Presenting two sides to the S-CHIP issue. We report. You all decide. And live with your choices without regard to how it all affects each and every one of us. And our children.

DO WHAT’S RIGHT FOR THE CHILDREN:

It’s September and that means it’s back to school for millions of children, and back to session for our Congress. There isn’t a healthcare advocate that I know who doesn’t realize that this session of Congress holds the healthcare and future welfare of almost 9 million children in their hands. It is a deeply disturbing fact that in this country, with all it’s wealth and innovation, we have children without access to consistent and comprehensive healthcare.

Many states have extended coverage to school-aged children through the States Children’s Health Insurance Program (S-CHIP). Yet there still are too many working families living in poverty or near poverty who can not afford health coverage.

Masschusetts is a state that has made covering kids a priority. But without a full appropriation of $50 billion, roughly 14,000 children in the Bay State will lose that coverage. Some of them were just covered by our health reform expansion, and now they are again in health insurance jeopardy. These are children living in families who earn between 250 - 300% FPL.

See here for how most Americans are living, in so called poverty.

More:

Without this funding for S-CHIP, chances are their parents will be in health insurance jeopardy as well.

That’s why late next week, hundreds of healthcare workers from SEIU Healthcare, traveling from many states across this country, will descend on Washington DC. They will go there to lobby members of Congress to keep their resolve and do the right thing by expanding funding of S-CHIP.

President Bush is waiting to veto this funding. He has already drawn a line in the sand. It is time for the voice of America’s children to be heard!

SEIU Healthcare workers from Jordan Hospital, Boston Medical Center and Union Hospital will advocate for our kids, bringing their petitions to add to the more than one million petition signatures that will be delivered to Congress.

Healthcare reform in Massachusetts will be forced to take a terrible step backward if the President vetoes this funding. In addition, as Massachusetts begins negotiating our new federal waiver to finance health reform, federal matching dollars may be at risk. The Bush administration may try to win these funding restrictions through rule-setting, holding our children and all of our reform efforts hostage to the Administration’s punitive policy.

And consider this:

Hospital CEOs and hospital workers, nursing home owners and nursing assistants all have this in common: we know that for healthcare reform to work, all of our kids must be insured!

If you haven’t signed the S-CHIP petition, please go to www.seiuhealthcare.org and sign it today. Do it for children throughout Massachusetts and throughout our country.

Celia Wcislo is a member of the Connector board
and Assistant Division Director, 1199 SEIU

The other side:

Every child in America should have access to health care. Thankfully, both the U.S. House and Senate have passed plans that would reauthorize and expand the federal Children’s Health Insurance Plan. But, funds to expand child health care should not come at the expense of America’s historical and fundamental commitment to our elderly. That’s exactly what happened in the House, where many members, including U.S. Rep. Charles W. Dent, were forced to choose between kids and the elderly when voting on House Bill 3162.

While the legislation contained the noble goal of expanding insurance for children, it also included many destructive components, including a provision to slash $2.7 billion in Medicare payments. Under that plan, nursing home residents in New Jersey and Pennsylvania would lose $210 million over five years.
[…]
In Pennsylvania and New Jersey, where roughly 80 percent of nursing home residents have their care funded through Medicaid and Medicare, the cuts would hit especially hard and exacerbate an existing funding gap between what Medicaid will reimburse nursing homes for caring for residents. In Pennsylvania and New Jersey, where two out of three residents are funded through Medicaid, nursing homes lose an average of $13 and $21.25 per resident per day, respectively.
[…]
While nursing homes will strive to provide quality health care no matter what funding cuts come their way, they will be forced to scale back those activities and events that enhance residents’ quality of life. In addition, those who work within America’s nursing homes — predominantly women and many minorities — could find their wages and benefits affected by the cuts proposed in House Bill 3162.

Nursing homes already are struggling to attract and retain staff to care for elderly, ill and disabled residents because these positions involve high physical and emotional stress on employees who can find higher compensation in competing health-care settings. Right now, 100,000 long-term care nurse and nurse aide jobs remain vacant nationwide; annual turnover rates are high — 49 percent for registered nurses and 71 percent for certified nursing assistants.

Slashing Medicare payments would complicate the challenges that already face each and every one of the more than 175,000 nursing home employees in New Jersey and Pennsylvania who work long, demanding hours to care for those least able to care for themselves.
[…]
Sufficient funding of health-care services for children and the elderly is the only responsible solution. Playing off the future of children against the well-being of the elderly is not policy — it’s passing the buck.

Stuart H. Shapiro, M.D., is president and CEO of the Pennsylvania Health Care Association. Paul R. Langevin Jr. is president of the Health Care Association of New Jersey.

Have the unions such as SEIU fully investigated this issue? Are they aware of the serious cutbacks to our elderly if this act is extended as is?

So which is it? Who gets the cut? The children of families who earn 300% above the poverty threshold, or the elderly- and those who care for them in jobs working as CNA’s? You decide.

One of the reasons elderly people, who can (and can’t) afford it, are moving to Mexican nursing homes (as in the post below) as opposed to American nursing homes, is because the costs of running the American nursing home. One of the biggest costs is always staff: Pay, benefits, insurances. So when we see more Unions come to these places, we expect to see costs skyrocket. It’s simple economics and it’s very much bad for the industry in whole. The big chains can cough up some money for pay and other staff needs; it’s the small locally owned and managed facilities that suffer, and end up closing doors.

So when I read News Releases like this, I have to ask: HOW ARE UNIONS BETTER for RESIDENTS? If more and more of them are seeking alternatives, including moving to another country, how can the unions make the claims they do?

DETROIT, Aug. 17 /PRNewswire/ – SEIU Healthcare Michigan, the state’s largest local health care union, was formed this week, the union’s leaders announced.

The new union will represent more than 55,000 healthcare workers statewide, including Registered Nurses, home care workers, nursing home aides and hospital support staff.

“SEIU Healthcare Michigan will be a champion for quality healthcare in Michigan,” said SEIU President Rickman Jackson. “Our members are on the front lines of the healthcare crisis in our state, and we’ll work endlessly to make sure all Michiganders have access to the healthcare they need.”

Access is one thing; the cost of it is quite another. And what do CNA’s and nurses have to do with making sure ALL of a state’s citizens have access??

The move coincides with the formation of SEIU Healthcare, a national union which represents 1 million members nationwide. The union’s agenda includes advocating for improvements in the health care system, including putting patients first, providing affordable care to every man, woman and child in America, ensuring long term care for the nation’s elderly and disabled population, and higher standards for pay, benefits, training and staffing for health care workers.

“We have similar goals for Michigan,” Jackson said, “as we know that many of our workers don’t have insurance or adequate coverage to address their needs. That’s why we have high turnover in the home health care field and certainly, a nursing shortage in Michigan.”

Jackson’s goals include affordable and adequate healthcare for nursing home and other healthcare workers; the creation of the state’s largest training center and creating a stronger voice for the professions his union represents.

“A quality work force equals quality care,” Jackson said.

Remember who is paying for nursing home care. Each and every one of us who pays federal taxes.

The customers are looking for alternatives. Culture change is happening and Eden type nursing homes are becoming more and more popular. The nurses and aides who work for these places have consistently rejected unions- and they don’t make any more money than the rest of us. Now we see elderly people going to Mexico and India for nursing home care; what next? We already know a great many people hire non nursing aides to come in and take care of their older loved ones- these families train these aides to do things their way…not our way.

We’re not taking the hint here. It’s time we change. Or the people who we think need us won’t- they are revolting now and demanding something better and cheaper. Can we go with this wave of change or will be go with the old model and join the unions and destroy our own line of work? Something to think about.

Here’s another career ladder idea, that seems to be working for this nursing home. A few things in this article show us some of the problems nursing home management has with CNA’s though, and why they can’t keep these vital positions filled.

POWELL - Thanks to a new training program, Jan Warren and Rey Moreno found out what kind of occupation they want - and what they don’t want.

Both have gone through training through the new Unit Support Assistant program through Powell Valley Healthcare.

The program is designed to provide support for existing staff while helping trainees work toward becoming certified nursing assistants.

Faith Jones, director of patient care services at PVHC, said the program is an outgrowth of brainstorming after attending a conference on nursing shortage issues last fall.

“We realized we have had all the same issues happening with our CNAs,” she said. “We were having a lot of struggles in filling CNA positions.”

Adding to that difficulty was the fact that, after spending $400 on a three-week certified nurses assistant training course and taking a test to become certified, some people ultimately decided they were not interested in the job.

“To do a CNA class, then end up with only two or three CNAs sticking with it, we were kind of spinning our wheels,” Jones said.

I think it might have something to do with the pay. CNA’s work extremely hard and this is never conveyed in the classes. Sure- they tell you what you’re going to be expected to do; they train you to take VS and make beds and turn and reposition patients; but they leave out the fact that you’re going to have 9,10, 11 or more patients to do it all with.

The conference prompted PVHC officials to reconsider how they recruit and train certified nursing assistants.

“We started thinking, ‘What could increase satisfaction with CNAs and give them support?’ ” Jones said.

One of the observations was that, while those assistants are considered support staff, they also need support.

Another problem: Considering aides SUPPORT STAFF. That’s nice. Support what? Without the aides where would a nursing home be? Look at it this way: Without housekeepers, the CNA’s would probably keep the place clean and presentable. Without CNA’s, the housekeepers wouldn’t be able to take care of the residents. CNA’s are vital. While they may be a dime a dozen, the CNA’s- a nursing home could not operate without them. Stop thinking of them as support staff.

“We decided to create a career ladder” leading to certified nursing assistant training, she said.

That ladder begins with the position of unit support assistant. Trainees start out with a two-day class, after which they perform tasks such as making beds, cleaning and visiting with patients or residents. Unit support assistants provide no patient care, Jones said.

After about four weeks of those duties, trainees can progress to nutrition support assistant. That comes with additional training and a raise. In addition to performing their previous duties, nutrition support assistants can prepare meal trays for patients or residents, help feed residents, measure intake and similar duties.

While stopping short of patient care, “they get a lot more patient contact,” Jones said.

“They do that for six weeks, and if they want to do the next step, they take the three-week CNA class.”

I wonder if this scares off people as well, from being aides? The feeding assistants can also be unit aides: This is what they do at my work. We’ve used these positions for a few years now with some success; the only problem is this: For every unit aide, we lose a budgeted CNA. We have told management we want the CNA back. To have someone feed and make beds and water plants is a nice extra, but it’s not worth the exchange of two or three more residents added to our assignments.

By the time they get to that point, employees have worked in health care roles for 10 weeks.

“They know what the job is like, and they know what they’re getting into,” Jones said.

Some, like Warren, decide they don’t want to go any further.

Warren said she enjoys the daytime working hours the NSA position provides, and she likes working one-on-one with the patients without adding the demands of becoming a CNA.

Warren, who works at Powell Valley Care Center, said she enjoys things such as watering plants for residents, making their beds, tidying their rooms and visiting with them.

“I make sure they feel like this is their home,” said Warren, who formerly worked at the Powell Valley Senior Citizens Center.

I doubt they know, truly, what the JOB is all about. Come back to us in two years and we’ll evaluate the data about the jobs and whether this ladder actually has an impact on the work of the CNA.

We need someone who can make the beds and help the residents get to and from activities, offer them drinks and assist with meals. We need someone who can supervise the residents when we cannot; we need this person on at least two out of three shifts. I think unit aides can be and should be utilized more. Without taking from the pool of CNA’s.

An article about the long term care, nursing home industry’s hope for the immigration bill (which is now dead):

Research repeatedly confirms that the quality of long-term care depends on staffing levels. Technology and evidence-based practices can make important contributions, but the ability to provide assistance and services to people who have significant limitations and health problems ultimately rests on having enough staff to respond to their needs.

For this reason, the long-term care industry has been very attentive to policy changes and proposals affecting the availability of personnel. Some of these changes involve reimbursement levels that constrain the ability of nursing homes to hire staff in a tight labor market. In 2007, however, the major focus of Capitol Hill is on those sources overseas of people who could eventually work in long-term care.

I don’t believe the reasons listed here are truthful. I do think the profit motive is driving this attention; the labor market would not be tight if staff were paid decent wages. I don’t expect them to pay us union demand wages, but certainly something more of substance than the usual $8, 9 or 10/hr…

This situation has motivated lobbyists for the nursing home industry to become fairly reliable advocates for policies that will increase the availability of workers from Asia, Central America, Mexico, and the Pacific Islands. American Health Care Association in particular has expressed frustration over the slow pace of the immigration reform that President George W. Bush had described in 2001 as a top priority of his administration. That priority was derailed by post-9/11 issues of national security and by outrage among members of his own party over the millions of Mexicans, Central Americans, and Asians who have illegally arrived and settled in the United States.

I remember this being one of Bush’s big pet projects when he was campaigning for office. Back then I was suspect of this whole thing.

The first question is surprisingly difficult because long-term care actually faces two separate staffing problems. Nursing homes face a systemic shortage of nurses and other clinical staff; they cannot compete with the salaries offered by hospitals, outpatient practices, and managed care companies for the shrinking pool of trained clinical and clinical support personnel. Nursing homes depend heavily on low-skill, low-wage workers to provide affordable support services such as laundry, housekeeping, transportation, and food preparation. Some of these low-income personnel are employed directly by the long-term care industry, but many are outsourced from companies that supply nursing homes with necessary goods and services. Ideally, an immigration reform package would address both of these staffing problems by making it easier for nurses to cross borders to work in the United States, while ensuring a steady supply of dependable, motivated, low-wage support workers.

THAT last sentence shows us what the policy makers and movers really think of American and legal immigrant nursing home staff: Undependable? Unmotivated? High wage ($12/hr????) demanding? Hmm. CNA’s should be mad as hell about this. So should nurses and all other nursing home staff. I’ve seen how these nursing homes get by with having illegal immigrants: They do outsource. A private hiring group (much like Manpower) does the hiring, background checks, ect…and the workers just show up at the facility to do their thing. No hassles for the nursing home- which- if raided by ICE, would face fines and all sorts of trouble.

I have a lot of personal concerns about illegal immigrants and the drain I believe they place on the US- resources, federal means tested programs and health care and the lot. But I also realize these people are human beings. They come to the US to work; we have many employers who hire them, illegally and treat them poorly. They exploit them; pay them even dirtier wages than we get; they don’t pay them for overtime and demand they work 7 days a week. The immigrants feel compelled to put up with all of this because it’s still better than what they had in their home countries and they fear being deported. BUT…at the same time these people are depressing the overall wages of nursing home staff- nurses, aides, housekeepers, dietary…Jobs Americans used to do until the industry decided to get more greedy. Our jobs are being given to those who will work for less and who expect less, and we will never stand a chance of bringing our work up to a higher standard.

Another concern I have is the safety of our residents. I have worked with a few illegal immigrants. They made serious mistakes and were lazy. They didn’t or couldn’t or wouldn’t read and understand English. So they couldn’t understand care plans. So they didn’t do what they were hired to do…and the errors were serious enough to cause the death of one resident; the aspiration of another and many many family complaints. The residents themselves refused the care of those who they could not understand. These immigrants used their “race” card as a defense too, claiming racism when confronted with the errors and terminations- after investigations by in house and state authorities.

It’s a tough call…but in my opinion utilizing immigrants is a bad idea. We’re dealing with human lives, not heads of lettuce or the packaging of meat products. We are trusted to care for frail and sick people who trust us to them good…why risk this?

I am appalled. Just appalled. After being away for two weeks on vacation, I come back here only to read how one nursing home administrator decides to bash those CNA’s who chose to do what is best for their own personal situations. He invokes the age old guilt trip bulloney tactic upon us. And he implores us to stay put for the sake of resident dignity. No matter HOW bad the damn job is, and the lack of management that creates almost ALL the reasons AIDES QUIT in the first place. We are allowed to hold ourselves to a certain standard. WE HAVE SOME DIGNITY TOO.

He asks, and Patti quotes:
Why then, caregivers, do you continue to move from job to job, facility to facility?

Well let’s count the reasons. While YOU sit at your desk, making executive decisions and doing all those very difficult and exhausting tasks with your Cross pen, we the aides are:

Barely getting enough information from our nurses during shift report and therefore placing our residents at risk.
ADMINISTRATOR: When is the last time you came in at 6 or 7am to listen to a shift report? Better yet, how about 10 or 11pm?

Getting assignments that are often unfair and depending upon whose ass we each kiss, downright brutal.
ADMINISTRATOR: When is the last time you worked as an aide? Surely you can remember getting the assignments from hell, day in and day out?

Going out to the units to do our work, which includes getting kicked, hit, slapped, yelled at, having items thrown at us. We report these incidents to your management team (AKA the DON) and we’re told there is nothing to be done about it.
ADMINISTRATOR: When is the last time YOU got bruised three or four times a shift, at work? Or had wads of your hair pulled OUT?

Struggling to get it all done and done right..those of us who care anyway. There are some aides who don’t care, who powder and perfume up their residents so they smell good yet who haven’t been washed with soap and water in days…who sit in feces and urine for hours and hours; somehow THESE aides manage to get the good raises and reviews. They get their “work” done by skimping. DO YOU know which aides actually do it right and those who don’t ADMINISTRATOR? Bet not.

Aides bathe, shower, lift, turn, reposition, pull up and transfer many, 8, 9, 10 or more totally dependent heavy human beings every day, several times a day. We clean up endless accidents and wipe up vomit, blood and bile. We change messy briefs all shift, and then some. We fight to do much of this too- because so many of our residents are demented or otherwise combative towards our efforts. Depending upon where some of us work, we also make the beds, do the dishes, sweep the floors and wash and dry the linen. We put away supplies. We’re expected to do repetitive documentation only to see the written record of our care ignored. We write out incident reports and rarely see action taken to make the situations YOU demand we report get better.

Do you know how it feels to keep a special resident clean, dry and comfy all shift? Only to come in tomorrow and find out the next two shifts neglected their duty to this resident who now has an open area or two? Are these minor little issues dealt with or are they just swept under some rug in someone’s nicely decorated office?

Some of us never get a break. We bust our asses all shift, running around answering call bells, dealing with irate families, dealing with panicking nurses AND taking the phones with us in case a call comes in. Some of us feel like we run the show because there is no real management. ADMINISTRATOR: When was the last time you worked a day in our shoes?

When you finally go home after a long day at work, are your back and leg muscles sore? How do your arms feel? Or being so thirsty you feel sick, cause you didn’t have time to take in an adequate amount of fluids to drink? (No I don’t think you know because you posted about your higher concern for keeping the refrigerators clean). Do you know how it feels to be dehydrated? AIDES DO.

Speaking of that, how do you think aides feel when they KNOW they haven’t given their residents enough to drink because there wasn’t enough time? When we’re expected to feed four and five residents who cannot do this for themselves? How do you think we feel when we know you and the other bosses are off in the cafeteria or break rooms or sitting at your desks, stuffing your faces with food, guzzling down fluids and we don’t have time to offer this very basic need to our residents? Do you assist during mealtimes? How many residents have lost weight at your facility? WHO IS DEDICATED here?

Did you know that we have days where all the above listed “items” occur within an 8 hour shift? In fact, do you realize most of our days are like that? DO you care? If so, what are you going to do about it?

Would you put up with this environment for 9.00/hr, or maybe even 10.00?
I didn’t think so. Enough said on pay. We are SAINTS for doing this work for these wages and don’t you ever forget THAT.

Did you thank the aides working for you today? And the nurses? Or are you one of those managers who doesn’t think any employee deserves to be thanked for coming to work?

Now I have some questions for the ADMINISTRATOR:

WHY do YOU work?

What factors are absolutely necessary in order for you to accept a job? Do salary, benefit packages, hours, travel distances from home, growth potential have an impact? When you have choices, as we each do, do you make a list of pros and cons for each job “opportunity”?

Have you ever gone home after a hard mean day at work, feeling GUILTY that you couldn’t provide even substandard care or even a little less than that? Do you wake up in the mornings dreading going to work? Simply because you know NO matter how much effort you put into your work, it makes so little difference to those you’re charged with doing just that?
Or, do you ever experience such days? DO you ALWAYS feel satisfied when you go home? AIDES DON’T.

We all chose nursing because we want to help people. When the workplace takes away the tools, resources and TIME needed to do this work, we feel dissatisfaction, ADMINISTRATOR. So yes, we move on. We hope the next nursing home is better managed and when it is so, we are content to stay. We want to be associated with a win-win situation in our work: Happy, relatively healthy residents AND HAPPY and content AND YES– decently compensated aides (and nurses). You get what you pay for in this work. When a facility experiences high turnover, look at the working conditions. Don’t blame the aides for leaving. Blame yourself.

Debating the need for respite care for the elderly…in NH.

(Subscription is required to access this link, but it’s free…)

ROCHESTER — A wedding takes someone’s primary caretaker out of town. The caretaker is exhausted and needs a break. Or the caretaker unexpectedly becomes ill.

Strafford County Administrator Raymond Bower says he’s seen each of these kinds of cases, and with little if any trouble the person receiving care is able to stay at a nursing bed at Riverside Rest Home.

Whether the ailing person pays privately or through Medicaid, Bower said for years it’s been “fairly easy” for the facility to make the transition to temporary respite care.

But that’s not the case at many other nursing homes across the state, several officials say.

The problem with holding beds for respite care are numerous.

First, who is paying for the bed? Keeping the bed empty costs as much as having someone in it. The very nature of respite care can mean an emergency admit or a well planned admit…it’s the quick admits that can bring uproar to the nursing home. Usually nurses and aides have little info about the resident; often the resident has little time to prepare for such an admit. Both invite trouble, for all. When we don’t have information and assessments done, we see falls, dehydration and all the other problems associated with poor admissions process. At one place I worked at, we had 3 “Respite” beds and it was a revolving door. Resident turnover was ridiculous! Every weekend we had different people in the beds, and little to no info about them. Some of them were really sick or had advanced dementia, and we never got more aides to help. Behaviors, suicide attempts, depression were all seen from the residents. And the families thought these beds meant better care, and likened this to a stay at the Hilton. We did away with the program because of all this.

I think we need alternatives. ANY nursing home admission, for the convenience of family is faulty in essence. Families DO deserve breaks, why not get this from home health care options or relatives? How do we expect a person, an elderly one at that who is confused and vulnerable to begin with, to just accept institutional care for a “few days”? It’s not right.

An almost haunting article from today’s New York Times. This is about elderly people who resign themselves to live their last years in a nursing home; many are not aware of the newer models of care.

At some point in life, you can’t live on your own anymore. We don’t like thinking about it, but after retirement age, about half of us eventually move into a nursing home, usually around age 80. It remains your most likely final address outside of a hospital.

To the extent that there is much public discussion about this phase of life, it’s about getting more control over our deaths (with living wills and the like). But we don’t much talk about getting more control over our lives in such places. It’s as if we’ve given up on the idea. And that’s a problem.

How do we get the word out that not all nursing homes are the hell holes? That, some nursing homes are actually HOMES where the resident actually makes the rules; where the resident actually makes her own schedule and is able to pick and chose just about every “option” we all take for granted in our own homes….

This week, I visited a woman who just moved into a nursing home. She is 89 years old with congestive heart failure, disabling arthritis, and after a series of falls, little choice but to leave her condominium. Usually, it’s the children who push for a change, but in this case, she was the one who did. “I fell twice in one week, and I told my daughter I don’t belong at home anymore,” she said.

My own thoughts about this are that when our parents can no longer stay in their own homes safely, one of the grown children should make some concessions for their folks…after all, they raised us, wiped our butts and fed us, nurtured us…don’t we owe them this back? I think we do. We live in a material world; we have two income families struggling to make ends meet - for what? A big pretty house and fancy cars and expensive toys and gadgets for our kids? Where does family value fit in with this?

She moved in a month ago. She picked the facility herself. It has excellent ratings, friendly staff, and her daughter lives nearby. She’s glad to be in a safe place — if there’s anything a decent nursing home is built for, it is safety. But she is struggling.

The trouble is — and it’s a possibility we’ve mostly ignored for the very old — she expects more from life than safety. “I know I can’t do what I used to,” she said, “but this feels like a hospital, not a home.” And that is in fact the near-universal reality.

Ahh yes…SAFETY. The old stand by reasoning for nursing staff in every medical facility. Safety comes first, even at the price of another person’s humanity. And dignity. And personhood. And privacy. Self determination. All this is lost upon an admission to a nursing home, let’s face that.

Nursing home priorities are matters like avoiding bedsores and maintaining weight — important goals, but they are means, not ends. She left an airy apartment she furnished herself for a small beige hospital-like room with a stranger for a roommate. Her belongings were stripped down to what she could fit into the one cupboard and shelf they gave her. Basic matters, like when she goes to bed, wakes up, dresses, and eats were put under the rigid schedule of institutional life. Her main activities have become bingo, movies, and other forms of group entertainment. Is it any wonder most people dread nursing homes?

I believe the nursing home industry has long forgotten what it’s like to allow for some humanity…and the things we do that are just part of the job, are robbing people of this. All the baths and showers and turning and positioning and feeding and everything else, are tasks we provide…caring…nursing…but do we forget the human being we’re so busy nursing?

The things she misses most, she told me, are her friendships, her privacy, and the purpose in her days. She’s not alone. Surveys of nursing home residents reveal chronic boredom, loneliness, and lack of meaning — results not fundamentally different from prisoners, actually.

The difference between a nursing home and a prison are simple: One houses criminals and the other houses an entire portion of our population that society has forgotten about. A little harsh perhaps, but true. If we really cared, we wouldn’t send our folks to a nursing home. We would FIND another way.

It’s not all doom and gloom though:

There has been, however, a small band of renegades who disagree. They’ve created alternatives with names like the Green House Project, the Pioneer Network, and the Eden Alternative — all aiming to replace institutions for the disabled elderly with genuine homes. Bill Thomas, for example, is a geriatrician who calls himself a “nursing home abolitionist” and built the first Green Houses in Tupelo, Miss. These are houses for no more than 10 residents, equipped with a kitchen and living room at its center, not a nurse’s station, and personal furnishings. The bedrooms are private. Residents help one another with cooking and other work as they are able. Staff members provide not just nursing care but also mentoring for engaging in daily life, even for Alzheimer’s patients. And the homes meet all federal safety guidelines and work within state-reimbursement levels.

Why aren’t we all renegades? Are we incapable of thinking outside the box?

They have been a great success. Dr. Thomas is now building Green Houses in every state in the country with funds from the Robert Wood Johnson Foundation. Such experiments, however, represent only a tiny fraction of the 18,000 nursing homes nationwide.

“The No. 1 problem I see,” Dr. Thomas told me, “is that people believe what we have in old age is as good as we can expect.” As a result, families don’t press nursing homes with hard questions like, “How do you plan to change in the next year?” But we should, if we want to hope for something more than safety in our old age.

Do you know where a Greenhouse style nursing facility is located in your state?

The last paragraph speaks loud to those who dare to listen:

“This is my last hurrah,” the woman I met said. “This room is where I’ll die. But it won’t be anytime soon.” And indeed, physically she’s done well. All she needs now is a life worth living for.

A life worth living. If we must subject our elderly to a nursing home, let’s try to find one that has embraced culture change. Stay away from the old medical model and seek the newer way. As staff, we can educate and push and assist our current places of employment to MAKE change.

Over at the Network 54 CNA Forum a CNA brought forth an issue that must be addressed. This is about giving proper notice when an employee decides to quit their job.

NO MATTER what, a CNA must give a two week notice in order to be considered for re-hire status. Also, it’s the right thing to do. Think about it. If an aide is scheduled to work many shifts but suddenly quits, it leaves ALL those shifts open and often unfilled. Who suffers? The residents, patients, clients fist and foremost. Then the aides left behind to do the extra work. Management has to fill the position and do all the human resource things associated with this: Background checks, abuse registry check, hiring, orientation, mentor-ship if there is any, and on the job training.

In any line of work, it is considered absolutely vital to give at least two weeks notice of intention to leave a position. If one holds a college degree, usually this is a four week or one month notice.

In the Network 54 thread, the aide uses the excuse she was sick and couldn’t manage to work- which is a reasonable issue but would have been better handled a different way. She should have gone to her doctor and got a note excusing her from work for several days. We cannot expect to just ask for time off with no notice and get it. The DON refused to grant the aides request.
The aide quit her job..and then when she felt better she tried to go back to work at the nursing home. She was told she wasn’t eligible for re-hire, because she walked off her job. Her action had a consequence.

While I sympathize for this aide, I also resent that she felt it was appropriate to simply quit. And leave her co workers the brunt of the work, probably many unfilled shifts of hours open and most importantly, left the residents in jeopardy of poor care. Had she brought in a doctors note we would have seen the same thing, perhaps. But at least we would know she was truly ill (which I don’t doubt) and management would have kept her on staff; she would have returned to work and spared us all the time and effort of training new hires and all that.

Giving proper notice for leaving a job is just the right thing to do. When it isn’t done, there are many who pay the price.

I have been reading here and there about shift report.

How some nursing homes don’t seem to think the CNA needs to hear report. I think this is not only wrong, it’s bad business and a law suit waiting to happen.

CNA’s are the hands on care giver. They are the eyes, ears, noses and hands of the health care team charged with providing care to residents. When a resident’s condition changes, does it not make sense that the first, and more often than not ONLY people who will have any direct contact with the resident KNOWS of the change?

Nursing home management, that decides CNA’s don’t need to get shift report are setting the residents AND AIDES up for potential injury, harm and distress. Physical and emotional. Nurses, going down the hall, barking out orders to the aides, AFTER the nurse has heard report is not acceptable. By then we have often done our first set of residents and it’s too late for some orders to be carried out. Or, the resident must be placed back in bed or otherwise inconvenienced. And it wastes time, that which CNA’s don’t have a lot of.

Consider this. A resident fell on evening shift. At the time no known issues resulted from the fall, but the resident needed to be observed and assessed periodically until the doctor could see them the next morning. The doctor tells the evening nurse the resident is not to do any weight bearing activities until he sees the resident. Day shift staff arrive and are given their assignments and are told to go about their job. The aide assigned to the resident who fell has no way to know that a fall occurred… The CNA doesn’t get this info and transfers the resident via a stand pivot. SNAP. A hip is broken.

Consider this. A resident’s urine is noted to be dark and foul smelling. The resident cannot speak for herself but is continent. The day shift aide assists resident to the toilet, where she voids a medium amount of dark smelly urine…the residents usual habits indicate she won’t be voiding again until sometime after lunch. A sample was needed from the morning void but that info was never passed on to the aide in time. Now the resident must endure many more hours of discomfort and pain from the UTI she has, all because of a lack of communication.

A resident was up most the night. For whatever reasons, he could not get to sleep. He is known to have behaviors, and a trigger to this is being tired…the aides don’t get report. They find him in a deep sleep and think, “Oh well, he has to get up to eat!” and wake him up…and the aide gets punched in the face. A nice black eye and broken nose are the result. And time spent at a doctors office, ex rays, pain and suffering…all on worker comp billing. Because it was never passed on in report to allow the resident to sleep this morning.

Shift report is vital to CNA’s. We NEED the information…even when it is repetitive and mundane, it is important. CNA’s must have this information BEFORE they asked to provide care. The little details are often so helpful to us. When we know Mr. Jones hasn’t slept all night, we will allow him to sleep in, to be the last resident we get out of bed. When we know Mrs. Smith might have a UTI, we will collect a sample - many times without being asked. When we hear that Ms. Brown fall last night, we will ASK if she is able to do any weight bearing.

Report doesn’t have to be this long boring ordeal. Many facilities only pass on information that is out of the ordinary; the typical, usual and common information doesn’t always need to be shared. Normal vital signs, BMs, percentages of meals consumed and cc amounts of fluid intake are not overly important, especially if this information is logged in a book somewhere. On the other hand, elevated temps and B/P’s DO need to be passed on; a lack of a BM in 5 days NEEDS to be passed on; consumption of NO fluids has to shared.

Part of what every CNA needs is information.
We use our training and experience to make everyone’s jobs a little easier; to make our residents comfortable. We depend upon good communication from previous shifts and nurses to provide care that is safe and appropriate. Nursing home management should always insist CNA’s take part in shift report. It should be a mandatory expectation; and, taking this one step further, if an aide shows up late for work, he or she should NOT be allowed to take an assignment until they hear report.