About SEIU in California:

The California agreement was set to expire at the end of last year; the union and the nursing homes are currently negotiating a possible extension. Whether, or how, the agreement will be extended may have been thrown in doubt thanks to complaints about the current agreement coming from Rosselli’s UHW-West.

On the SEIU’s side of the 2003 bargain, the union agreed to use its clout with Democratic legislators in Sacramento to accomplish three goals of interest to nursing home owners:

The SEIU pledged to use its lobbying muscle to pass a 2004 bill increasing MediCal subsidies to nursing homes by more than $2 billion over four years, according to patient advocates. The bill passed, creating a windfall for nursing home owners.

The union also agreed to attempt to pass tort reform legislation that would have limited patients’ right to sue in the event they were neglected, raped, abused, or killed. (The union’s tort reform lobbying efforts were put on hold, however, after a 2004 SF Weekly story led union members and advocacy groups to complain.)

The SEIU also pledged in the 2003 pact to staunch any efforts by patient advocates to push for legislation or regulations requiring nursing homes to provide enough staff to keep patients safe and healthy, unless the nursing home companies agree to such reforms in advance. The SEIU will “oppose any long-term-care-specific staffing and reimbursement legislation or regulation that fails to meet mutually agreed objectives,” the agreement states.

According to lobbyists for nursing home patients, the union has indeed been successful in repressing efforts by nursing home advocates to pass legislation that would have tied increases in state nursing home subsidies to improvements in the quality of care.

In return, the nursing home chain owners agreed to allow the SEIU to recruit workers into their union. Under ordinary circumstances, nursing home owners vigorously resist union organizing drives by occasionally intimidating and firing union-sympathetic workers, and by attempting to convince them that union membership isn’t in their interest. Under the lobbying agreement, however, the nursing home chains would refrain from these tactics in a certain number of facilities if the union helped to pass the 2004 funding bill, and in more facilities if the union got tort reform legislation passed.

This is specific to CA. Other states as well, have fallen to the new union movement…which basically is all about getting you to sign onto a union, taking your money in the form of dues, and allowing management to still call the shots. People should be very concerned about this. Not just SEIU, but all of them. They are trading their values for memberships. Is it worth it?

Our friends over at the National Clearinghouse on the Direct Care Workforce have linked to a PDF article that is WELL worth your time. Print it out and plan on a good half hour or so to read this. This article is about leadership skills among the front line workers- CNA’s, dietary staff, ect.

Highlights:
Page 3

Some facilities look at CNAs and see shining stars. One such organization took some of these heavenly lights and put them in
charge of a special club for assisted living residents who had some memory impairments but weren’t ready for the special Alzheimer’s unit. The new group leaders received training in recreation and activities and ways to socialize with and support residents. “These caregivers take great pride in the fact that they are now coordinators and in the deep connection and
involvement they have with these residents,” said the administrator.

Page 4:

One of the easiest and most popular means of building leadership from the ground up in long term care facilities is to give staff opportunities to mentor new hires and subordinates. “You can have a position that says senior aides are able to teach and model best practices of organizations. They can assist in orientations and help identify and address barriers to keeping employees,” says Powell. Some companies are going online. “We started nurturing our medication aides by providing monthly online training that includes leadership skills,” says Sandi Flores, RN, head of Community Education, a provider of assisted living and residential care education in San Marcos, Calif. “We found that when we give them leadership skills, retention rates just
soar,” she says. “You can take this to the bank. I say, ‘Give me a little money for staff training, and I can save you
thousands on staff turnover.’”

A creative and impressive idea for Assisted Living:

The program starts with a three month orientation period, during which caregivers take classes about dealing with dementia, assisting people who need physical assistance, and related topics. If they complete all the requirements by the end of this period,
caregivers become a PCA 1 and get a monetary bonus. They then can go on to become a PCA 2, which requires additional training and a minimum of nine months employment at the facility. At the completion of this phase, caregivers get a pay raise, a certificate of achievement, and formal in-house recognition. At level PCA 3, caregivers become certified care associates. “These are specially selected people,” says Kanaskie. “They have to demonstrate exceptional performance, express interest in customer performance, and demonstrate leadership skills.” Candidates at this phase must interview facility leaders and complete a project—something that improves resident care or makes life easier for staff.Past projects have included organizing a resident choir and leading group validation services for patients with dementia.
“This program enables motivated caregivers to become highly competent —if not experts—in their role. They feel good about their ability to do their jobs. They put extra work into it, and we recognize their efforts,” Kanaskie says.

Like I said, this is in PDF format. It should be printed out and read in hand. I found it to be extremely motivating and plan to bring it to work and show my DON. If they did these types of things at my work I GUARANTEE the turnover would decrease. We don’t get paid much. We don’t get recognition for the HARD work we do. THESE things would improve morale and would show that management CARES and wants to see everyone do better. AND I daresay having a program or two like some of these would help keep unions OUT too.

Here’s an interesting article that every pro union person should read…this happens A LOT. Is this a sell out or a good idea?

OLYMPIA, Wash. (AP) — Service Employees International Union Local 775 has a confidential agreement with several for-profit nursing home operators, promising to help push for $60 million increase in state money for nursing homes.

In exchange, the companies have agreed to accept the union’s organizing efforts, The Seattle Times reports.

According to a draft agreement obtained recently by the newspaper, SEIU Local 775 has promised no strikes and will let operators, not the union or workers, decide which homes can be offered up for organizing. The union also agreed not to try to organize more than half of a particular company’s nonunion homes.

The union and the operators have also agreed not to speak ill of each other.

A strict confidentiality clause has prevented both sides from disclosing details of the agreement to the media, even though the existence of the pact was publicly known. David Rolf, president of Local 775, would not talk about the pact or say how closely the draft obtained by The Times looks like the final agreement.

SEIU is the largest union in North America, with about 1.9 million members. It’s also the largest union in Washington, where SEIU and its affiliates represent more than 100,000 workers.

SEIU Local 775 represents 28,000 home-care workers and about 1,500 nursing-home workers in 17 facilities statewide.

Union leaders and some nursing-home executives have said their partnership - which is modeled after similar agreements in other states - has given them stronger political clout in the state Capitol.

“Wouldn’t it be something if people thought unions weren’t about creating problems but they were actually about working with management to solve problems?” Rolf said. “Where is it written that the thing we need to do most is have fights?”

But there are critics of the pact, who say it goes much further than it should.

“This a terrible abrogation of a union’s duty,” said Jamie Court, president of the Foundation for Taxpayer & Consumer Rights, a California-based consumer-advocacy group that has criticized similar alliances the SEIU has formed elsewhere.

“These types of agreements are unions becoming wholly owned subsidiaries of the health-care corporation that they are supposed to have an adversary relationship with.”

But SEIU leaders say years of conflicts have done little to improve things for nursing homes or their workers in the state.

Adam Glickman, spokesman for SEIU Local 775, said union leaders in Washington recognized that nursing homes have been underfunded for many years, so they started discussing teaming up with operators.

“It doesn’t do workers a lot of good to form a union in a nursing home if there’s no money to negotiate over,” Glickman said.

The union is pushing lawmakers this year to approve a $60 million Medicaid increase in the next two-year budget, which would be matched by federal money. Much of the money would go toward worker wages and benefits and patient care.

As of last week, it was unclear how much money the nursing homes would get. Gov. Christine Gregoire has proposed an additional $15 million, and legislative leaders indicated they probably would not go much higher.

About workplace teams- groups brought together in an effort to make change, seek input, tackle problems and issues:

Why Be Part Of A Team?
You’ve been asked to participate on a team to accomplish some task. Immediately your decision-making process begins.

* What is the purpose of the team?
* Is it a topic that interests me?
* Who will be on the team with me?
* What kind of authority will we have?
* Is it important to management?
* What is the reward for participating?
* What is the risk (perceived as punishment) for not participating?
* How long will it run?
* Will I be better off as a result of my participation?

And:

Factors That Influence Team Motivation

I. Purpose
I have asked people for years to describe the characteristics of their most successful and rewarding team experiences. At the top of almost everyone’s list is a clear purpose, focus, or mission. But further, for long-term motivation, it must be a purpose or mission that they find aligns with their personal wants and needs.
[...]
II. Challenge
Another term that I hear frequently when I ask about team motivation is challenge. The human species, as with most animals, has been given a survival mechanism called fight or flight syndrome. When presented with a challenge, our defenses are alerted to move us to action….to run away from danger or address it directly.
[...]
III. Camaraderie
If one studies highly effective groups, one finds that the most successful groups over the long haul tend to address both the technical needs and human needs. These groups are at the same time competent in the work they perform and highly functional in their interpersonal relationships. The group is well balanced in both technical and human skills.
[...]
IV. Responsibility
In general, people and teams are stimulated by being given responsibility. Having ownership of an identifiable block of work is a long-held tenet of motivation in groups.
[...]
V. Growth
Finally, personal and team growth can provide another basis for sustained motivation. When people feel they are moving forward, learning new concepts, adding to their skill base, and stretching their minds, motivation tends to remain high. Personal growth adds value to the individual, enhancing self-esteem and self-worth.
[...]
VI. Leadership
A good leader can be a catalyst for motivation in the short term, but the best leaders create the conditions for the team to motivate itself.

Lots of other good stuff here.

Some thoughts and ideas about nursing homes and Unions and how to avoid them.

To avoid unionization, management must act like a union when employee grievances arise

The number of unionized workers in the private sector continues to diminish; it is estimated that no more than a small fraction of the nongovernmental workforce is currently unionized. To maintain a productive nonunion workforce, however, the management of nursing homes and assisted living facilities needs to assume the role that unions played at an earlier time in corporate America.

Nursing homes are typically managed in a very autocratic manner. Staff are given little to no leeway in the day to day tasks they are assigned to do. CNA’s are paid poorly and the work is very hard on them. Many aides seek union representation based upon these things: Better pay and benefits; less forced overtime, a voice in policy and procedure planning. These are the nut and bolt reasons aides want to join unions.

But another set of reasons is very clear as well. For whatever reason, the nursing home environment is very degrading to so many. Staff disagreements, disrespect, poor treatment from charge nurses and others; family who make demands that are often superficial and often leave other residents with less time for care. The workplace culture of the typical nursing home is a sad sight. Aides are left feeling they have no recourse for their concerns and issues. They feel helpless and devalued.

Unfortunately, not many nursing homes and assisted living facilities have managers trained to “supplant” unions, and that lack of training can be a significant detriment to a company’s overall well-being.

This is very true…the lack of sound and basic management experience we see in so many who lead is evident…the administrators try hard to be fair, to be honest, to do the right things…but MANY of them have no real MANAGEMENT experience. Sure, they are college educated with business degrees. Yes, they are licensed to do their job. But to actually manage staff— I don’t think so.

Some ideas to make a nursing home UNION FREE:

Alternative Dispute Resolution Programs

Human resources (HR) executives must be expert in administering alternative dispute resolution (ADR) programs, of which there are many types. ADR programs are generally welcomed by both management and employees, because they are cost-effective and swiftly arrive at fair resolutions. One obstacle that I frequently encounter, unfortunately, is management’s fear of giving up its traditional power. Yet by involving employees in the process, management will not be perceived as arbitrary or capricious. I always try to explain to administrators and managers that by being proactive rather than reactive, they create a general feeling among employees of inclusion, and that goes a long way toward increasing productivity and morale.

While there are many ADR programs that I recommend as part of an overall proactive program, the three most common types are:

* Arbitration. This is an adjudication process during which a third party hears both sides of a dispute, weighs the evidence, and renders a decision. Both sides may agree prior to the commencement of arbitration that the arbitrator’s decision will be binding, or they may agree that there could be an appeal to another body to reach a mutually acceptable decision.

* Mediation. In this case, the third party does not render a decision but facilitates open and ongoing communication designed to lead to a mutually acceptable settlement. In most cases, the mediator is an outside professional without the authority to render a decision.

* Peer review. This is a representative adjudication process that relies upon a selected panel of managers and employees. A majority of the panel is required to render a binding decision. Peer review should not threaten management’s perquisites, because in most cases employees will side with management.

These programs give all employees a voice in every aspect of their work. Usually the issues that would be addressed by these programs would be disciplinary actions, evaluations and pay raises (or lack of). Most times, the employee filing a concern is found to be correct with their issue. Management has to agree to accept the terms of the agreements made and so do the employees.

Focus Groups

When management successfully supplants the role of a union, it also undertakes one of unions’ traditional roles: listening closely to what employees think and feel about their jobs, their futures, and their company and its policies.

One of the best means of doing this is through focus groups, which provide management with significant opportunities to gather reliable and representative information about its workforce and their attitudes. Focus groups also permit management to communicate real issues through ongoing employee involvement.

Not just with employee attitudes, these groups can render extremely valuable information about procedures, risks, quality of nursing care, safety and budgetary issues. CNA’s, housekeepers and dietary workers have a lot of really good insight into the ways and hows and means of their jobs. They also have ideas for improvement and innovation. Listen to them!

Team Building

Focus groups lead to team building. While focus groups are exploratory, teams are the instruments that implement strategic plans designed to accomplish specific goals.

Historically, unions have created a sense of employees playing on the same team, a sense of employee solidarity. In today’s complex work environment, management can create that same spirit of solidarity to accomplish commonly shared productivity goals and to solve important problems.

Teams can serve such purposes as enhancing communication and resolving conflicts, but teams are most effective as a means of increasing productivity and enhancing employee morale. When it comes to meeting certain productivity criteria, for example, the entire team is mutually responsible for reaching those goals. One need only look at various sports teams to see how valuable mutual cooperation is to winning. In successful corporations, no one is an individual sprinter, although individual initiative is extremely important to the overall success of a team and the achievement of its goals.

I have two thoughts about team building. I think there are two different types of teams to be spoken for…the actual teams that work together each shift…in each unit and department. And then there are other teams- groups brought together to address problems and issues. BOTH groups need to learn to work together to accomplish anything.

1) Unit based teams can and should be given some autonomy as to how they work together. Group norms, expectations and problems can be dealt with by the members of the team, without management involvement. Scheduling, assignments and activities can be planned by the staff who regularly work these units. In order to achieve a well run team it’s leader MUST be well versed in leadership skills…and most charge nurses have no real management experience. So this is risky.

2) Teams pulled together to address broader company wide issues need to be educated on how real teams work. Ideas about building consensus, debate, and all those other skills are not naturally learned.

Coaching
An essential spur for a team’s success is having an effective coach. A coach is a counselor, not a disciplinarian. The coach encourages employees to do better, to accomplish more; the coach works to rehabilitate negative employee attitudes, emphasizing what’s positive; the coach is not a punitive taskmaster.

Team leaders, focus group leaders ALL must get out of the BOSS mode and get into the “We’re working together to make it better” mode. Management has to drop it’s hat and allow others to help them MANAGE.

Of all the advice offered up through this article I have linked to here, this is one of the best:

Employee Advocate Representative

As unions have shop stewards who represent the interests of the union members by reporting back to union officials, so nonunionized companies can have what is known as an Employee Advocate Representative (EAR). The EAR position is usually a trial assignment aimed at improving morale by involving employees in a broad spectrum of management activities and decisions. When employees want to make their concerns known to management, the EAR listens and then voices those concerns to management. The EAR is both the ears and voice for employees. This position may or may not be salaried and is held for a limited time. Once a term expires, another employee is either chosen or volunteers to be the EAR. To enhance a sense of employee inclusion, the EAR position should be filled by as many employees as possible. Such rotation ensures the greatest amount of employee inclusion and further guarantees that no employee is perceived as a being a tool of management. In small companies, the EAR can work in that position for an hour or two each week.

An in house mediator…someone who is trusted to speak up for those who don’t want to speak for themselves. Someone who is respected and fair; someone who has the ability to see ALL sides of issues YET someone who works on the units. The person who accepts this role must be emotionally strong as well. Management must allow this person the time to perform the very important tasks needed. This might mean a shift a week of being assigned to NON NURSING duties.

This is the first in a series of articles we will be writing on topics related to nursing home staff turnover, keeping the aides happy and keeping the UNIONS out.

About nursing staff turnover, in nursing homes.

Nurses are at a premium throughout California, but high nursing home employee turnover is leaving some facilities scrambling just to fill ranks.

Nursing homes are not an attractive post for certified nursing assistants because they work extremely hard for minimal wages, said Tippy Irwin, coordinator of the Long-Term Care Ombudsman Program for San Mateo County.

As a result, the industry turnover rate is 8 percent. Nurses who are employed at nursing homes often have to work two jobs and come to work under enormous stress, which hurts the residents for which they care, Irwin said.

“The system needs to change,” Irwin said. “They need to recognize that (CNAs) are the pivotal people because that’s where the care is all happening. CNAs need to be paid what they’re worth. They’re lowest on the economic ladder, and yet they are the ones doing the heavy hands-on work.”

Even when given comparable wages, however, some nursing home administrators say they still can’t attract enough nurses. The reasons why nurses avoid long-term care facilities — and why they are sometimes attracted to them — appear to be a mystery.

Let’s list some reasons why this work is unattractive, to CNA’s:

1) The obvious- very low pay

2) The work itself…physically brutal, demanding, hard, non stop…

3) Poor Management
* Good aides are not recognized via pay raises, special bonuses, a write up based on their GOOD traits ect.
* Bad aides are given too much slack and leeway, and they are often the ass kissers to management
* Managers/DON types don’t come out to the units often to see who is working hard and who is not
* New CNA’s are not given adequate training/orientation periods. Who mentors the new aides?
* Families: Some are very rude, abusive and have too many expectations. Management needs to be supportive of staff!
* Aides who abuse policies are allowed to continue employment. Call out queens, those who are late or leave early…
* The other side- being TOO strict with policies can lower morale and cause turnover (POINT SYSTEM anyone?)
* A DON who disrespects CNA’s- where there is high turnover there should be a BIG question as to the worthiness of the DON
* Charge nurses with BIG HEADS and little anything else- they ruin the atmosphere and morale
* Schedules- no creativity. It’s always every other weekend; every other holiday…CNA’s are given little leeway in this
* The work we do is often over supervised or under supervised- there is little middle ground (AKA trust)
* Assignments are not always fair, spread out evenly; aides get stuck working with the same residents and it can get OLD

4) Lack of autonomy
* CNA’s are given little voice in the work they are asked to perform. Their input is rarely asked for when decisions are being made about policies, procedures, ratios, new admissions and budgetary issues. How many CNA’s are invited to join safety committees and daily rounds? How many CNA’s are asked to give feedback when a care plan is being written? (and not just the ass kissers; aides from all 3 shifts)

* CNA’s are not trusted in the work they are asked to perform. Nurses, especially those with big heads and egos, are always out to make aides look bad or to “catch” them doing something wrong. Why not catch them doing things RIGHT and being positive about it?

* Ratios make this work difficult to manage. Resident demands vs. real needs are lost in the daily shuffle and it makes the shift very difficult to work. Expectations of overzealous families, catering nurses dictate which residents are priorities, vs. real and true medically needy residents.

These are things management can think about. What can be controlled and what can’t? How can these issues be addressed? Culture change is hard work. The mindset of so many who work in the nursing home, from the Administrator to the aide to the housekeeper to the dietary worker can and should change.