If you’re looking for prepared programs to further you’re knowledge as a CNA, this site has a comprehensive listing of courses. For LTC facilities mostly, this site offers online classes that staff can participate in through their employer.

Academy of Certified Health Professionals

ACHP Educational Programs

A revolutionary continuing education program designed to meet the complete needs of health care providers. Programs are geared to real life educational needs based on feedback from nursing assistants, charge nurses, administrators, staff development coordinators, CNAs and nursing directors.

A sample list of course titles:
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Skin Integrity Management
Course Number 150
Professional Point Value 10
Level of Difficulty
Description: This course details the anatomy and physiology of the integumentary system, age related changes, and preventive care to maintain skin integrity.

Pressure Ulcer Prevention
Course Number 250
Professional Point Value 15
Level of Difficulty
Description: Knowing that prevention is the best treatment of pressure ulcers, this module outlines the risk factors identified for skin breakdown, causes of skin breakdown and caregiver implications related to pressure ulcer prevention.

Weight Loss Management and Intervention
Course Number 350
Professional Point Value 15
Level of Difficulty
Description: Adequate nutritional intake is imperative for skin integrity and wound healing. Unplanned weight loss puts the frail and elderly at risk for pressure ulcer development and impaired wound healing. This course defines the necessary nutrients, vitamins and minerals for optimal health, plus caregiver methods to reduce unplanned weight loss and optimize nutritional intake.

Wound Healing in the Elderly Individual
Course Number 450
Professional Point Value 20
Level of Difficulty
Description: Building on the material presented in Courses 150, 250, and 350, this module provides, in great detail, the phases of wound healing, the ideal environment to promote wound healing, and how the CNA can positively impact wound healing.

Developing and Implementing Resident Safety Protocols
Course Number 160
Professional Point Value 10
Level of Difficulty
Description: Nursing assistants are the first line of defense against resident accidents and injuries. This course will explore realistic and hands-on techniques to ensure the safest environment and care for the frail, elderly and disabled needing assistance.

Infection Control for the Nursing Assistant
Course Number 260
Professional Point Value 15
Level of Difficulty
Description: Because even the mildest of infections can be life threatening to the frail, elderly and disabled, it is imperative the CNA have a good working knowledge of the chain of infection and how to prevent the transmission of infection to those in their care. This course will cover those topics, plus other techniques to reduce the risk of infection both to residents and staff alike.
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There are MANY others.

Also, this service offers a CAREER LADDER PROGRAM based on the completion of the courses. This would be geared for facilities and not individual CNA’s.

White Coat writes about his experience watching an old woman die in an ER. She had been transferred to the ER from a nursing home:

As I walked in to evaluate her, I could tell she wasn’t going to live much longer. She didn’t respond when we called her name and she didn’t move when I gently gave her a sternal rub. She had agonal breathing and wasn’t moving any air. I just stood there for a second. Everyone was obsessed with her being a DNR. This is a woman, for Pete’s sake. She’s a grandmother, maybe a great-grandmother. Someone’s wife. A next door neighbor. The one who always seemed to win at BINGO in the nursing home. Someone who baked cookies for the church bake sale.

Then my mind began to wander. What songs did she used to sing to her kids to help them go to sleep when they were scared at night? What were her fears? Did she know how to bowl? How many people have her picture sitting in their homes somewhere and will forever look at it differently after today? Did she have any co-workers? Would they even know she was gone? How long had it been since she cooked her husband’s favorite meal, waiting to surprise him when he got home from work? It was like I was subconsciously overcompensating for her being a “DNR” by thinking about all the things that made her human. A whirlwind of these whacked out thoughts kept running through my mind.

How often do we label our residents/patients by their diagnoses or diseases, or, in this case, their Living Will status?

This is haunting:

I stood there and watched her for a little while. I watched her take her last breath. I watched her heart generate it’s last electrical impulse on the cardiac monitor. It felt strange not to be calling out orders for medications and chest compressions. For some stupid reason the whole scenario bothered me. She died in the bright lights of an ED room and the only ones at her side were a doctor and a nurse she had never even met before.

Is there a lesson to be learned here? When I worked in nursing homes, far too often we shipped off very ill people who we knew were going to die; the nurses knew it, the aides knew it. Usually the defense for uprooting the resident was incidental and based on legal fears; one nurse used to often say “No resident is going to die on my shift HERE!” Whatever. As the doctor says, why do the ER thing? Can’t we just allow our residents to die in the setting they now call home? Even those with no family deserve better.

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.

More Congressional fallout for the private equity buyouts of nursing homes.

Private equity firms have been rapidly buying up nursing homes in the last few years, sometimes using complex ownership structures to shield them from lawsuits. Now they have attracted attention in Washington.

Two members of the United States Senate on Thursday asked the federal agency that oversees nursing home inspections to account for what The New York Times described in September as an increase in health and safety violations at nursing homes bought by private investors. The lawmakers, Max Baucus of Montana of Chuck Grassley of Iowa, also sent letters to private equity firms, including the Carlyle Group and Warburg Pincus, seeking information about their nursing home investments.

Mr. Baucus, a Democrat, and Mr. Grassley, a Republican, are the chairman and ranking member, respectively, of the Senate Finance Committee. They have already squared off with some of the biggest players in the private equity industry. Earlier this year, they proposed a bill that would more than double the tax rate on publicly traded investment firms such as the Blackstone Group and the Fortress Investment Group. Such a measure would also likely apply to Kohlberg Kravis Roberts if it goes through with its plan to go public.

On Thursday, the two lawmakers turned their attention to private equity’s role in the nursing home industry. Most nursing home fees are paid by Medicaid and Medicare, two programs overseen by the Senate Finance Committee.

In a press release, Mr. Baucus and Mr. Grassley expressed concern about the findings in the report, by The Times’ Charles Duhigg, that after nursing homes were acquired by buyout firms, their residents were generally worse off than under the previous owners.

“Nursing homes aren’t just investment vehicles,” Mr. Baucus said in a statement. “They’re homes for some of America’s most vulnerable citizens.”

Let’s hope this attention from Congress scares off some of these unethical groups. Sometimes though, these investigations and hearings only serve to create more unscrupulous investing deals- the bad guys learn how to hide themselves even more. We will stay on top of this.

Reactions from that NYT article about nursing home investments vs. quality care:

First:

WASHINGTON, Oct. 2/PRNewswire-USNewswire/ – Concerned that the trend toward private equity ownership of nursing homes is diverting taxpayer money to enriching top executives and buyout firms at the expense of quality care, the nation’s largest healthcare workers union is calling on Congress to take action to improve the quality of care and hold private equity firms accountable for their ownership of nursing homes.

Citing a recent New York Times investigation, the experience of nursing home caregivers, and concern over the pending buyout by the Carlyle Group of the nation’s largest nursing home provider, HCR Manor Care, SEIU sent letters Friday to the Chairmen of the House Committees on Ways and Means, Energy and Commerce, and Oversight and Government Reform, and to the
Chairman and Ranking Member of the Senate Finance Committee.

Then this:

To US Senators want to know if nursing home abuse and neglect are more prevalent in facilities owned by private Wall Street equity firms, and they are asking the Government Accountability Office (GAO) to find out. Their requests come on the heels of a New York Times investigation that found that the quality of care at nursing homes dropped sharply after they were acquired by private investment concerns.

Senators Hilary Clinton (D-NY) and Charles Grassley (R-Iowa) based their requests on the report in the New York Times that said drastic cost cutting measures imposed on nursing homes once they were purchased by private equity firms made nursing home neglect and abuse far more likely. Recently, private investment firms have looked to nursing homes as a possible route to easy money. These firms buy facilities, drastically reduce their costs, then turn around and sell them at huge profits.

Good to see some action coming from the NYT article. The NYT isn’t always accurate with it’s reporting; and they are known to have an agenda that isn’t always friendly towards the business community. In this case though, we KNOW through our own work and experiences that these nursing homes are just bad places. WE know of the staff cutbacks, the supply shortages and neglect forced upon the residents. I hope something good comes of this. Our elderly deserve so much better.

More about nursing homes/assisted living facilities hiring and then firing or HIDING staff who have criminal backgrounds.

NEW PORT RICHEY - A man applied for a job at a home for the elderly. He had pleaded no contest to a violent felony; he was hired nonetheless. One morning last week, police say, he lunged at an 78-year-old Alzheimer’s patient and punched him in the face.

The man went to jail, but he was not the only person with a criminal record on the New Port Inn’s payroll. At least two other caregivers also had records. And before state investigators arrived Tuesday to survey the facility, those caregivers were swept out of view.

Not good. I suspect we will be reading more about this in the coming weeks. (I hope so anyway).

The tales found in the Texas Department of Aging and Disability Service’s disciplinary files can be savage, sad and stomach-turning. But they are intended to serve an essential purpose: protecting Texas grandparents, disabled children and the terminally ill from abusive or dishonest nurse aides and other caregivers.

But dangerous blind spots plague the system that oversees them, a Star-Telegram examination has found. Across the state, caregivers facing discipline for sexual misconduct, theft, abuse — and a fatal case of neglect — were all able to find and hold new jobs.

Consider this: The department has banned about 680 people — for life — from working at any of the facilities it regulates. Yet every two years, the department renews the certifications of some of those same workers as nurse aides. One San Antonio aide, blacklisted for stealing an elderly man’s identity in 2005, has a new certification good through 2009. A Lubbock aide banned for swindling an elderly woman out of more than $100,000 works for a healthcare staffing company and insists she’s not caring for patients — “We do billing,” she said. Another, banned for neglect, was fired from a Plano nursing home only after the Star-Telegram questioned her status in August.

Just how do those workers keep getting recertified? All the state requires for renewal is evidence that an aide is still working.

So if a blacklisted aide continues to hold a job and sends that evidence to the state, no one checks to see whether they should be working before issuing the renewal.