Hard Truths

In our work as CNA’s, we see many contradictions. A lot of DO AS I SAY but little of DO WHAT I DO. We have well written care plans that, in the perfect long term care setting, would be ideal for each resident. We have leaders who brag about the “excellent” care facilities provide.

But the CNA knows the truth.

Sometimes these truths are uncomfortable.

And the truth can hurt. It hurts our residents. It hurts US. It hurts humanity when it becomes the norm. Sadly, this is how it is in most nursing homes. Staffing ratios that change from one shift to the next. But the care plan goals and objectives do not. Why is this?

I read all the wonderful programs and processes at the various nursing home trade web sites we link to. The ideas, and the thoughts behind them are based upon good nursing care practices. Much emphasis is placed upon involving the CNA’s in the programs such as eliminating wheel chair use. CNA’s aren’t stupid. We know how these things are harmful.

Much effort is put into making sure staff “understand the importance”; many hours are logged into convincing staff (namely CNA’s) that these ideas are best for our residents. Care plans are written with great detail as to exactly when and how far a resident needs to ambulate (or whatever the program demands).

CNA’s aren’t stupid.

Yet, all this “education” and “staff buy in” baloney only goes so far.

The baloney shows its true colors when there aren’t enough staff to follow through with the programs. A CNA can assist several residents with walking to the dining room, for sure. But to expect the CNA to ambulate 10, 12 or more to meals is a bit much- when we add in the meal set up, assisting with eating, cleaning up and the myriad of other tasks we’re charged with.

The baloney shows its true colors when 3 aides are assigned a unit on evening shift that is staffed with 5 aides on days. It has always baffled me why evening shift has less aides…the claim that the shift isn’t as task-orientated is crap!

Some more uncomfortable truths:

Evening shift aides could keep all their residents out of wheelchairs IF they had enough support in the form of adequate staffing. But NO. Management cannot justify the ratios based upon the low standards of care they like to pretend are excellent.

Evening shift aides could make sure their residents are brought to the bathrooms more often and therefore decrease incontinence; which could lead to less brief use and…wow…less need to purchase all the products designed to “manage” incontinence. And a nice side effect would be less odors.

I am quite sure more than a few residents would appreciate a shower more than once a week- evening shift staff could do these. Clean residents are happier residents. They smell good, look good, feel better and often want to participate in their lives more.

Residents would not have to go to bed right after dinner, or even at 7:30pm, if there were enough aides. What adult retires THAT early in the evening? When residents are in bed, they are at risk of bedsores, contractures and all the problems associated with immobility. In the end, these problems cost far more money and time to correct than a couple extra CNA’s would cost.

I am quite sure nursing homes save money when they don’t have to keep Activity Staff on the clock past 4 or 5pm each day. Most residents would like to stay up later at night, and socialize and enjoy some activities and outings and other similar things. Having things to do is what keeps life interesting and entertaining. Looking forward to nothing is depressing and demoralizing.

I am quite sure nursing homes save money when they purchase chair and bed alarms vs. having a couple more aides scheduled. The alarms don’t require an hourly rate of and the other costs of employing an aide.

I am quite sure nursing home management can do little to change these truths. They can, however, try very hard to provide the right ratios and activity staff and other supports needed to enable carry through of these excellent (and medically sound) programs. Either that, or down grade the expectations to what can reasonably be done. In other words, care plans and programs should be, and must be, formulated and written with staffing ratios in mind.

Ideally, the resident’s needs should justify the ratios. The CNAs know the truth though.


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