A nursing home in New York City cut off health benefits to it’s staff over last summer, and they have been on strike since February.

After three wearying months of walking the picket line, 220 nursing home workers at the Kingsbridge Heights Rehabilitation and Care Center in the west Bronx have had plenty of time to sharpen their message.

“Health care workers like us should have health care coverage,” said Jacqueline Simono, who has worked for 10 years at the six-story, 400-bed nursing home.

In August, the nursing home stopped paying the workers’ health insurance premiums, and as a result, their coverage was cut off. That, the workers say, was the main reason they went on strike on Feb. 20.

The workers, members of 1199 S.E.I.U. United Healthcare Workers East, say they are expecting the National Labor Relations Board to give them some good news soon to help end the strike.

Sadly, those on strike are not earning any income and I cannot imagine how they are making ends meet right now. The costs of health care benefits is skyrocketing for everyone- not just health care workers. We’re seeing more and more businesses from every sector dropping coverages or increasing premiums.

Reading the rest of this article, it isn’t clear what’s really going on here. One thing: If these staff belong to a union, it is the unions’ job to make sure benefits are part of any bargaining plan. Somehow, somewhere, someone let the ball drop here.

I did a little digging into this situation and found a couple articles worth mention.

From a May 7th article:

NEW YORK–About 5,000 members of 1199SEIU from across the Northeast rallied May 3 to support 220 strikers at the Kingsbridge Heights Nursing Home, whose owner, Helen Sieger, has refused for six years to sign a contract with SEIU or pay into the 1199 health benefits fund.

The overwhelmingly immigrant strikers entered the rally at Fort Independence Park in a boisterous show of force, calling on a broad spectrum of militant national labor traditions.
[…]
Bartosz and Tomas, two strikers from Poland, described Helen Sieger’s anti-labor practices: “We have no sick days. We have no health benefits. We are required to arrive at 10:30, but are only paid from 11:00 on. Though we should finish at 7:00, we often have to work later, also without pay.”
[…]
A number of federal, state and city politicians and union officials spoke at the rally, including SEIU President Andy Stern and Sen. Charles Schumer. Barack Obama spoke through a recorded message. SEIU members from Albany and Rochester, N.Y., turned out, along with others from Massachusetts, New Jersey and the Washington-Baltimore area.

The rally highlighted the role that immigrants play in organized labor. A win for the Kingsbridge workers will be a victory for both the immigrant rights and labor movements.

There were not 5000 people at any rally for this. That is a gross exaggeration. Using militant strike methods wins few friends in these causes; however, asking politicians to speak on the behalf of those on strike is admirable.

The fact that many of those on strike are immigrants leads me to ask the tough question: Are they legally entitled to work in the US? Are these people just doing another job Americans won’t do? I wonder how many American CNA’s worked for this facility?

Finally, I ask this: If there is a strong union here, HOW do we explain such bad working “conditions” that include no sick days, not being paid for actual times worked, and so on? In many places of employment, meal breaks are not paid time. So, employees are expected to be on premises for 8 1/2 hours- eight of which are paid and the other that is not. And exactly how much longer were they made to stay over 7:00? A few minutes or hours? If minutes, then this issue is moot. If hours, then there is a serious problem. The devil is in the details, and we’re not getting those.

I also found the latest survey information for this facility. As usual, it doesn’t provide a clear picture of the facility, but all in all it isn’t THAT BAD. I have no doubt this place is a dungeon to work in; I also have little reason to believe the management gives one hoot about the workers. But my instincts tell me we’re not being given ALL the facts.

I ask people to be skeptical on these articles because the lack of detail can make a huge difference. A unionized nursing home should NOT have these issues. A union that has failed it’s members, however, might encourage a strike just to blow smoke in the air around it’s own failings and obscure the truth.

Much of the work we do is aimed at keeping our residents clean, dry, fed, toileted and hydrated. We focus on these things because it is OUR job. There are other things though, that often get lost in the daily shuffle. I work for an agency as a part time job (as well as a full time job at a rehab facility) and through my experiences here, I’ve seen a lot of rushed care and the results of it.

When working short, there’s a saying among aides: Face, Hands and Butts. FHB. This means that our time should be spent washing faces, hands and butts and the rest can go unattended. This isn’t ideal but it is the reality when we’re pressed for time.

Even when our units are well staffed I have seen some pretty poor quality cares that leave me wondering if some of us cannot put ourselves in our residents’ shoes…

No matter how short staffed, we must always consider resident dignity.

Complete bed baths, whirlpools and showers can be postponed.

Washing faces doesn’t mean simply wetting a wash cloth and wiping it over a face. It means using gentle soaps/cleansers. It means using another wash cloth dampened with water, to rinse off the soap. It means paying close attention to the eye areas, removing the residue and drainage we often see. It means making sure noses are clean and the area around mouths is clean as well. Shave the men.

Oral care MUST always happen- how would YOU feel if your teeth weren’t brushed???

Care must be given to underarms. They need to be washed, rinsed, dried. If needed, a light coat of deodorant is called for. Body odor is a major dignity issue for our residents.

Hands have to be washed. Period. Several times each shift. Nail care can wait, unless they are long and ragged or dirty.

Incontinent care has to happen. Buts and other areas MUST be cleaned. Period. No skimping here.

I can’t count the times I have witnessed residents being brought out with messy hair, or worse, with hair dos that are not becoming to them. Ladies like to look presentable. Imagine how you would feel with greasy, slicked back hair…it’s up to US to make hair look nice. Hair should be combed/brushed no matter what; if ladies’ hair is permed, a little spritz with some water often works wonders to bring back some curl.

Clothing choices? It usually doesn’t matter when it comes to staffing issues. Residents have clothes and we assist them with dressing. BUT what does matter is matching colors at best and avoiding clashes at worst: Striped shirts do not go with plaid pants! Just like an elegant fluffy blouse doesn’t go with sweatpants. Some of our male residents prefer to wear t shirts under their tops; and MOST of our ladies like to wear bras. Don’t skimp on this.

A quick note about briefs: For the residents who use them, we have to ensure they are correctly applied. The right size is paramount. Too big a brief is not only wasteful but a major cause of discomfort. Small briefs often lead to nasty red marks in the groin areas. Make sure the brief is centered, and the front portions are pulled up enough to allow for movement. Don’t let the brief bunch up anywhere.

Residents who use wheelchairs need special attention for comfort AND skin issues. This is a no brainer but I have seen countless times, bunched up shirts in the back and sides. Pants that are wedged up in front. We need to make sure these things don’t happen. Take the time to pull down tops once a resident is positioned in their W/C; fix the wedgies and pull down the lower parts of pants. Make sure the resident is seated properly and is comfortable.

As much as most of us don’t like providing less than ideal care, we can do so on shifts where we just don’t have time. Assignments are often increased with two or three residents when there’s been a call out. Always check with the charge nurse about your priorities when staffing is an issue. Better yet, ask the nurse for a meeting with all the aides on the shift, to plan ahead for those times.

Always consider safety, comfort and dignity. Some will say not always in that order, either.

Two resources for CNA’s and other direct care workers for learning.

Self study articles from the state of Oregon’s Community Nursing Tools site; these are all in PDF:
Aspiration
Challenging behaviors - Part 1
Challenging behaviors - Part 2
Constipation
Dehydration
Documentation guidelines
Fall prevention
Infection control
Influenza
Medical terminology - Part 1
Medical terminology - Part 2
Medication safety
Pain management
Pneumonia
Quality care - without restraints
Your body - changes through the years

And this, ABUSE PREVENTION TRAININGS, again, in PDF. Facilitators Guides for each module are available as well.
Module 1: Person-Centered Care
Module 2: Identifying Potential Signs of Abuse & Neglect
Module 3: Abuse and Neglect – Defining & Reporting
Module 4: Stress Triggers and Trigger Busters – Life Influences
Module 5: Stress Triggers and Trigger Busters – Job Challenges
Module 6: Stress Triggers and Trigger Busters – Client Behaviors
Module 7: Stress Trigger Signals
Module 8: Active Listening
Module 9: De-escalation – Conflict Resolution
Module 10: De-escalation – Client Behaviors
Module 11: When Abuse Happens
Module 12: Active Communication – Learning Circle

We write of Culture Change often here, and for a reason. It simply makes sense to adopt to this newer model of caregiving. And, it saves many cents, too! McKnights LTC News has the scoop right here:

Nursing homes that have adopted aspects of the culture change movement, or at least strive to, are more likely to see benefits in resident satisfaction, staff retention, higher occupancy rates and improved operational costs, according to a recently released survey of directors of nursing.

In the report, which was conducted by The Commonwealth Fund, nursing homes were broken into three groups: culture change adopters (31%), culture change strivers (25%) and traditional nursing homes (43%). Of the adopters, 60% reported improvements in operational costs compared with 31% of traditional nursing homes. Additionally, staff absenteeism decreased in half of the homes that adopted culture change, according to the report. Roughly a third of traditional nursing homes reported any such similar decrease in absenteeism. Culture change is a movement emphasizing resident-centered care in nursing homes.

Over at the Huffington Post, Harold Pollack speaks up for direct care workers- CNA’s, home health aides and others. It’s good when our voice is heard at the bigger blogs.

Every day, my family and countless others trust direct care staff to care for our loved ones. Yet we pay them less than we pay many of the college students brewing skinny lattes at Starbucks. Meager staff pay and benefits are the shameful back story of the generally positive effort to move intellectually-disabled people out of state institutions into the community. Starting hourly wages for direct care workers are typically a dollar or two above minimum wage.

Not surprisingly, low morale and turnover are huge problems. Families hope that the job means more than a paycheck, especially since we can’t always monitor what they do. We hope that direct care workers treat our loved one with diligence, dignity, and skill he deserves. Many do. Given human nature, not every care worker earns the paycheck she doesn’t get to receive. I’ve met too many people who clock in, take the cruddy paycheck, and don’t do much else. If I got $9.85 per hour, I wouldn’t be the Energizer Bunny, either.

We do have our share of lazy peers who make us all look BAD. But in every line of work I have ever seen, including our Congress, there are lazy and uninspiring people to tend with.

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.

Over at Long Term Living (used to be Nursing Homes Magazine) they’re asking for ideas and solutions to the ever present big time issue: STAFFING PROBLEMS. Go over and leave your thoughts and opinion. I did.

Up in Canada an investigation is under way. A nursing home resident died as a result of a fall, out of a mechanical lift.

The faulty lift equipment that caused the death of an east Toronto nursing home resident had already malfunctioned twice within the same long-term care chain, according to a health ministry document obtained by the Star.

Leisureworld Caregiving Centres documented the two earlier incidents when the same type of lift broke down at another home in its chain, last November and December, according to the ministry’s May 8 letter to Health Canada, warning of safety hazards. The letter said there were no injuries as a result of the first two malfunctions.

It was not until Wally Baker’s April 30 death that Leisureworld replaced the lifts (motorized equipment used to move residents from bed to chair to toilet) throughout its 26 homes in Ontario. But chief executive officer David Cutler said the company took action to address the problems last November and December, including contacting Health Canada, which monitors nursing home equipment.

Wow. Pardon me for a moment here. I have worked with all kinds of mechanical lifts, of every variety and made by most manufacturers. Some are better than others; some are easier to use. None ever presented a hazard to my residents though, as long as I used the equipment correctly. We were trained by the manufacturers on how to use each lift, through the years, as we got them. I really don’t understand how this happened.

Has anyone ever experienced a close call with a lift? Was it the lift itself, the staff using it improperly a (lack of training on the proper use)? Was it the resident being unsafe and jeopardizing the transfer? I’ve seen that happen many times as well.

An article about the difficulties many have with finding placement for their loved ones who have dementia. And behaviors.

“After going from crisis to crisis, Joan is finally in a place where they have the time and training to really help,” said her husband, Terry, 76, a retired math teacher and businessman from Shoreview. “How many places can you get kicked out of? Let’s see, for us it was four in one year.”

The combination of dementia and behavioral problems can overwhelm families.

The combination can even overwhelm care facilities, said Annette Peterson, an Alzheimer’s Association counselor in Bloomington who talks every day with weary and sometimes frantic family caregivers.

To meet the needs of people with dementia, and who tend to be “violent”- facilities must have enhanced staffing ratios and dementia-specific activity based programming/care. The facility needs to be designed to allow for freedom of movement while ensuring the safety of wandering residents. Meals should be served buffet style and not at specific times. Routine is good for some with dementia but not all. Ware-housing these people with the non-memory impaired will not result in good outcomes. In the future, facilities will need to copy the model written about in this article.

Nursing homes can expect some new guildlines coming this fall with regards to MRSA and infection control.

While many studies have looked at MRSA in hospitals, “we found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people,” the reviewers said.

That’s despite nursing home conditions that are ripe for breeding the bacteria, including residents with compromised immune systems living in close proximity and taking multiple medications that can foster bacterial resistance.

Open wounds such as bed sores – a common problem in nursing homes – and the use of catheters, also common, enhance older people’s vulnerability.

Recognizing the importance of the issue, the Association for Professionals in Infection Control and Epidemiology (APIC) is updating its MRSA recommendations to “apply more specifically to long-term care settings,” according to Liz Garman, a spokeswoman.

Those new recommendations are due to be released late this summer, she says.

One of the typical things is strict isolation of patients who test positive for this infection. There are not enough single beds in most nursing homes to accommodate this. It will be interesting to see how nursing homes follow up on the recommendations.