Archive for the 'Employment Issues' Category

The New York Times has published an article about investigations of health care facilities pay practices. It rings true for many of us: Do we really get paid for actual time we work?

In St. Louis, the Labor Department has recovered more than $1.7 million in back wages for 4,000 employees of hospitals and clinics operated by SSM Health Care, a Roman Catholic system.

In Boston, the Partners HealthCare System agreed to pay 700 employees more than $2.7 million in overtime back wages to resolve a lawsuit by the department alleging violations of the Fair Labor Standards Act.

And under the proposed settlement of a class-action lawsuit in California, Kaiser Permanente would pay $7.25 million to hundreds of registered nurse coordinators, case managers and other medical workers. The employees said they had been denied overtime pay because they were improperly classified as exempt.

This is when they classify nurses as supervisors. They are, but they usually do not meet the federal standards for being exempt.

Nursing assistants, licensed practical nurses, janitors and cooks “are particularly vulnerable to wage violations,” Mr. Stripling said.

In many cases, employees say they were not paid for work performed during meal breaks.

“Most nurses put the patient first,” said Charles D. Boal, a registered nurse who worked in the critical care unit of The Western Pennsylvania Hospital in Monroeville, near Pittsburgh.

“We often gave up lunch breaks to see that a patient was taken care of properly,” he said. “If you brought your lunch from home or got food in the cafeteria and took it to the nursing unit, you would be interrupted by phone calls, by physicians and family members who wanted to talk to you. We really did not have an uninterrupted meal break.”

How many of us have given up a break, or shortened one, because of patient/resident care demands? I know I have. Multiple times. We need to MAKE sure we are being paid for those minutes given off our breaks. Don’t let the facility management con you into believing they don’t HAVE to pay you because a supervisor/other did not ASK you to give up break times.

Previously here, we posted an article for nursing assistants:
Getting Paid For Every Minute You Work

Advancing Excellence has announced updates to to their GOALS and several of these give voice to the direct care workforce. AE is now in it’s second year of operation.

Advancing Excellence in America’s Nursing Homes is a coalition-based campaign concerned with how we care for the elderly, chronically ill and disabled, as well as those recuperating in a nursing home environment.

There are over 7300 nursing homes participating on a voluntary basis.

Originally the group listed 8 goals member nursing homes should work on. Those goals are located HERE.

Newly revised and updated, three are of interest to CNA’s- this is a PDF file.

GOAL 6 — STAFF SATISFACTION
NEW
Participants in this goal will have to assess staff satisfaction at least annually and upon separation; plus incorporate results into quality improvement efforts. AE has not yet decided on a target objective for this goal but it will probably be twofold: A) Increasing the number of staff surveyed and B) Raising satisfaction scores by a yet undetermined amount.

GOAL 7 — STAFF TURNOVER
REVISED
AE will ask nursing homes to reduce current levels of staff turnover for each of the following categories of employees: RN, LPN, CNA, DON, and NHA. Turnover will be measured separately for each of those categories. Participants will have to regularly measure and report staff turnover and develop plans to reduce the rate of turnover for each of the staff categories.

GOAL 8 — CONSISTENT ASSIGNMENT
REVISED
AE will increase its efforts to encourage and help nursing homes to adopt “consistent assignment” of front line staff – that is 85% of long stay residents in a nursing home have a maximum of seven (7) CNA caregivers each month AND 85% of short stay residents have a maximum of seven (7) CNA caregivers over two (2) weeks. Participants will be asked to set targets to increase the number of residents being served by a consistent assignment model by a yet undetermined amount.

In another post we will examine, more closely, what some of the AE member nursing homes are doing to promote the goals.

The results from the National Nursing Assistant Survey conducted in 2005 are published:

The NNAS is a nationally representative survey of 3,017 CNAs working in nursing homes, who were interviewed by phone in 2004–2005. Key survey components are recruitment; education; training and licensure; job history; family life; management and supervision; client relations; organizational commitment and job satisfaction; workplace environment; work-related injuries; and demographics.

Not surprising to me:

Results:
One in three CNAs received some kind of means-tested public assistance.

More than half of CNAs incurred at least 1 work-related injury within the past year and almost one quarter were unable to work for at least 1 day due to the injury.

Forty-two percent of uninsured CNAs cite not participating in their employer-sponsored insurance plan because they could not afford the plan.

Years of experience do not translate into higher wages; CNAs with 10 or more years of experience averaged just $2/hr more than aides who started working in the field less than 1 year ago.

There is MUCH more at the linked article. We CNA’s have been screaming these issues for years now so it is nothing new to us. Question is: What will change with all this information? Who reads it? Who has the political and moral courage to fix some of this?

Earlier Patti shared an article for nursing home management to pay attention:
Keeping Unions Out: It’s Now or Never

The article she linked to implores management to take action to become more employee-friendly. There are some issues that management might not be able to change. Health insurance for staff is a BIG issue. Affordable and practical insurance is needed.

SEIU’s Andy Stern is calling on US to help him advocate for this important need. He will be testifying before Congress and will be sharing worker stories about health insurance, the lack of or inability to afford.

When I think about what’s wrong with health care, I think of Jacqueline.

It’s one thing to talk about our broken health care system, but Jacqueline lives it every day. For 19 years, she’s worked as a nursing home CNA in Wisconsin. Short staffing in her unit means skipped treatments and longer waits for her patients. And a lack of equipment and supplies puts the strain on the entire facility when things get busy.

Unbelievably, while Jacqueline spends her life providing care for her patients, she can’t afford it for herself or her family. The coverage her employer offers costs too much on her salary.

This has to stop. Congress needs to hear how this crisis is affecting real people. Share your story: http://action.seiu.org/page/s/memberstories

Next week, I’m going to Capitol Hill for a Senate roundtable on fixing health care. It’s one of three roundtables that Senator Max Baucus is holding to hammer out the final details of a health reform bill.

If you’ve got a story to tell, now is the time to do it. Do you have health insurance? If not, why not? Does your employer offer it? Is it too expensive for you to afford? Have you held back on seeing a doctor or other health care needs due to costs? Let Andy know.

At McKnights LTC News, an important and honest article aimed at nursing home management- about unions, the Employee Free Choice Act and keeping unions OUT. The advice offered is simply good management, something that is missing in too many nursing homes.

One of the points that caught my eye as being different:

Gauge employee attitudes through surveys and feedback sessions so that unions cannot take advantage of employee discontent.

Employee surveys should become a “pattern and practice” at the company and should be done on an annual basis. Employee surveys will let management know how employees feel about a host of important factors, such as pay, benefits, supervisors, general work environment issues, fair treatment (or lack thereof), appreciation levels, and even whether the bathrooms are clean.

Initially I would recommend more than once a year…I’d do this every quarter until a pattern is developed and which would show employees a concentrated effort on managements part.

Create a communications strategy for reinforcing the value of maintaining a union-free workplace.

It is important to consistently explain to employees and supervisors the value of working in an environment free of interference from third parties. This means that employers have to “walk the walk” and honor the commitment to treat employees with the dignity and respect they deserve. For example, a company newsletter can be used to honor certain individual accomplishments or those of employee teams. Other communication devices, such as company Web sites, can be used to enhance employee identity with the company, which might alleviate the desires of certain employees to place a value on unionization.

About this “walk the walk” business: Get up from your desks and get out onto the units. Go talk with the aides and others. Catch them doing something good and WRITE THEM UP for it- a positive feedback tool that can work wonders for morale. Join the aides during their lunch breaks. HELP them with their workload when they’re short staffed. No union people will DO THAT.

Most notably:

Create a policy modification (employee handbook) in response to employee survey input, which includes informal and formal dispute resolution procedures and “positive” discipline.

Employees want to know that their input on the survey actually means something and that the company is responsive to their opinions. In addition, a formal grievance procedure should be utilized, which includes a two- to three-step process (e.g., an initial complaint to a supervisor followed by subsequent steps to a plant manager, and then to the company president). The final step could include binding arbitration if the dispute cannot be resolved to the employee’s satisfaction at an earlier stage.

When a company’s policies mirror the typical union perks, unions have less chance of gaining hold. A grievance process is just one perk; almost every policy can be written to union “standards”, and this will be difficult for a union to counter.

Read the entire article nursing home management- DON’s, Adminstrators, Owners…take some action now before you lose control over your staff.

Direct care workers- CNA’s and others- have been pushing for better pay, better benefits and working conditions for YEARS now. Direct care worker advocates have also been speaking LOUD on our behalf. We’ve barely made any progress, and many of us hope that the new President will lift us out of the world of low pay, disrespected work…the prospect of the Employee Free Choice Act passing into law will help elevate these dreams.

The LTC industry is getting excited about this as well, but for a more sinister reason.
From McKnights LTC News:

A major development is afoot in the labor movement, and it could have interesting implications for long-term care.

I’m talking about American unions’ recent plans to unify. In case you haven’t heard, the leaders of the two major federations and the nation’s 12 largest unions have formed the National Labor Coordinating Committee. The interim body will help form the federation.

Naturally, the thought of one massive union, 16 million members strong, is enough to send shivers down a long-term care employer’s spine. But let’s think about this a minute.

Clearly, a single union could have an impact on unionization. This is the year of the card check, and if the Employee Free Choice Act passes, nursing homes could be facing a serious increase in union activity.

Sounds good huh? Never trust the LTC industry to do the right thing for YOU.

But there also may be at least one area in which nursing homes can benefit from a unified labor front. That is immigration reform. The AFL-CIO and Change to Win federations recently said they are joining forces to support the effort. That includes a path to citizenship for undocumented workers.

Why worry about immigration reform, in the broader picture here?

Read on:

The American Health Care Association, the largest association of nursing homes, if you will remember, was in favor of a guest worker program that would provide a temporary workforce of skilled and unskilled workers for employers in the future. Given the industry’s reliance on low-wage help, that is not surprising.

Read that last sentence. LOW WAGE HELP. The thinking here is simple: Bring in as many immigrants as possible, allow them to fill our shoes, at lower rates of pay…supported by the Unions of course…And read between the lines: Unskilled workers = low wages is NOT GOOD FOR US. These efforts will drive down our rates of pay. Why would any facility hire an American CNA who will expect a living wage- when hiring an immigrant who will work for cheap hourly rate is a viable option? We need to seriously think this out and speak up on it.

What is your opinion on this?

The politics of the Employee Free Choice Act (card check)…excellent article about how it MIGHT just happen this time. Or not.

Another article about lax CNA oversight, and how it harms patients, residents and other consumers.

Since 2007, the state Attorney General’s Office has charged more than 50 nursing home workers, including five in the Rochester area, for kicking, neglecting, tying up, stealing from or sexually abusing residents.

Most were fired after abuse was reported. But in at least several cases, accused workers in Rochester homes found jobs at other area facilities shortly after their former employers reported abuse to the state. Among them, a certified nurse’s aide accused of kicking an 87-year-old resident, and another convicted of stealing patients’ Social Security numbers.

Oversight of nursing home hiring practices hinges on a careful balance between protecting employees from wrongful accusations and guarding vulnerable residents against mistreatment that’s found in local facilities.

The gap between reporting of abuse, and the investigation and conclusion, is where the problem lies.
This is a problem in most states, and there are no simple answers. However, it seems to me that anyone accused of abuse or neglect, should immediately have their certifications placed on HOLD, pending investigation. Facilities who are hiring can look up names in a database, and make hiring decisions based upon this as well as background checks. It might seem unfair to the aide being investigated- and this should not be about just aides, but nurses as well. Protecting our residents is the most important factor.

What’s the situation with home health care vs. nursing homes? Allotting funds for alternatives to nursing homes is becoming more and more popular, and from all accounts, less costly. Allowing families to hire their own loved ones is an option some states are considering.

If home health care agencies can’t find enough reliable, compassionate caregivers to tend to the growing number of elderly and disabled, why not pay clients to hire their own relatives or friends to provide their in-home care?

More than a dozen states, including Ohio, are exploring that choice as a way to head off a looming shortage of home health aides and to help control skyrocketing Medicaid costs for nursing home care.

Home care typically costs less than a third of what states pay for nursing homes. But at current wage scales of $10 to $12 an hour, the turnover rate among home health agency staff is high — 90 percent of aides leave their jobs within the first two years, according to the Institute of Medicine.

Would friends and family do a better job while also saving states hard-pressed Medicaid dollars?

Initial reports from states that allow elderly clients to hire and fire their own in-home workers, including family and friends, suggest it may be one solution.

Sounds good to me.

But does this save money?
Yes.

In a 2006 report, Arkansas found it reduced nursing home admissions 18 percent over a three-year period through a program called Cash and Counseling. The program gives elderly clients the option to employ their own caregivers, direct their own mix of services and pay aides through a budget they control. Case managers advise clients and monitor care.

While the program raised the state’s costs for in-home care, higher costs were offset by savings in reduced nursing home admissions and other long-term care costs, Arkansas found.

And:

For the past decade, Ohio has been struggling to shift more of its frail elderly and disabled away from nursing homes and into lower cost alternatives such as assisted living and home care. In 1995, 90 percent of Ohio’s long-term care recipients were living in nursing homes. By 2005, that percentage had dropped to 65 percent. The Ohio Department of Aging estimates the shift has saved Ohio taxpayers $1 billion.

That’s A LOT of money!

Consider:

States like Oregon and Washington that have long advocated a variety of care choices for the elderly spend more than 60 percent of their Medicaid dollars on nursing home alternatives, including adult foster homes and group facilities as well as home care.

In the national discussion about health care reform, perhaps programs like these should be brought to the table. A lot of people are fussing about the potential severe shortage of aides, nurses and money to cover nursing home care, for the baby boomers. It seems to me we can save a real lot of money by thinking outside the box.

Did you know that CNA’s who work in other settings besides nursing homes often keep their credentials after being abusive or neglectful?

A small fraction of Texas’ 117,160 nurse aides, the front line of care at nursing homes, are accused of appalling acts of abuse, neglect or exploitation. For such offenses, the Texas Department of Aging and Disability Services can strip aides of their certifications if the abuse happened at a state-regulated long-term care facility.

But it only does so for a minuscule number each year — 55 in 2008. And more than a third of aides fall outside of the department’s jurisdiction because they work at doctors’ offices, at hospitals or in home healthcare.

It’s the same in every state.

That all could change under a plan by state Sen. Jane Nelson, R-Flower Mound, who wants all nurse aides placed under the regulation of the tough-minded Texas Board of Nursing. Her proposal, which includes new training standards, follows similar recommendations by the Legislative Budget Board.

But representatives of the long-term care industry aren’t convinced that the move is a good idea.

At a recent Senate finance committee hearing, Nelson called nurse aide training and regulation “very inconsistent.” Yet with Texas facing a serious nursing shortage, healthcare operators are increasingly relying on the aides, Nelson said in an e-mail to the Star-Telegram.

“We want to make sure they are sufficiently trained and have proper oversight,” she wrote.

Discipline, at present, is piecemeal. An aide investigated at a hospital, for instance, might be fired but wouldn’t necessarily lose certification. The abuser could simply move on to a new job.

I think it’s an excellent idea to place ALL CNA’s under one jurisdiction, in every state. In some states, CNA practice is regulated by a Board of Nursing. In others, it’s under a Board of Health or some other dept.

The article goes on to explain the politics of Texas and how the push to better prepare CNA’s is being bucked; and the thought of one central base for all nursing records and information is being resisted. Texas has some of lowest standards in the country, for CNA training. It is also among the highest with reported abuses and other failures. More Texas nursing homes received 3 stars or less in the CMS’s new Star Rating System as well. I think they have a problem in Houston…and everywhere else.