinton had the most comprehensive and detailed reform ideas of the three. Obama has the least; and McCain is in the middle.

Still, I’m shocked to see so many have little faith in Obama. I tend to agree with most of the comments left on this: He doesn’t have the experience, clout and political will to make the changes necessary to take this on. The lack of mention of health care workers is disturbing to me. The major unions have endorsed him at this point though; previously they had endorsed Mrs. Clinton.

However, Senator McCain’s reform plans don’t go into enough detail to give me any sense of direction. I do know that McCain’s Immigration reform plans can and will have a huge impact on the health care worker crisis: Immigrants will be employed more and more to work as CNA’s, direct care workers and the like. This work is one of those jobs Americans “won’t do”…Immigrants will be given access to work in the US, for periods of time, regardless of their education or skill. Whether this is a good thing or not depends upon one’s experiences with immigrants.

I firmly believe little change can come via politics and elections, when it comes to older Americans and their choices for retirement and life after, including long term care. I believe too many people place too much hope in these elections. It’s always a good idea to keep all candidates in our radar on these issues. In the big picture though, it’s also good to recognize what little they can really do.

Question:
At work today I got into trouble because one of my residents’ fell. This man is independent and never needs our help. He can do his own care- showers, dressing, walking, meals, toileting…the works. As far as I know he has never fallen before. I was busy with one of my other residents who requires total cares. I was in the middle of bathing her when the nurse came in to tell me the man fell and why wasn’t I with him? After I finished up with my lady’s care, I was told to fill out a report which wanted to know what I COULD HAVE DONE to prevent the fall; THE LAST TIME RESIDENT WAS TOILETED; THE LAST MEAL consumed- all things that had nothing to do with this fall!!

Later, I was written up for the fall. I told the DON that everyone is responsible for ALL the residents on the hall I was working. Yes, he was assigned to me, but when I am busy with other residents, my co workers should step up and cover for me. What do you think of this?

Answer:
You should not have been written up, in my opinion.

Every resident must be assigned to a CNA. It’s law. No way out of that. Every aide accepts their assignment and therefore responsibility for the residents on it. Each CNA is responsible for her assigned residents and the unit, as a whole, cannot do this.

It’s tough when bad things happen to good aides, though.

Did you read the man’s care plan? Are you absolutely sure he is independent in his cares? If so, did you check in with him to see if he needed any help, with anything? I think sometimes we assume these residents who are able to do their own care never need ANY help- and this isn’t always the case. When doing this check in, it’s always a good to ask when they’re planning to get up; what they’re bathing plans are and the like. This way, you can have some awareness that Mr. Smith is going to be up and about around 9am, and might need someone to just peek at him.

Of course this is where team work comes into the picture. Every time an aide is going to be tied up for awhile with residents, its always a GOOD thing to let as many peers know where you’re at. And include the nurse with this info as well. If you’re so inclined (and I would be) I would ask peers to keep an eye and ear out for your other residents…especially if I was going to be tied up for a longer period than usual with the other resident. A good charge nurse would make sure your other residents are covered as well. It’s a balancing act though: Asking every aide to cover the others’ residents every time personal care is being performed is just not practical.

As for the report: It’s called an Incident Report. The questions asked do indeed have everything to do with the assessment of a fall. By asking you what you could have done to prevent this fall, the answers you provide are supposed to be helpful to prevent a repeat in the future.

Did you know most residents fall because they are trying to get to the bathroom? If they’re hungry they might be trying to rush out to a meal. Usually there are other questions too on these reports- about all sorts of things. Often we don’t know the prior condition of any resident when they have fallen without a witness.

It’s very important for CNA’s to answer these things honestly…however….when we’re written up it takes away the desire for CNA’s to have any respect for these reports. These things should never be used as a means for punishment. When independent residents fall, it is NOT the direct fault of the aides. It was caused by something else. It IS up to management to figure out why the fall occurred- but by placing blame on the aides they are short changing this process. This is another example of autocratic management style- which isn’t helpful. And, I have to wonder if nursing homes with high fall rates have these kinds of managers.

I’m sorry you got written up. Of all the things CNA’s don’t have control over, the FALL tops the list. The work loads alone should tell all that it’s impossible to be everywhere at the same time- or even once an hour. A good fall prevention program begins with a trusting environment where no one is disciplined for falls unseen. Once that is in place, true prevention strategies can be developed AND the CNA’s are the most valuable asset to this process.

The latest word from CMS on helping consumers decide which nursing homes are good: Star ratings.

June 18 (Bloomberg) — Nursing homes, like luxury hotels in travel guides, will soon get star ratings for quality and safety, according to Medicare, the federal health insurance program for the elderly and disabled.

Medicare’s new ranking system will help people choose the best nursing homes for relatives and push operators to do better, said Kerry Weems, the program’s acting administrator, on a conference call with reporters today.
[…]
“The public is hungry for information and this is an easy way to evaluate quality,” Weems said. “The new `five-star’ rating system will provide a composite view of the quality and safety information.”

All I can say is they should have CNA’s be part of this rating system. As in, asking CNA’s to actually rate the facilities based on the special insight and insider info they have. Bet most nursing homes would get two, maybe three stars at most if the aides were doing the rating.

I have seen a disturbing trend of late. Quietly, medical and nursing facilities have been laying off staff in higher numbers. Not just housekeepers and janitors either; but nurses and CNA’s. In my state, a couple weeks ago a highly rated hospital closed down a unit and laid off 23 nurses and aides. Another facility was going to trim down a nursing unit by 15 beds, and would have laid off about 20 LNA’s and several nurses; the facility changed it’s mind on this, for now.

What’s going on? Did we ever think CNA jobs would be targeted for lay offs? Times are getting tough.

Cape Cod Hospital has notified an employees’ union it intends to eliminate about 17 full-time positions, including jobs held by cleaning staff, shuttle bus drivers, nursing assistants and food service workers.

The hospital is looking to save $800,000 through a combination of layoffs and not filling currently vacant positions, said David Reilly, spokesman for Cape Cod Healthcare Inc., the parent company of Cape Cod and Falmouth hospitals.

The job loss affects only Cape Cod Hospital, which is feeling the brunt of a multimillion-dollar revenue decline.

The 16.9 positions are “full-time equivalents,” meaning each is the equivalent of a 40-hour-a-week job. But the job loss could actually affect more than 17 individuals, since several of the jobs are shared by part-timers.

Revenue is the income a facility receives to pay for it’s operating costs. Much of this money comes from the federal government and state government, as well as from insurance payments. But, because these sources are not increasing their rates of reimbursement to the facilities, we have a shortfall.

Don’t assume belonging to a union will save CNA jobs:

‘The entire health system is feeling the pressure,” said Jerry Fishbein, vice president of 1199 SEIU, United Healthcare Workers East, whose union represents the workers whose jobs will be eliminated.

As required by collective bargaining stipulations, the hospital gave the SEIU a “30-day notice” of its intent to lay off the employees.

The next step is for the union to meet with hospital officials to see if they can whittle down the list, said Fishbein, whose union has 1,200 members at Cape Cod Hospital. “At the end of the day, there will undoubtedly be some layoffs. We certainly think the numbers should come down. It’s process of negotiation.”

This process might save one job, or position. It’s not comforting to know this process, negotiation, is all the unions can offer us when we face a job loss.

Last month, Cape Cod Healthcare CEO Steve Abbott announced that the organization had suffered a $17.6 million revenue loss in seven months.

The company responded by laying off 11 employees, mainly in mid-management and clerical positions, requiring a dozen senior executives to take a 10 percent pay cut and asking employees to consider early retirement.

The cut backs weren’t enough. So now they take it to the next level.

“Cutting back on the nursing assistants is a big problem for us,” said Stephanie Francis of the Massachusetts Nurses Association.

The two nursing assistant jobs scheduled to be eliminated could require nurses to pick up the slack and spread themselves thinner among patients, she said. Such a move would be in direct opposition to the Patient Safety Act being proposed on Beacon Hill, which requires a certain ratio of nurses to patients, Francis said.

Well usually the nurses whine when it’s THEIR job on the line; they complain when they are replaced with the less skilled, lower educated unlicensed assistive personnel (as we’re known as); they cite patient care problems when there are more of US then them. Since UAP don’t fall under Nurse s scope of practice rules, this claim is disingenuous at best. BUT, at least she’s sticking up for the aides in this case.

Abbott, who is retiring this summer, has blamed some of the hospital’s financial woes on the rise of off-site, privately run surgical centers and on an independent physician association, Physicians of Cape Cod, that he says is making fewer referrals to Cape Cod and Falmouth hospitals and their affiliated laboratories and services.

By sending patients to private organizations for procedures that receive lucrative reimbursements, the physicians in the I.P.A. are forcing the nonprofit hospitals to absorb more and more of the cost of serving the community, Abbott said.

More disingenuous stuff here. First off, remember this is Cape Cod. Kennedy country. John Kerry country. Where the rich live and house up for the summers. These people will not utilize the services of a public hospital no matter what. Cape Cod is full of private facilities that offer services at far cheaper rates than the public hospitals, believe it or not. Private sector doesn’t always mean more costs. The people who reside in this area do have a right to pick and chose where they will receive their health care, surgeries and the like. I do know these private facilities offer jobs to nurses and CNA’s and pay them better.

Do we take away this choice in the name of saving jobs? I think not.

What is certain is times are changing. More and more medical and nursing facilities are going to be forced to make cutbacks; this will result in patient care being put in jeopardy in many situations. I would expect to read more and more similar articles in the next decade or so, too. The trend is only just beginning. Brace yourselves.

Cell phones are a wonderful addition to our lives. Communicating quickly with family and friends is a good thing most the time.

However, at work, in nursing, they are fast becoming a nuance. I see many nurses and aides who constantly check their cells for messages; or who are texting someone. Right in the middle of patient care! Or a residents’ mealtime!

Message to CNA’s:
Cell phones no longer interfere with most medical equipment. This is no excuse to use them while we are working. Surely any message can wait until a break. Nothing is more aggravating than watching your co-worker drop everything they’re doing to TEXT someone. Or to check a call. Not only is this aggravating, it’s very unprofessional.

Message to management:
What is YOUR policy on this? Where I work we are not allowed to carry our cells with us on the units. Equipment problems are not the stated reason either. Rather, common courtesy and professionalism are cited. Cell phones take time and attention away from resident care; residents and co workers perceive the use of cell phones during care as rude (IT IS!). Staff are allowed to use their cells on their breaks only, and in the break room only- not in patient care areas.

A nursing home in New York City cut off health benefits to it’s staff over last summer, and they have been on strike since February.

After three wearying months of walking the picket line, 220 nursing home workers at the Kingsbridge Heights Rehabilitation and Care Center in the west Bronx have had plenty of time to sharpen their message.

“Health care workers like us should have health care coverage,” said Jacqueline Simono, who has worked for 10 years at the six-story, 400-bed nursing home.

In August, the nursing home stopped paying the workers’ health insurance premiums, and as a result, their coverage was cut off. That, the workers say, was the main reason they went on strike on Feb. 20.

The workers, members of 1199 S.E.I.U. United Healthcare Workers East, say they are expecting the National Labor Relations Board to give them some good news soon to help end the strike.

Sadly, those on strike are not earning any income and I cannot imagine how they are making ends meet right now. The costs of health care benefits is skyrocketing for everyone- not just health care workers. We’re seeing more and more businesses from every sector dropping coverages or increasing premiums.

Reading the rest of this article, it isn’t clear what’s really going on here. One thing: If these staff belong to a union, it is the unions’ job to make sure benefits are part of any bargaining plan. Somehow, somewhere, someone let the ball drop here.

I did a little digging into this situation and found a couple articles worth mention.

From a May 7th article:

NEW YORK–About 5,000 members of 1199SEIU from across the Northeast rallied May 3 to support 220 strikers at the Kingsbridge Heights Nursing Home, whose owner, Helen Sieger, has refused for six years to sign a contract with SEIU or pay into the 1199 health benefits fund.

The overwhelmingly immigrant strikers entered the rally at Fort Independence Park in a boisterous show of force, calling on a broad spectrum of militant national labor traditions.
[…]
Bartosz and Tomas, two strikers from Poland, described Helen Sieger’s anti-labor practices: “We have no sick days. We have no health benefits. We are required to arrive at 10:30, but are only paid from 11:00 on. Though we should finish at 7:00, we often have to work later, also without pay.”
[…]
A number of federal, state and city politicians and union officials spoke at the rally, including SEIU President Andy Stern and Sen. Charles Schumer. Barack Obama spoke through a recorded message. SEIU members from Albany and Rochester, N.Y., turned out, along with others from Massachusetts, New Jersey and the Washington-Baltimore area.

The rally highlighted the role that immigrants play in organized labor. A win for the Kingsbridge workers will be a victory for both the immigrant rights and labor movements.

There were not 5000 people at any rally for this. That is a gross exaggeration. Using militant strike methods wins few friends in these causes; however, asking politicians to speak on the behalf of those on strike is admirable.

The fact that many of those on strike are immigrants leads me to ask the tough question: Are they legally entitled to work in the US? Are these people just doing another job Americans won’t do? I wonder how many American CNA’s worked for this facility?

Finally, I ask this: If there is a strong union here, HOW do we explain such bad working “conditions” that include no sick days, not being paid for actual times worked, and so on? In many places of employment, meal breaks are not paid time. So, employees are expected to be on premises for 8 1/2 hours- eight of which are paid and the other that is not. And exactly how much longer were they made to stay over 7:00? A few minutes or hours? If minutes, then this issue is moot. If hours, then there is a serious problem. The devil is in the details, and we’re not getting those.

I also found the latest survey information for this facility. As usual, it doesn’t provide a clear picture of the facility, but all in all it isn’t THAT BAD. I have no doubt this place is a dungeon to work in; I also have little reason to believe the management gives one hoot about the workers. But my instincts tell me we’re not being given ALL the facts.

I ask people to be skeptical on these articles because the lack of detail can make a huge difference. A unionized nursing home should NOT have these issues. A union that has failed it’s members, however, might encourage a strike just to blow smoke in the air around it’s own failings and obscure the truth.

We write of Culture Change often here, and for a reason. It simply makes sense to adopt to this newer model of caregiving. And, it saves many cents, too! McKnights LTC News has the scoop right here:

Nursing homes that have adopted aspects of the culture change movement, or at least strive to, are more likely to see benefits in resident satisfaction, staff retention, higher occupancy rates and improved operational costs, according to a recently released survey of directors of nursing.

In the report, which was conducted by The Commonwealth Fund, nursing homes were broken into three groups: culture change adopters (31%), culture change strivers (25%) and traditional nursing homes (43%). Of the adopters, 60% reported improvements in operational costs compared with 31% of traditional nursing homes. Additionally, staff absenteeism decreased in half of the homes that adopted culture change, according to the report. Roughly a third of traditional nursing homes reported any such similar decrease in absenteeism. Culture change is a movement emphasizing resident-centered care in nursing homes.

Over at the Huffington Post, Harold Pollack speaks up for direct care workers- CNA’s, home health aides and others. It’s good when our voice is heard at the bigger blogs.

Every day, my family and countless others trust direct care staff to care for our loved ones. Yet we pay them less than we pay many of the college students brewing skinny lattes at Starbucks. Meager staff pay and benefits are the shameful back story of the generally positive effort to move intellectually-disabled people out of state institutions into the community. Starting hourly wages for direct care workers are typically a dollar or two above minimum wage.

Not surprisingly, low morale and turnover are huge problems. Families hope that the job means more than a paycheck, especially since we can’t always monitor what they do. We hope that direct care workers treat our loved one with diligence, dignity, and skill he deserves. Many do. Given human nature, not every care worker earns the paycheck she doesn’t get to receive. I’ve met too many people who clock in, take the cruddy paycheck, and don’t do much else. If I got $9.85 per hour, I wouldn’t be the Energizer Bunny, either.

We do have our share of lazy peers who make us all look BAD. But in every line of work I have ever seen, including our Congress, there are lazy and uninspiring people to tend with.

The NYT has another good article up today:

Serious Deficiencies in Nursing Homes Are Often Missed, Report Says

WASHINGTON — Nursing home inspectors routinely overlook or minimize problems that pose a serious, immediate threat to patients, Congressional investigators say in a new report.

In the report, to be issued on Thursday, the investigators, from the Government Accountability Office, say they have found widespread “understatement of deficiencies,” including malnutrition, severe bedsores, overuse of prescription medications and abuse of nursing home residents.

And this is news? Not to most CNA’s who work in nursing homes.

The nine states most likely to miss serious deficiencies were Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, the report said.

More than 1.5 million people live in nursing homes. Nationwide, about one-fifth of the homes were cited for serious deficiencies last year.

“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.
[…]
The study was done at the request of Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin, who is chairman of the Senate Special Committee on Aging.

I have an idea for the Senators.

Put a CNA on every survey team. A CNA who has worked in nursing homes, who has some experience, who is savvy and can point out the cover ups and lies and distortions that we KNOW are happening.

With all due respect to the average survey team made up of people with numerous fancy titles, education and college degrees, who is better at identifying abuse and neglect than the seasoned CNA?

All the intellectual brilliance in the world will not be able to sniff out perfumed and powdered and otherwise fluffed and buffed, but not truly clean (as in showered recently) residents.

No degree in any field can separate real malnutrition caused by lazy and uncaring aides who don’t take the time to feed residents who cannot feed themselves, from the sad but very common and natural lack of desire to eat we see with people with late stage dementia.

Only a CNA can assess a unit for the true needs of any given resident population…a quick look around, copies of assignments, and observation of am or pm care pretty much tells it all. And CNA’s know the odors of pretty smelling air fresheners used during the inspections to cover up the real scents of a nursing home.

How about this: CNA’s who are part of a survey team should seek employment at facilities a month or so before the scheduled visit…get hired and work a few weeks beforehand. Then file a report with a lot of useful and honest and true information.

I suspect most nursing homes would sorely fail their inspections if this were to happen. The fact is nursing homes operate one way when it’s inspection time (”THE STATES’ HERE!!*) and another way the rest of the year (*ARE WE SHORT AGAIN TODAY?!?*) It’s time to re-think how surveys are done and who makes up these teams. By not having a front line worker on the team, the team always misses out on what’s really happening, since, it is the front liner who really KNOWS.

Send Senator Grassley a message about this HERE. He’d love to hear from CNA’s, this I know.

And Senator Kohl likes feedback as well…contact him HERE.

Over at Long Term Living (used to be Nursing Homes Magazine) they’re asking for ideas and solutions to the ever present big time issue: STAFFING PROBLEMS. Go over and leave your thoughts and opinion. I did.