The National Association of Health Care Assistants- NAHCA- used to have a magazine for CNA’s called “CNA TODAY”- it ceased publication a couple years ago. NOW, they introduce a new magazine for ALL direct care workers in the nursing field, titled, “MY CAREGIVER”.

From the MY CAREGIVER web site:

My Caregiver is a quarterly magazine published by the Academy of Certified Health Professionals (ACHP) for and about health care assistants and their role in long term care. It is a special magazine, a publication virtually every person in the long term care industry will want to read.

With a circulation of 10,000, we reach nursing assistants, Directors of Nursing, facility Administrators, nursing home residents, and their families, product manufacturers, policy makers, and other health care associations.

The first issue of My Caregiver debuted March 2008. It evolved from the original CNA Today magazine to focus on health care assistants from diverse settings in long term care. The original magazine, CNA Today, launched June 2001 and was unveiled at the NAGNA National Convention.

Now My Caregiver will prove to be a remarkable resource for information on long term care for all who perform the role or duties of a nursing assistant, regardless of title.

The magazine is published quarterly and costs $15.00/year for non NAHCA members; $10.00/year for members.

NAHCA’s main web site is HERE.

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.

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.

Over at the PHI blog, Elise shares an interview of Barbara Bowers with readers. It’s pertinent here as well. Barbara is a tireless advocate for CNA’s and direct care givers- advocating better working conditions and wages among other things.

Nurture relationships between direct-care workers and the people they care for. “Those relationships are the most important thing to people in long-term care. That I’ve heard from the first day, and hear over and over again,” she says. “We know that, yet we still don’t seem to do much about it. We still don’t even have permanent assignments in lots of places.”

Show more respect for direct-care workers. “I think we need to better understand how to be supportive of CNAs,” she says. “I still hear all the time that CNAs feel like they’re looked down on, scolded publicly, humiliated. The nurses doing that don’t realize they’re doing it at all - they don’t mean to do it. I think they actually have a tremendous amount of respect for CNAs. They just don’t know how to supervise.”

Improve wage, benefits, and staffing ratios. “Certainly we need more staffing and we need more money,” she says. “I don’t know if we need any more studies to tell us people would be happier if they got paid better and they got better benefits - we just need to do something about it.”

Give CNAs more control over their work. “I don’t know if we know enough about how to better organize the work so CNAs can get more control over their work flow, so they can do what they know they need to do.” Hiring enough people is part of it, she says, but that’s not the only factor. “It’s also things like how they’re supervised, how they’re trained.”

At another time I will further address some of the points listed here…I think there’s a lot more to all this that needs to be spoken about.

Nursing Home Magazine does it again: AN excellent article about dysphagia and swallowing problems, some of which is aimed at CNA’s:

Dysphagia is not unusual among older adults living in long-term care facilities. One study recorded the presence of mealtime difficulties in nursing home residents and found that nearly 90% had impairments that included dysphagia, poor oral intake, positioning problems, or challenging behaviors. Furthermore, 68% of the residents experienced dysphagia, compromising their ability to enjoy meals, let alone consume the necessary calories to meet nutritional requirements. Dysphagia can lead to aspiration, choking, dehydration, malnutrition, and pneumonia. In fact, aspiration pneumonia is the fifth leading cause of death in people over 60 years of age and the third leading cause of death in people over 80. Clearly, food intake is crucial to many residents’ health and quality of life.

Residents with dysphagia often require modified diet consistencies, such as thickened liquids or pureed foods. In addition, nursing assistants must often comply with specialized feeding techniques, such as placing food in the non-impaired side of the mouth, limiting the use of straws, or facilitating the use of adaptive feeding equipment. In the dining room, nursing assistants who provide help to, monitor, or feed residents must follow the techniques for the residents’ safety and nutritional health. Failure to successfully comply with swallowing and feeding recommendations can cause inadequate hydration and nutrition and unsafe feeding.

More:

Through therapy, a speech-language pathologist can help many residents with dysphagia learn compensatory swallowing techniques. Researchers have found that poor staff training and a lack of understanding about feeding recommendations can cause malnutrition and dehydration in long-term care. McGillivray and Marland conducted a review of the literature on assisting people with dementia during meals. Their review found that mealtime assistance is often stressful for residents and staff because feeding becomes task centered and staff have not been sufficiently educated or trained.

I think ALL staff could use more training.

Did you know?

Signs and Symptoms of Dysphagia
Some signs and symptoms of dysphagia are not commonly known. For example, did you know that a persistent low-grade fever might be a sign of dysphagia? Did you know that if a resident is spitting food at meals, he or she might have oral phase dysphagia and might be unable to chew properly? Review the list below with your staff. Residents displaying the following signs and symptoms of dysphagia should be seen by a speech-language pathologist:

* Having trouble recognizing food
* Difficulty placing food in mouth
* Drooling or spitting
* Food falling out of mouth
* Pocketing of food in mouth
* Rocking tongue back and forth while chewing
* Food left in mouth after the swallow
* Chewing for a long time
* Coughing before, during, or after the swallow
* Delayed or absent rise of the larynx during the swallow
* Requiring 3–4 swallows after each bite
* Continuous throat clearing during or after the meal
* Wet or hoarse voice
* Complaining of something caught in throat
* Refusing to eat or very slow eater
* Lasting low-grade fever
* Unplanned weight loss or unexplained loss of appetite
* Pneumonia
* Malnutrition or dehydration

This article provides an excellent review of swallowing problems for nursing home residents and would be a timely and good resource for an in service.

Florida state representative Pete Nehr has penned an op/ed that is very timely.

Part of it:

As an elected state representative, one of my most important duties is to provide for the safety of my constituents. As you read this, the largest nursing home chain in the United States, HCR Manor Care, is being purchased by the Carlyle Group, a private equity firm that owns Dunkin’ Donuts, Baskin Robbins and Hertz Rental Cars. The details of this acquisition are particularly worrisome. Carlyle will pay for the company by loading it down with $5.5-billion in debt. To pay back this debt, Manor Care will have strong incentives to do what 60 percent of other nursing homes purchased by private investment firms have done: cut costs by significantly reducing staffing, sometimes below federally recommended levels, and cutting other budget items at the expense of patient care.

At the same time, Manor Care’s executives will be making up to $250-million in this deal and the Carlyle Group stands to make up to $60-million.

He’s written much more so make sure you check it.

In South Dakota state legislators are considering using the state pay model for it’s nursing homes and training centers.

PIERRE - Turnover caused by low pay is creating what one lawmaker called a “looming crisis” in staffing South Dakota’s nursing homes and adjustment training centers.

The Legislature’s Appropriations Committee recently discussed - without taking action - a possible pilot program to use a state-employee style of pay for direct-care workers in nursing homes and training centers, which work with people with disabilities.

Such a plan could cost millions of dollars from the state treasury. Without action, a center or nursing home might close, throwing the burden of care for its residents or clients onto the state, some lawmakers fear.

Sen. Jerry Apa, R-Lead, said some reports show turnover rates of 48.5 percent for some direct-support staff.

“The fact of the matter is, we have a looming crisis here, and if we don’t get a hold of it and address it, one of the ATCs is going to close,” Apa said, according to audio minutes of the meeting.

Rep. Jim Putnam, R-Armour, who helps lead the Joint Appropriations Committee with Apa, also anticipates a growing problem unless change is made.

“I don’t think anyone in the state wants to have a nursing home or an ATC or any of the other folks that care for people close up,” Putnam said. “I don’t know that’s a problem at the moment, but it certainly could be one on the horizon.”

Read the rest of this article; some interesting stuff!

A CNA/artist uses her talent to brighten up holidays.

Obert, a certified nurses assistant, uses her spare time as an artist to make her workplace, San Juan Living Center, a little more colorful. A self-proclaimed Halloween “nut,” she typically decorates for the Christmas season but decided to expand to other holidays this year.

“I have been a CNA going on 12 years now,” Obert said. “But I really like to add a little to my residents’ hallway if I have the time. I enjoy making decorations and hanging them up. I am in a cardboard phase right now.”

Obert drew various cardboard characters that her husband cut out and she then painted. She collects cardboard from leftover boxes from her work, and for larger pieces, her husband gathers refrigerator boxes.

“Halloween is my favorite holiday, but normally I would just decorate for Christmas,” she said. “The residents really enjoy it. I am always looking at Halloween decorations, but with the prices really going up, I started looking at stuff more closely. I thought to myself, ‘hey this stuff is kind of flimsy and I could make things better than I could buy.’”

I bet she would make a great Activities Assistant!

Two Congressional Committees have agreed to investigate the dealings of Carlyle Group and other private investment firms, and the management practices of nursing homes.

Two Congressional committees announced yesterday that they would investigate business practices at nursing homes owned by private investment groups.

The scope of the inquiries by Representatives John D. Dingell of Michigan, chairman of the Energy and Commerce Committee, and Barney Frank of Massachusetts, head of the Financial Services Committee, are still being determined, but will probably include hearings and proposed legislation, a committee spokeswoman said.

The investigations are the latest scrutiny of private equity investments in nursing homes.

Last week, Senators Max Baucus, Democrat of Montana and chairman of the Finance Committee, and Charles E. Grassley, Republican of Iowa and its ranking minority member, sent letters to five private investment firms seeking information on their ownership and management of nursing home chains. The senators also asked the agency responsible for many payments to nursing homes, the Centers for Medicare and Medicaid Services, about its oversight of such homes.

This month, officials in five states expressed concern about the Carlyle Group’s $6.3 billion acquisition of the nation’s largest nursing home chain, HCR Manor Care. State legislators in Florida, Illinois, Pennsylvania, Michigan and Washington have asked regulators to investigate the acquisition by Carlyle, a private equity giant, or withhold approval pending greater scrutiny.

“There are serious concerns that private equity firms are reducing the care at nursing homes by decreasing the number of employees,” Mr. Dingell said. “We’ve been made aware that nursing home residents are losing their ability to use lawsuits to fight poor care, and that people may be suffering.”

It should never get to the point where I lawsuit is needed; nursing care should come first even over the profit margin. Alas we know better.

Representatives of the Carlyle Group and other private equity firms said their companies intended to cooperate with all inquiries. Carlyle said it was committed to maintaining high standards at the 552 Manor Care facilities after the deal closes, which is expected late this year.
[…]
To counter such criticisms, Manor Care began sending letters to regulators and officials in the 32 states where its facilities are located, pledging to maintain staff levels and other quality standards. The company has also sent letters to residents and their families criticizing the article in The Times and the union’s efforts. The mailings have said that the Carlyle Group does not intend to overhaul Manor Care in ways that make it harder for regulators to trace ownership.

But documents filed with Maryland regulators indicate that Carlyle plans to reorganize Manor Care to make each nursing home a stand-alone company, and to separate ownership of the homes’ real estate and operations. Other private investment groups have used such structures to avoid liability and regulatory scrutiny.

Uh huh…here we go. Already these groups are trying to hide the very people who should be held accountable when poor care results in actual harm or even deaths of residents, all in the name of profits.

The Congressional inquiries and hearings may lead to significant shifts within the nursing home industry.

“When Congress has examined nursing homes in the past, it’s led to fundamental changes,” said David Zimmerman, a professor at the University of Wisconsin and president of the Long Term Care Institute, a nonprofit group. “The government pays for a great deal of nursing home care. If they demand transparency on ownership and liability, they’ll get it. Private equity groups have reasons to be concerned.”

Let’s hope so. Let’s get the profit motive out of the nursing home business and put the caring motive back. These places are bad enough, we don’t need any help from people who have no idea what it is we do…private equity groups should be banned from having anything to do with health care facilities.

…is worth so much. Do the elderly have poor sleep patterns?

As every sleep researcher knows, the surest way to hear complaints about sleep is to ask the elderly.

“Older people complain more about their sleep; they just do,” said Dr. Michael Vitiello, a sleep researcher who is a professor of psychiatry and behavioral sciences at the University of Washington.

And for years, sleep scientists thought they knew what was going on: sleep starts to deteriorate in late middle age and steadily erodes from then on. It seemed so obvious that few thought to question the prevailing wisdom.

Now, though, new research is leading many to change their minds. To researchers’ great surprise, it turns out that sleep does not change much from age 60 on. And poor sleep, it turns out, is not because of aging itself, but mostly because of illnesses or the medications used to treat them.

“The more disorders older adults have, the worse they sleep,” said Sonia Ancoli-Israel, a professor of psychiatry and a sleep researcher at the University of California, San Diego. “If you look at older adults who are very healthy, they rarely have sleep problems.”