I found a new blog about nursing homes- it’s called LTC Reform. Good stuff over there- we’ve added it to our blogroll.

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.

Some have read the article at the NYT about nursing home investors buying up homes, cutting back services to the point of near neglect, and selling the properties for a huge profit. This is an awful horrible thing to read about, but it’s been happening a lot longer than some think. Those of us who have worked for chain owned facilities KNOW of the cutbacks and supply shortages, and many of us learn to work around it. When we do that, we enable this scheme to continue. When we make excuses for these places, when we claim it’s “not that bad”- we are allowing some terrible wrongs to happen. We’re fooling ourselves just a little; but in fact we are fooling the public a lot. One thing about this: We may not even be aware we are employed by one of these nursing homes believe it or not. IF you were hired by an outside group, and IF the facility places limits upon basic supplies AND there are a very few RN’s in house, you probably work at an facility that is being managed under this profit driven scheme.

Nonetheless, the details of the article are ethically wrong and we would all do the entire industry a favor by refusing to work at facilities owned by these groups; families and doctors would be wise NOT to allow an admission and investors would be shocked to know they are party to such neglect- investors are often people like you and me- who buy some stock hoping to make a little profit. Being assured by the holding company of good care and all, and having little real knowledge of the industry, investors continue to buy.

This should also serve as another reason we need to work towards getting people out of nursing homes. The desire to earn a few million bucks on the lives of our most treasured and vulnerable people is inexcusable. But money talks- our elderly often won’t.

We would be very interested in hearing from more aides who believe they are currently or have, in the past, worked for a home managed like this.

A breakdown of how much money some states are spending on alternatives to nursing home admissions.

Black people get poorer care than others, says this report:

WASHINGTON (Reuters) - Elderly and ill blacks in the United States are more likely to live in poor-quality nursing homes, researchers said on Tuesday in a study that shows clear patterns of segregation persist.

And in a finding that defies stereotypes, nursing homes in the Midwest were the most segregated, with those in the South the least likely to show disparities, the researchers reported in the journal Health Affairs.

“This study shows us that racial segregation has a significant impact on the quality of care received by nursing home residents,” David Barton Smith of Temple University in Philadelphia, who led the study, said in a statement.

Barton Smith’s team used U.S. government data on 1.5 million patients in 14,374 nursing homes in 2000, covering close to 90 percent of all nursing homes and residents.

“Blacks were nearly twice as likely as whites to be located in a nursing home that was subsequently terminated from Medicare and Medicaid participation because of poor quality,” they wrote in their report.

Ten of the 20 nursing homes with the greatest disparities in quality of care were in Wisconsin, Indiana, Ohio, and Michigan. In Milwaukee, blacks are more than twice as likely as whites to live in a nursing home with inspection deficiencies, substantial staffing shortages and financial problems.

I question the honesty and agenda behind this report. As far as I can tell, ALL people in MOST nursing homes do not get the good care they should be getting. Color certainly has nothing to do with it.

About being a CNA:

“This is just a great place to work. It’s a hard job, but it’s a rewarding job,” said Lynda Haffner, a certified nursing assistant at Cooney Home.

Haffner describes her job as “hands-on care” of 12 to 16 residents, from getting them dressed in the morning, to assisting them to breakfast and lunch. She also helps them with trips to the bathroom and puts them to bed for naps in the afternoon.

Haffner also works as a restorative technician, assisting the physical therapist with residents who need help walking or doing range-of-motion exercises.

“We try to keep people as ambulatory as possible,” she said.

She’s worked at Cooney Home, the county’s nursing home, for the past 11 1/2 years.

Prior to that she was a beautician for 17 years and then a CNA at the hospital in Deer Lodge.

What does she like best about her job?

“The residents,” she responded, without a second of hesitation. “They each have their own personality.

“They just appreciate everything you do for them,” she said. “It is such rewarding work.”

She admits that every once in a while she meets a cranky person, but this behavior fades once she learns the person’s likes and dislikes.

The hardest part of her job?

“I didn’t think ever, ever, ever, ever, I could help with some one passing on,” she said.

But now that she’s worked closely with residents, “it just seems rewarding and nice to be able to do that.”

And when asked if she would recommend her work to others:

“It’s hard work. It’s satisfying and rewarding work if you like working with people.

“You have to care for people. You have to be organized. And you can’t mind dirty work.”

Yes Ma’am it is.

Special Dementia Programs and building design make for a more meaningful admission to a nursing home- if there is such a thing.

After Gail Aylward was diagnosed with Alzheimer’s disease, she moved into a condo with her brother and daughter. A few years later, she started to wander.
[…]
Once thought of as cold, sterile environments, many nursing homes are trying to feel more like home. And, within the cozier settings are features to make life easier for patients.
At Dillworth, brightly painted doorways point out where walls end and patient rooms begin.

Parc Provence in Creve Coeur, the area’s only nursing home exclusively for people with Alzheimer’s and other forms of dementia, arranges patient areas in a circular pattern. The formations eliminate blind corners that can be unsettling to these patients, said Dr. David Carr, medical director at Parc Provence.

Many Alzheimer’s patients lose weight or become dehydrated because they struggle to eat independently. At Dillworth, fire-engine red plates help patients distinguish mashed potatoes and chicken from the plate itself. Parc Provence prepares food on each floor so the aromas will stimulate patients’ appetites.

To keep patients from leaving the unit, Dillworth has carpet squares near the door that are arranged like a checkerboard. To an Alzheimer’s patient, the different colors make the floor appear uneven, so patients steer clear.

There’s also an effort to recreate family life. Patients can bake cookies, do laundry, set the table or exercise. While folding towels, the ladies will often reminisce about their lives before Alzheimer’s.

One thing not mentioned too often in these articles is the activity programs. They must be altered to work with this special population. The everyday average activity program doesn’t serve our Dementia residents well; I have been very impressed with the programming offered at most special care units like this.

About being paid for the hours we work…this is an article about the LTC industry and Fair Labor Standards Act (FLSA or the “Act”):

Another minefield, as simple as it may seem to navigate, is tracking and counting “hours worked” to determine if overtime pay is due. The key words are “compensable hours,” and hours can be considered compensable even if they are not scheduled or authorized beforehand or approved after the fact if they are indeed “worked” by the employee. The time is worked for purposes of the FLSA if the employer “suffers” or “permits” it to be worked. That is, if the employer, or one of its “agents” for this purpose (head nurse, unit coordinator, department head or, for that matter, any supervisor), knows or reasonably should know that the employee has performed work, it must be counted. Rank-and-file employees should be instructed that any time they are performing work, it is “on the clock.” Supervisors must be trained to, among many other things under the FLSA, recognize that any time an employee is performing job-related tasks, be it before or after the start or end of a shift, during lunch or other unpaid breaks, or even at home, he/she must ensure that the time is included in compensable hours for overtime calculation purposes. If the supervisor “suffers” or “permits” the employee to work, it is counted toward the overtime threshold.

THIS means, simply, that if you work, you get paid irregardless of whether the DON or other supervisor “approved” the hours. Often I read at the forums that we’re not paid because the time wasn’t approved by the boss. Legally, we have to get paid.

Employers must also become familiar with what job-related activities are considered compensable activities and which are not. For example, requiring an employee to change into a uniform at the worksite is compensable, while worksite clothes-changing for employee convenience is not. Pre-shift distribution of work or assignments and, by all means, shift change meetings or “report” are compensable, as are simple things like having an employee pick up or drop off mail or packages on the way from/to home or during lunch. Performance of work during unpaid lunch periods is particularly troublesome—a huge minefield—for healthcare employers. Regulations require that the lunch break be “uninterrupted” and be at least 30 minutes for the employer to exclude it from time worked. It is not uncommon for LTC employees to eat at their workstations or with residents, and it is also not uncommon for caregivers to be called or be called back during lunch break to deal with resident issues. All of these are problematic. If the employee’s lunch break is interrupted—he/she performs any work—the entire break becomes compensable time in determining if overtime pay is due.

So…remember this when you’re on your break and get called to the unit. Check your pay stubs to make sure you’ve been paid. It helps to keep a personal log of the hours you work…a little notebook will suffice for this purpose. The date, time clocked in, out, breaks (especially) taken and clocking in/out AND, importantly, going back to the unit. I think it’s safe to say a great many of us get screwed over often, in pay because of these “little” things. We work hard and we often miss our breaks. Let’s get paid what we’re due.

More than ever, medical errors and poor nursing care will become a very hot topic in the near future.

WASHINGTON, Aug. 18 — In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

“If a patient goes into the hospital with pneumonia, we don’t want them to leave with a broken arm,” said Herb B. Kuhn, acting deputy administrator of the Centers for Medicare and Medicaid Services.

The new policy — one of several federal initiatives to improve care purchased by Medicare, at a cost of more than $400 billion a year — is sending ripples through the health industry.

It also raises the possibility of changes in medical practice as doctors hew more closely to clinical guidelines and hospitals perform more tests to assess the condition of patients at the time of admission.
[…]
The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year — about 270 a day.
[…]
Consumer groups welcomed the change. And while hospital executives endorsed the goal of patient safety, they said the policy would require them to collect large amounts of data they did not now have.

Lisa A. McGiffert, a health policy analyst at Consumers Union, hailed the rules.

“Hundreds of thousands of people suffer needlessly from preventable hospital infections and medical errors every year,” Ms. McGiffert said. “Medicare is using its clout to improve care and keep patients safe. It’s forcing hospitals to face this problem in a way they never have before.”

Christine K. Cahill, a registered nurse who used to inspect hospitals for the California Department of Public Health, said: “This is a great start. Infection-control specialists have been screaming for 20 years that federal and state officials should pay more attention to this problem because hospital infections hurt patients and cost money.”
[…]
The rules, first reported in The Star-Ledger of Newark, carry out a directive from Congress included in a 2006 law. When they were proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay.

But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.

Trust me. Someone WILL pay these bills. Hospitals are great at shifting costs; they will simply charge more for services and we will all pay for the errors of a few and the ensuing costs to care for the results. That pressure sore? Think about all the time, the dressing changes and wound care…the products…everyone will pay. But we won’t see any benefit from this. Less money coming into the system will mean even less money for wages and benefits. It’s strange how these rules are thought out. IF there were enough nurses and aides to begin with, pressure sores wouldn’t be prevalent now would they? If OR nurses weren’t so rushed, there wouldn’t be so many errors; same with medications and other things. AND if we all just washed our hands more often, and wore gloves with each contact with patients/residents, these infection rates would go down. It’s pretty elementary.

An interesting read:

Reports that Manor Care’s CEO Paul Ormond would personally realize between $118 and $186 million when his company, the largest nursing home chain in the United States, is acquired later this year by a private equity group got us thinking about staffing in nursing homes. Knowing that the federal government has reported that more than 90% of nursing homes do not have enough staff to take care of their residents, we wondered how many nurses and nurse aides could be hired for a year at Manor Care’s nursing facilities with that same money.

Using federal wage estimates for nursing home workers, we calculated that Manor Care’s 278 nursing homes could hire an additional 5346 certified nurse aides or an additional 2198 registered nurses if $118,000,000 were spent on staff (19.2 aides or 7.9 RNs at each Manor Care nursing home). If Mr. Ormond’s $186,000,000 windfall were spent on staff, Manor Care could hire an additional 8427 certified nurse aides or an additional 3464 RNs (30.3 CNAs or 12.5 RNs at each Manor Care nursing home).

Like all nursing home chains, most of Manor Care’s revenues come from public programs, Medicare and Medicaid. How should our public health care dollars be spent? One man’s windfall or certified nurse assistants and registered nurses in nursing homes?