The following post submitted by a registered nurse currently working in a nursing home setting offers a pointed reminder of the seriousness of what happens when corporate greed is allowed to dictate minimum staffing standards…
I am an RN in a nursing home licensed for just over 200 residents that offers skilled, intermediate and personal care. This facility has four nurses stations/units. I work on a unit with 38 residents. Many of these individuals have dementia.
My unit is allowed four nurses aides and an LPN on day shift, 3 nurses aides and an LPN on evenings, 1 – 2 aides and an LPN on nights.
While I try hard to understand the “budget” for staffing on my unit, my repeated requests for additional help has been ignored. In August I had eight (8) resident falls on my unit and they all happened on evening shift. My unit’s LPNs are frequently out of time compliance on distributing medications.
I would like to see mandatory staffing based not only on the number of residentts, but also on their needs. This is especially important on a unit that has residents with many needs.
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September 24, 2008 at 3:30 pm
Jonathan Rosenfeld
Thanks for providing ‘real life’ examples of what can happen with under-staffing in nursing homes. Most people do not appreciate the little things that nurses and other nursing home staff do to help their residents. Many of these little things, like providing additional assistance walking or opening a door, have a huge impact on the quality of care and patient safety.
Jonathan Rosenfeld
Chicago, IL
http://chicagonursinghomelawblog.com
October 15, 2008 at 11:00 pm
J.D.
That is so very true. I’m only a student nurse right now, although during clinicals, I see the exact same things you mentioned in regards to staffing. I feel so bad for the residents that hardly get any attention. They really get dirty. The nursing assistants ‘clean’ them, although they do it half-half(for the lack of better term), because they have to hurry up for the other residents. – J.D.; Chicago, IL
October 18, 2008 at 9:47 am
Gregory D. Pawelski
(Best Syndication News) On Friday, September 26, 2008, Reps. Pete Stark and Jan Schakowsky introduced the “Nursing Home Transparency and Quality of Care Improvement Act of 2008.”
The bill increases the transparency of nursing home ownership, ensures that residents and their families have information about the quality of care at these facilities, and strengthens enforcement of nursing home compliance with quality of care standards. It is a companion bill to S. 2641, introduced by Senators Charles Grassley and Herb Kohl.
The Nursing Home Act enables nursing home residents and government regulators to better know who actually owns the nursing home and who controls the decision-making that impacts the quality of care provided. In addition, the bill improves the reporting of information on staffing levels and direct patient care expenditures.
http://www.bestsyndication.com:80/?q=20081017_nursing_homes_legislation.htm
October 26, 2008 at 3:51 am
Gregory D. Pawelski
The Bush Administration’s Easing the Reins on Nursing Homes
According to government documents back in 2001, the Bush administration, through Thomas A. Scully, then administrator of CMS, wanted to ease regulatory requirements on nursing homes, reducing the frequency of inspections and lessening or eliminating some penalties (meaning deregulation).
The administration wanted to move away from adversarial enforcement toward a more collaborative one, in which regulators would work with nursing homes to improve care. You can see where that got us in the present market meltdown and economic crisis.
Senator Charles E. Grassley, long-time advocate of nursing home patients, has said it was risky to reduce the frequency of nursing home inspections. Today’s good nursing home can become tommorrow’s poor performing facility, if there is a change in ownship, a new administrator, a new director of nursing or an influx of patients with more severe illnesses.
One of those administration’s goals was to devise new measures of the quality of care by using data reported by nursing homes. Surveyors look at self-reported and unaudited data, data reported by the facilities themselves and unverified by any oversight agency to ensure it is even true. This leads nursing staff to do charting by rote, instead of charting care that they’re actually giving.
Government reports have said that nursing homes with a low ratio of employees to patients were significantly more likely to have quality-of-care problems. This administration did not want to set mandatory staffing ratios for the industry. Without sufficient staffing levels, patients don’t receive even basic humane care, which translates into even more taxpayer dollars down the drain.
One example of this lack of quality care is when nursing homes put LPNs in charge of floors. Nursing home would rarely pay RNs their salary to run the floor. LPNs do not receive training in nursing school on how to be a charge nurse. RNs have at least three months of training in leadership on a floor. Therefore, nursing homes are being run by untrained staff, as well as lack of CNA staff.
That is why RNs are hired to make sure the paperwork is perfect before the so-called, unnannounced survey inspections. Nuring homes would improve greatly if all charge nurses were RNs. With no disrespect to all the fine LPNs, they are not formally trained to do the job of an RN, yet they are placed in that role in nursing homes.
This nation needs to write or call their federal congressional delegation to get the “Nursing Home Transparency and Quality of Care Improvement Act of 2008″ passed and implemented.
November 11, 2008 at 7:56 pm
Gregory D. Pawelski
Taxpayers still reward bad nursing homes with millions in bonuses and CMS blessings
Nursing homes throughout the country are eligible for hundreds of millions of dollars in taxpayer-funded bonuses despite past violations of basic health-and-safety standards.
According to a Des Moines (Iowa) Register review of 81 bonus payment programs in 36 states, it shows that some homes are collecting quality-of-care bonuses approved by the same federal agency that considers them to be below-average caregivers (CMS).
More than 60 bonus programs exist to help nursing homes do what they are legally required to do, such as pay the minimum wage or install fire sprinklers for resident safety.
Of course, the total cost to taxpayers is unknown, according to the Centers for Medicare and Medicaid Services (CMS), which approves and helps fund each of the bonus-payment programs now in effect but does not track any of those payments.
The Register examined eight bonus programs in the seven states where recent regulatory violations don’t disqualify a home from receiving a bonus that is touted as being directly related to quality care. Those eight programs are costing taxpayers $312 million per year.
Toby Edelman, nonprofit Center for Medicaid Advocacy, thinks the government seems to be saying, yes, we’re going to impose fines for poor care, but at the same time we’re going to be giving you bonuses. It just doesn’t make any sense.
Mary Kahn, a spokeswoman for CMS, said the law does not require, and thus the agency cannot require, that Medicaid-funded bonuses be linked to quality of care. The head of CMS, Kerry Weems, wrote in a recent letter to Iowa Sen. Charles Grassley that fines and sanctions for substandard care typically have no bearing on the bonus programs in various states.
Weems pointed out that CMS is proposing a pay-for-performance plan that would tie some federal grants to a care facility’s compliance with minimum standards of care. But that plan has yet to be approved.
The bonus programs didn’t attract much attention until March of this year when the Register reported that Iowa’s program was providing bonuses to some of the worst homes in the state. This got Senator Grassley to write to CMS that he found the newspaper’s report very disturbing. He asked them for information on other bonus programs throughout the nation.
This kind of system was devised FOR the industry, BY the industry, with the incestuous blessings of totally-corrupted, oversightless agencies and tolerated by powerful politicians with NO spine, NO ethics.
http://www.desmoinesregister.com:80/article/20081109/NEWS10/811090341/-1/SPORTS09
November 17, 2008 at 11:56 pm
Diane
Be careful. If the nursing home knew what you were thinking, YOU WOULD BE FIRED!
My mother died in a facility in Kokomo, Indiana. The facility is owned and operated by one of the largest nursing home corporations. They killed my mother.
The states always sides with the disgusting owners of these facilities that are licensed to kill and steal from taxpayers.
THEY SYSTEM DOESN’T CARE ABOUT OUR LOVED ONES. Too many of these facilities are owned by elected officials at all levels, attorneys and doctors. IT’S A JOKE ON AMERICAN CITIZENS. I HATE THEM.
December 20, 2008 at 11:04 am
Gregory D. Pawelski
I know what you’re talking about Diane. The nursing home my mother is residing at in Sinking Springs, Pennsylvania has fired the Medical Director for speaking out against failures in care delivery. And one of the best RNs the home has ever had, and which the former Medical Director has verified as being very good at his clinical work, was fired because of speaking out against failures in care delivery at the home.
They can’t fire me, I don’t work there. However, I’ve been put on restriction since I’ve informed CMS of the deficiencies and violations there. As a result of the CMS survey, the facility was found not in compliance with the Long Term Care regulations, and cited. Besides me, the administrator told my mother there was a number of other care-givers that were put on restriction. Really a pathetic nursing facility.
March 18, 2009 at 9:30 pm
brenda j.
I just started working at a nursing home as CNA in training: read:no training,
on my own last night, 45 beds, 1 nurse who couldn’t be bothered, and me.
I ran all night, couldn’t keep up, just wanted to keep them clean and comfortable, so many, so many, and 3/4 incontinent, 1/2 with motion sensors for fall risk, 1/3 with just a need for some extra compassion, and more every night with signs of infection. I cry every time i walk out. I get yelled at and shunned because i take too long, when all they want is a drink, a clean blanket, and maybe even a hug. i thought that was what anyone needed, but apparently, only if they can get it themselves. I have NO TRAINING and I was ALONE for an 8 hour overnight shift. Oh, and I have to wash those wheelchairs and chart those bm’s.
April 19, 2009 at 10:25 pm
Gregory D. Pawelski
Nursing home care falling short
http://talk.baltimoresun.com/showthread.php?t=147677