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.

Some wireless devices are causing problems with hospital equipment.

CHICAGO (AP) - Wireless systems used by many hospitals to keep track of medical equipment can cause potentially deadly breakdowns in lifesaving devices such as breathing and dialysis machines, researchers reported Tuesday in a study that warned hospitals to conduct safety tests.

Some of the microchip-based “smart” systems are touted as improving patient safety, but a Dutch study of equipment - without the patients - suggests the systems could actually cause harm.

A U.S. patient-safety expert said the study “is of urgent significance” and said hospitals should respond immediately to the “disturbing” results.

The wireless systems send out radio waves that can interfere with equipment such as respirators, external pacemakers and kidney dialysis machines, according to the study.

This is just an FYI post.

How often do we see our residents acting out? A lot. Do we ever wonder if it’s the drugs they are taking? Perhaps we should.

Ramona Lamascola thought she was losing her 88-year-old mother to dementia. Instead, she was losing her to overmedication.

Last fall her mother, Theresa Lamascola, of the Bronx, suffering from anxiety and confusion, was put on the antipsychotic drug Risperdal. When she had trouble walking, her daughter took her to another doctor — the younger Ms. Lamascola’s own physician — who found that she had unrecognized hypothyroidism, a disorder that can contribute to dementia.

Theresa Lamascola was moved to a nursing home to get these problems under control. But things only got worse. “My mother was screaming and out of it, drooling on herself and twitching,” said Ms. Lamascola, a pediatric nurse. The psychiatrist in the nursing home stopped the Risperdal, which can cause twitching and vocal tics, and prescribed a sedative and two other antipsychotics.

“I knew the drugs were doing this to her,” her daughter said. “I told him to stop the medications and stay away from Mom.”

Not until yet another doctor took Mrs. Lamascola off the drugs did she begin to improve.

At work, we should ask the nurses if our residents are taking any new meds; if they are, we should ask if there are specific or not-so-specific side effects WE should know of, and report. So many times older people are drugged up and we think this is WHO the person is…I once worked with a woman who was DX with dementia- but she wasn’t demented. It was her meds. It took months to figure things out, but she ended up being discharged from the nursing home. If it weren’t for the excellent nurses who were very aware of drug interactions and side effects, the poor lady most surely would have died in the facility.

Residents with dementia: Who are WE to decide who they have relationships with? This is a thought provoking article.

Bob’s family was horrified at the idea that his relationship with Dorothy might have become sexual. At his age, they wouldn’t have thought it possible. But when Bob’s son walked in and saw his dad’s 82-year-old girlfriend performing oral sex on his 95-year-old father last December, incredulity turned into full-blown panic. “I didn’t know where this was going to end,” said the manager of the assisted-living facility where Bob and Dorothy lived. “It was pretty volatile.”

Because both Bob and Dorothy suffer from dementia, the son assumed that his father didn’t fully understand what was going on. And his sputtering cell phone call reporting the scene he’d happened upon would have been funny, the manager said, if the consequences hadn’t been so serious. “He was going, ‘She had her mouth on my dad’s penis! And it’s not even clean!’ ” Bob’s son became determined to keep the two apart and asked the facility’s staff to ensure that they were never left alone together.

After that, Dorothy stopped eating. She lost 21 pounds, was treated for depression, and was hospitalized for dehydration. When Bob was finally moved out of the facility in January, she sat in the window for weeks waiting for him.

People with dementia should have rights too. But until we loosen up a little, they won’t.

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.

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.

Up in Canada an investigation is under way. A nursing home resident died as a result of a fall, out of a mechanical lift.

The faulty lift equipment that caused the death of an east Toronto nursing home resident had already malfunctioned twice within the same long-term care chain, according to a health ministry document obtained by the Star.

Leisureworld Caregiving Centres documented the two earlier incidents when the same type of lift broke down at another home in its chain, last November and December, according to the ministry’s May 8 letter to Health Canada, warning of safety hazards. The letter said there were no injuries as a result of the first two malfunctions.

It was not until Wally Baker’s April 30 death that Leisureworld replaced the lifts (motorized equipment used to move residents from bed to chair to toilet) throughout its 26 homes in Ontario. But chief executive officer David Cutler said the company took action to address the problems last November and December, including contacting Health Canada, which monitors nursing home equipment.

Wow. Pardon me for a moment here. I have worked with all kinds of mechanical lifts, of every variety and made by most manufacturers. Some are better than others; some are easier to use. None ever presented a hazard to my residents though, as long as I used the equipment correctly. We were trained by the manufacturers on how to use each lift, through the years, as we got them. I really don’t understand how this happened.

Has anyone ever experienced a close call with a lift? Was it the lift itself, the staff using it improperly a (lack of training on the proper use)? Was it the resident being unsafe and jeopardizing the transfer? I’ve seen that happen many times as well.

Nursing homes can expect some new guildlines coming this fall with regards to MRSA and infection control.

While many studies have looked at MRSA in hospitals, “we found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people,” the reviewers said.

That’s despite nursing home conditions that are ripe for breeding the bacteria, including residents with compromised immune systems living in close proximity and taking multiple medications that can foster bacterial resistance.

Open wounds such as bed sores – a common problem in nursing homes – and the use of catheters, also common, enhance older people’s vulnerability.

Recognizing the importance of the issue, the Association for Professionals in Infection Control and Epidemiology (APIC) is updating its MRSA recommendations to “apply more specifically to long-term care settings,” according to Liz Garman, a spokeswoman.

Those new recommendations are due to be released late this summer, she says.

One of the typical things is strict isolation of patients who test positive for this infection. There are not enough single beds in most nursing homes to accommodate this. It will be interesting to see how nursing homes follow up on the recommendations.

From California:

LOS ANGELES, April 11 /PRNewswire-USNewswire/ — The California Nurses Association/National Nurses Association today condemned the Service Employees International Union for targeting CNA/NNOC leaders and members with threats and intimidation, stalking them at home and in patient care units at hospitals.

In a statement today, CNA/NNOC — the nation’s largest RN union — demanded SEIU International President Andrew Stern “immediately renounce the actions of SEIU staff and cease and desist these despicable attacks against anyone who speaks out against his pro-corporate agenda.”

“SEIU’s behavior, sending swarms of staff to threaten women in their homes, is especially disgraceful, and another illustration of their contempt for a predominantly female profession that they treat as chattel in so much of their activity, including trying to force RNs into his union,” said CNA/NNOC Executive Director Rose Ann DeMoro.

Roving bands of SEIU staff, four or five at a time, arrived on the doorsteps of at least two CNA/NNOC female Board members in Southern California Thursday, with video cameras to film their abusive exploits.

Is this what we pay dues for?

“Union membership is about collective democracy. Nurses decide they need a union and then choose the union of their choice,” Cuaresma said. “We will continue to give voice on behalf of our patients and we will never be intimidated in our struggle to defend our ratios and our hard-won benefits. Stern should rethink his strategy — he will not intimidate me or the CNA.”

Thursday’s attacks on CNA/NNOC Board members are the latest escalation by the Service Employees Union which has in internal conversations bragged about its intent to “destroy” CNA/NNOC for challenging SEIU’s practices which the RNs say compromise patient safety, erode RN standards and professional practice, and undermine workplace and union democracy.

Also on Thursday, CNA/NNOC obtained a letter from an SEIU staffer who resigned in disgust with the behavior of SEIU International and quoted a top SEIU official bragging of plans “targeting ten to fifteen C.N.A. bargaining units.”

SEIU’s corporate partnerships compromise patient safety

Perhaps the most egregious behavior of SEIU International, says CNA/NNOC are its deals with corporate hospitals and nursing homes, sacrificing patient safety for agreements to help it recruit more SEIU members.

For example, SEIU has signed pacts with nursing home operators in California and Washington state agreeing to lobby for the nursing home chains. Under the 2003 California deal, SEIU agreed to oppose legislation requiring nursing homes to provide enough staff to keep patients safe and healthy, and to not report health care violations to state regulators except when required by law.

Five years later, according to a report cited in the Los Angeles Times this week, despite increased state funding for nursing homes, the direct result of SEIU lobbying, nursing homes are spending less in California on direct patient care, and reports of patient mistreatment have shot up 38%.

Similarly, in partnership with hospital corporations, SEIU lobbied in California against the RN-to-patient minimum ratio law, and worked to erode the law after it was enacted.

Unions should work for the people who pay them to represent them. Not against them. Clearly the SEIU has held the hands of nursing home industry leaders, who have goals that are not in favor of good patient care. We might think unions are a good thing, but we should be careful consumers (that would be me and you!) when it comes to what a union really offers, AND how it operates behind closed doors.