We all like to sit back and demand better pay, better benefits and what not. We all agree this might help solve the pending shortage of CNA’s and direct care workers. Yet we all forget where the money comes from for all this; and we forget to look at consumers’ choices and preferences.

I’d like to share a couple articles I found for the purpose of showing how states’ are grappling with health care decisions.

Paralyzed since he broke his neck in a 1996 diving accident, Clay Freeman depends on 11 machines and around-the-clock care to stay alive.

With assistance from in-home caregivers who took him to classes, Freeman graduated from Chemeketa Community College in 2006.

He also has relied on caregivers to take him to movies, on shopping trips and other outings, including school functions and sporting events for his five nieces and nephews.

Distressingly, the Salem quadriplegic has had a hard time retaining the caregivers who serve as his conduit to daily life. Some have burned out tending to his complex needs. Others have resigned to take less rigorous work that pays better.

When another caregiver called it quits early this month, Freeman, 34, was left with two of the five hands-on assistants he needs to monitor his machines and assist him with breathing, eating, toileting and more.

Mr. Freeman wants to remain free- he doesn’t want to be institutionalized. Who can blame him? His chances of complications with his health will increase a lot with an admission to a nursing home. His independence will cease to be. His education will go unheeded. Not to mention the sheer fact that staying in his own home costs MUCH less than living in a nursing home would cost.

The caregiver crisis posed life-threatening complications for Freeman and crimped his federally mandated rights to live with as much independence as possible, according to a lawsuit brought against the state of Oregon on his behalf.

“Mr. Freeman is now at risk of being forced to live in a nursing facility — an institutional setting — because he has been unable to hire and train three of the five personal attendants needed to meet his daily needs,” states the lawsuit.

The federal civil-rights lawsuit asks that the state be required to provide enhanced caregiver compensation so that Freeman can hire the help he must have to deal with his daunting disabilities.

Mr. Freeman is suing his state to ensure it increases the rate of pay for his home health care aides. A good thing. Home health aides are very important to consumers who rely upon them to keep them out of the nursing homes.

Under contract terms with the state, average pay for Oregon’s 11,500 unionized home health care workers is slightly less than $10 per hour. To recruit and retain caregivers for Freeman, the state must pay at least $12.90 per hour, his lawyers say. The state also has to ensure that his caregivers get proper training, the lawsuit asserts.

A federal judge has issued a temporary ruling in Freeman’s favor. A week ago, U.S. District Court Magistrate Thomas Coffin ordered the state to provide Freeman with five caregivers at the $12.90-per-hour rate. Coffin also directed the state to supply Freeman’s caregivers with training provided by a licensed registered nurse.

Freeman’s lawyers are asking for a permanent court order that would enforce the higher pay rate. Opposing lawyers are expected to make oral arguments before Coffin at a hearing this summer.

Of course no state or union can force anyone to work for a private citizen who is seeking services. We are free to choose. But it is cited as being the ideal working environment for CNA’s: Private home care.

The second article highlights the clash between state government and nursing home industry lobby groups, unions and others. Each state receives a certain sum of money to cover ALL nursing care- from the federal government. The states must match this sum with a percentage of cash as well. And the state has the final say in where this money goes to. In these tough times, and in good times as well, it makes fiscal sense to keep people in their own homes as long as possible. Preventing nursing home admissions is key to keeping costs low for everyone.

Nursing homes get 80 percent of the money Pennsylvania spends to help people who are too old or disabled to care for themselves. The Rendell administration says that must change.

The administration has the goal of an eventual 50-50 funding split between nursing homes and programs that help people remain in their homes and communities. Rendell’s proposed budget includes no increase for nursing homes, while giving a $20 million increase to programs that help people stay at home rather than entering nursing homes.

The federal government has marked certain sums of money given to each state to be used for home care situations only. These are not small amounts of money: We’re talking billions from the fed. By slowly cutting back the nursing home admissions and increasing the home health options, states are saving millions and millions of dollars that are budgeted to other programs. The nursing homes are fighting this move. The costs of a nursing home bed is falling short of the payment received. Who pays the difference? We all do via cut backs. It’s a lose-lose situation.

Groups representing nursing homes said state funding for nursing home residents covered by Medicaid — about 60 percent of Pennsylvania’s 82,000 nursing homes residents — is $12 per day short of what it costs to care for those residents. “Pay your bill,” one of their leaders shouted.

But what about Mr. Freeman? Doesn’t he have the right to stay at home? Or are we heading towards a society that forces people to enter nursing homes for the better of “all”?

In a separate rally, groups representing disabled people applauded Rendell’s proposal to increase funding for home and community-based programs. They characterized nursing homes as profit-driven organizations that underpay and overwork their workers while robbing their residents of freedom.

Very true. Are nursing homes bleeding the system so much now they have become a liability with regard to funding? It’s starting to look that way.

The Rendell administration says nursing homes receive an average of $173 per day for people covered by Medicare, and that rate is one of the best in the country. It costs about $70 per day for a home or community-based program, they claim.

I did the math quick and it’s a little off, but the costs savings are pretty close to these numbers.

The two states highlighted here, Oregon and PA, are facing the same issues every state is struggling with. The question used to be how can fund BOTH options. We can’t. As a country we would go bankrupt very fast. No one could afford the tax burden, which would be upwards of 50%…we already pay high taxes….and, to boot, our tax rates now are less than what they were ten years ago when these problems were just beginning to surface. We couldn’t afford this all then and we certainly cannot afford it now.

To give to one means taking away from another. The Robin Hood thing? Not really…it’s not about stealing from the rich to give to the poor. It’s more about stealing from all to give to a few. It’s also about being smart with budgets and choices.

I believe most of us have some form of a personal budget we follow. Cash for food shopping; cash for gas. Cash for the rent…the car payment.

When we decide we need more food to feed our families, we have to take from the other budgeted money- we might drive less to save gas money and move some of it to cover the extra food. Or the rent might be paid late. We have to make choices about where to cut back. When we’re at the grocery store, we might decide to spend less on store brand products or buy the lower octane gasoline to save money. In tight times we eliminate spending that isn’t required to live.

State governments must do the same thing. Funding programs and the like that cost much more than viable options is foolhardy and stupid. Nursing homes cost a lot more to maintain. Home health care is a viable alternative that consumers prefer. We can’t blame the states for standing up to what is fiscally sound and consumer driven, no matter what it means to us personally.

Question:
At my facility we’re not allowed to call out! Lately there’s been a lot of call outs and even more aides quitting. So we work short all the time. A couple aides have hurt their backs too cause we’re short all the time. Anyway I got the “bug” last week and had a fever, vomiting, and diarrhea. I felt horrible. I couldn’t eat anything; I couldn’t keep anything down. I called work to let them know I would be out for my shift and they put me through to the DON. who told me to come in for work, to report to her prior to clocking in so she could assess whether I was too sick to work. If I didn’t follow this directive, I would be terminated. SO I went to work and the DON took my temp (101.2)- she gave me Tylenol and a couple spoonfuls of Pepto Bismol; she told me report for duty. If I didn’t feel any better in an hour to come back and see her.

Is this legal???

Answer:
Your email tells me your employer is having a hard time with staffing. It appears that the place is going through a downward spiral of problems and management is part of that. When an aide shows up for work, sick with fever and infection, she exposes not only the residents, but her co workers as well.

It’s very likely more than a few will catch the illness. So, it spreads like a fire. As each aide comes down with the bug and misses work, management feels it has to do something to curb what it perceives to be an abuse of attendance policy. Management should be prepared for a staffing crunch knowing a virus is going around. But, this facility’s management is punishing the very people who are out in the battlefields where the germs are located. It’s old fashioned and autocratic.

Instead of being proactive, the DON is being REACTIVE and in a very negative manner. Her actions are telling her staff that she doesn’t trust their judgment on their own bodies health. She is also telling them she has no respect for them. A warm body on the schedule is all that matters, even if that body’s temp is 101.

The Legality of this:
If this is a policy, it must be written as such.

I called a lawyer friend and relayed this scenario and she gave me the following advice: Is the DON a doctor or a Nurse Practitioner?? If not, she is straying from her nurse practice laws. Nurses cannot diagnose illnesses, diseases, disorders and the like. Perhaps she is sending staff to a doctor who is legally licensed to perform a medical assessment. She would be smart to do this. She should NEVER give staff ANY medications without a doctors’ order. She is putting her license on the line by doing so. She knows this. And is counting that you don’t know this.

Legally this practice is not advised for management. They are risking a discrimination lawsuit if this “policy” doesn’t cover ALL employees of this facility- so, when the dietary aide or the cook or the maintenance man calls out, the DON/Management must apply this same requirement towards them. They too must come in, be assessed, and determined if they’re “healthy” enough to work or not. And this would mean doing so 24 hours a day, 7 days a week. Even on holidays and weekends.

What To Do?
If you find yourself too ill to perform the duties of your job, you can and should call out. However, you should also make every attempt to get better or try to reduce your symptoms so you can work. In other words, do take Tylenol/Advil to get the fever down. Immodium will end just about every episode of diarrhea. After this, if you still feel too sick, call out. Make sure you follow the policy- most facilities require 2 or 4 hours notice.

Have your spouse or a friend make the call for you if you’re concerned with being harassed by the DON. Instruct your spouse/friend to take a message but to be firm: You will not be showing up for work. Make sure your reasons are given: Details- fever, vomiting, ect. and the actions you have taken to try to make it better. Then call your doctor and make an appointment. You’ll need to be assessed and diagnosed properly; and the MD will need to write you a note excusing you from work. Often, this note will include actual dates you are not recommended to work.

A doctors note will not protect your job.
We need to know this and not rely upon it. The note does give credibility to you though: You’re putting the effort into seeing the doctor to find out what is wrong and get better; you’re paying money to do in most cases; you want to show your employer you weren’t goofing off, ect.

You can still be terminated unless you’re a member of a union which has rules on this.

I would not wish to continue employment at a facility where this practice occurs. I would leave on my own free will and seek employment at another place with more enlightened management.

The NYT has another good article up today:

Serious Deficiencies in Nursing Homes Are Often Missed, Report Says

WASHINGTON — Nursing home inspectors routinely overlook or minimize problems that pose a serious, immediate threat to patients, Congressional investigators say in a new report.

In the report, to be issued on Thursday, the investigators, from the Government Accountability Office, say they have found widespread “understatement of deficiencies,” including malnutrition, severe bedsores, overuse of prescription medications and abuse of nursing home residents.

And this is news? Not to most CNA’s who work in nursing homes.

The nine states most likely to miss serious deficiencies were Alabama, Arizona, Missouri, New Mexico, Oklahoma, South Carolina, South Dakota, Tennessee and Wyoming, the report said.

More than 1.5 million people live in nursing homes. Nationwide, about one-fifth of the homes were cited for serious deficiencies last year.

“Poor quality of care — worsening pressure sores or untreated weight loss — in a small but unacceptably high number of nursing homes continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.
[...]
The study was done at the request of Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin, who is chairman of the Senate Special Committee on Aging.

I have an idea for the Senators.

Put a CNA on every survey team. A CNA who has worked in nursing homes, who has some experience, who is savvy and can point out the cover ups and lies and distortions that we KNOW are happening.

With all due respect to the average survey team made up of people with numerous fancy titles, education and college degrees, who is better at identifying abuse and neglect than the seasoned CNA?

All the intellectual brilliance in the world will not be able to sniff out perfumed and powdered and otherwise fluffed and buffed, but not truly clean (as in showered recently) residents.

No degree in any field can separate real malnutrition caused by lazy and uncaring aides who don’t take the time to feed residents who cannot feed themselves, from the sad but very common and natural lack of desire to eat we see with people with late stage dementia.

Only a CNA can assess a unit for the true needs of any given resident population…a quick look around, copies of assignments, and observation of am or pm care pretty much tells it all. And CNA’s know the odors of pretty smelling air fresheners used during the inspections to cover up the real scents of a nursing home.

How about this: CNA’s who are part of a survey team should seek employment at facilities a month or so before the scheduled visit…get hired and work a few weeks beforehand. Then file a report with a lot of useful and honest and true information.

I suspect most nursing homes would sorely fail their inspections if this were to happen. The fact is nursing homes operate one way when it’s inspection time (”THE STATES’ HERE!!*) and another way the rest of the year (*ARE WE SHORT AGAIN TODAY?!?*) It’s time to re-think how surveys are done and who makes up these teams. By not having a front line worker on the team, the team always misses out on what’s really happening, since, it is the front liner who really KNOWS.

Send Senator Grassley a message about this HERE. He’d love to hear from CNA’s, this I know.

And Senator Kohl likes feedback as well…contact him HERE.

I read an article over at Long Term Living/Nursing Home Magazine and it brought to light some issues CNA’s have with this work.

At first the article didn’t seem to say much new or different; the issues of low pay and poor benefit packages are discussed as being barriers to attracting good staff. We all know this is the number one problem nursing homes and assisted living facilities face- high turnover.

What disturbed me and caused me to write this post:

The study, which was funded by the National Institute on Aging, also revealed that assisted living workers, who are primarily black, often face racial discrimination from residents, who are primarily white. Nearly half of black employees reported experiencing racism, Ball says, with many of those situations arising from comments made by residents suffering from dementia. Overall, she says, facilities need to make sure their employees feel valued and appreciated.

This is in Georgia. But it happens in every state.

Of all the careers one can chose to work in, nursing is one of the most rewarding. To help another person in need is a good feeling. In no other profession, though, do we see management allowing discrimination to happen, daily, as a matter of routine course. Under the guise of resident/patient rights, aides of color are constantly victims of resident harassment and disrespect. Management bars these aides from caring for said residents- and this leads to resentment and bad morale among all the aides.

No where in any Resident Rights document is the right to ask for or turn down care from nursing staff based on their the race, sex, religion or sexual orientation. Period. Not only is this illegal, it’s immoral. It’s also just poor management when the leaders promise residents and their families only female aides will work with their loved ones. What happens when only male aides show up for work? Don’t say it won’t happen. It has and it will.

In most businesses the customer is always right, no matter what. Business owners and their agents will do most anything to satisfy those who purchase their products or goods. This is, after all, customer service. But what do we do when it’s a patient/resident, demented or not, who overtly displays racism against a nurse or an aide of color?

I’ve seen it at my work. Most of my residents (patients actually) cannot speak for themselves and they are not of age anyway. Some of our best aides, who happen to be black, have been singled out as not being good enough to work with some of our residents, by their families. They insist upon “white aides” for caregivers and that their child never have to have a permanent aide of any other color…and management cowards right down to them. They send out announcements to the nurses (via emails) stating “only so and so CNA’s are allowed to be assigned to Mrs. Smith, per family wish”…and the only names listed are of Caucasian aides. The nurses keep this all quiet of course but we hear them talking about it when they’re making out the assignments. How does it make one feel if you’re an aide of color?

Oftentimes families cite a language barrier as the problem. This is a legitimate concern. We’ve had aides from Haiti, Mexico and other nations, who barely speak any English. How they passed a CNA course and state test baffles us, because they often cannot read and comprehend care plans, assignments and other written directives. Concepts of math are not well understood either- so weights and percentages of meals consumed are huge problems for these aides. I can understand and justify a request for non- English speaking staff not be assigned to certain residents/patients. These staff CAN take charge of this problem themselves and learn to speak English fluently; as well as learn to truly understand this language and work with it. They have a choice here.

But we cannot choose the color of our skin.

In any kind of work the management should never stand for this quasi-discrimination that they excuse or write off as resident rights. While we want our customers to be happy and content, we have to take a stand that’s morally right as well as legal. Discrimination is wrong on every level and for any reason.

How can facilities make sure their staff feel valued and appreciated?

Simple. Tale a stand to this nonsense right from the get-go.

Nursing home administrators and DON’s need to tell residents and their families upon admission that they never ever have a choice or say in which CNA is going to care for their loved one. It doesn’t hurt to mention aides (and all staff) of color, or certain religions or sexual orientations are protected by labor laws. Administrators and DON’s need to make it clear they will not tolerate any form of discrimination.

Demented residents will make comments and sometimes these will be very nasty. Some demented residents will always react poorly to having certain aides care for them, and be fine with other aides. I don’t have an answer for this dilemma. I can say it certainly burdens everyone when this happens. One of the good things about dementia is it causes people to FORGET…usually within minutes of any event or problem or escalation. Sadly this memory deficit can be of help in situations where derogatory remarks are made. Usually these residents are able to become very tolerant of their aide, regardless of race, sex, religion- when the resident realizes on some level that the aide is not out to harm them. This can only happen over time, through consistent assignment.

I made a mortal error the other day. I broke the TOS over at ALLNurses.com.

I discovered they had a CNA forum a couple months ago and have been reading it when I have time. In not one posting over there has anyone ever dared to share a resource with the intended audience. So I decided to link to this site.

BIG BOOBOO. Within a couple hours I received this:

Private Message
Apr 18, 2008 08:29 PM
Subject: Deleted Post
From:
Location: SC
Join Date: Apr 2005
Posts: 1,210
jb2u (Husband, Father)
Dear Member,

As per the terms of service for this website, the following post has been deleted.

Originally Posted by Patti1029:
=======================
I have been a reader of these forums for a long time and just found this specific forum for CNA’s! This is wonderful. I wanted to share with other CNA’s my web site, which has been around for over 10 yrs now-
NursingAssistants.net

There is much information there that I think is worth sharing with others. I will link to this forum now that it up and running!
=======================
(From the terms of service….)
Advertising or Self Promotion:
We do not allow any form of commercial advertising in the bulletin board post, avatars, or signatures. This includes using your avatar or signature to link to other websites or promotional messages that are advertising in nature. Please note, this includes links to political parties’ websites.

Please do not post any messages anywhere on this site that are primarily for the promotion or advertising of any website, forums, email address, business, MLM, activity, personal blogs, or other entities that you have an affiliation with (ie. no self-promotion).

If you are interested in advertising to our nursing audience, please visit our advertising pages for more information.

If you would like to advertise your site, please follow the link above to our advertising pages. If you have any further questions, feel free to pm me.

Sincerely,
Jay, Assistant Admin

Whatever. I guess I can’t complain too much as I didn’t read the TOS and never have. And I know CNA’s are not nurses.

What bothers me most about this is the fact that ALLnurses started a forum for CNA’s- whom everyone knows are the lowest paid members of the team. Most of us are lucky if we earn more than 10 or 12 bucks an hour…on wages like that, how can ALLnurses expect a CNA to BUY advertising space on their site?? Gee whiz. Why don’t they have a free resource page?

I COULD charge people who link to this site which gets over a million hits a month; but I don’t. Money isn’t everything to us. It is to ALLnurses though, who brag non stop about the hits they get each month. Bet they make good money too on all of us. I know all too well the costs involved with keeping up this site and the forum that goes with it. I knew it ahead of time and took the chance that I would be able to fund these costs. Every web site owner knows this and takes the risks associated. ALLnurses is no exception.

The least they could do is have a resource page for nurse and CNA web sites that are not out to make a buck. It would cost THEM nothing to do this but it might give them some respect from the little people on the Internet.

I found an article about nursing homes and restraint use.

WASHINGTON (AP) - The use of physical restraints on nursing home patients declined nearly 40 percent nationally in recent years as the federal government, states and the nursing home industry placed greater emphasis on eliminating what once was a common practice.

Overall, about 5.9 percent of 1.5 million long-term patients were physically restrained repeatedly in 2006. That’s a drop from 9.7 percent in 2002.

Read the rest of this entry »