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As I’ve written many times over the years, the comments made by readers who currently or previously worked in nursing homes are some of the most powerful indictments of serious problems within the greedy nursing home industry! Along with family members and loved ones, these folks know all too well that the system is broken badly and is desperately in need of fixing!
A comment left earlier today by one such reader, a CNA with many year’s experience of caring for nursing home residents, points out the dangers and stresses caused by understaffing. Understaffing is caused by? Corporate greed. The CNA wrote:
“I’ve been a CNA for a while now and I’m exhausted. Today I alone was responsible for 16 residents with nine of the 16 being total care and 11 of the 16 requiring assistance by a minimum of two staff members. It’s impossible!!! Unfortunately those total care residents were only changed once because of the lack of time during day shift.
Inadequate staffing creates a situation that is incredibly hard – mentally and physically – because I care and love my residents. Something has got to change. Our residents are suffering!
No wonder there are so many issues with skin tears. Some CNAs get in such a hurry to get everyone done in time or they’ll get in trouble for running late or if they clock out even one minute late they get their attendance bonus taken away. But let the administrator come out of their office and out of their plush leather desk chair once a week and throw afit because the closets are a mess or there’s a lift in the hallway or some other unimportant bullcrap! They don’t worry about the CNA whose back is broke, with sweat running down their face, or that there are 10 more residents to lay down and change before the end of the shift.”
I believe this comment from a certified nurses aide points out that short-staffing, which is directly related to corporate greed, is the source of suffering for both nursing home residents and nursing staff. I have no doubt the emotional toll is especially heavy for the nurses and CNAs who truly love and care for their residents. The best and brightest staff get burned out and worn out because of inadequate staffing.
The suffering caused by short staffing clearly harms nursing home residents. Everything from medication errors to bedsores can be traced to short staffing. My observation is that inadequate staffing is the single largest cause of nursing home resident neglect leading to illness and death.
When a nursing home CEO (as many do) earn mutliple million dollar annual salaries and the front line caregivers (CNAs) barely earn above minimum wage and often lack health insurance or other benefits, something is seriously wrong with the nursing home industry!
As a resident of Kentucky committed to nursing home reform, I was thrilled when our 2013 legislative session ended a few weeks ago without passing Senate Bill 9. The bill’s intention was to make it much more difficult to sue nursing homes by mandating that a panel of three physicians would have to, by majority vote, approve of the merits of a lawsuit against a nursing home before it could tried in court.
Most nursing homes in Kentucky are owned by for-profit corporations. Most hospitals in Kentucky and owned by non-profit corporations. Kentucky’s hospitals have never sought such protection. So it’s obvious what this dysfunctional bill was all about: protecting nursing home profits. With a smaller profit margin nursing home bosses like Kindred President & CEO Paul Diaz might not be able to make an obscenely huge salary of over $6.4 MILLION like he did during 2012. This is all the more an obscene situation when you consider how cheaply Kindred and other nursing home giants run their facilities — meaning they don’t provide adequate staffing to care for their residents and the front-line caregivers are woefully underpaid, many not even having health insurance as part of their compensation.
While Senate Bill 9 passed in the Kentucky Senate, thankfully it never received a hearing in the House Health & Welfare Committee, so it couldn’t up for a vote by the House. While the fact that this bill was able to pass in the Senate is disturbing, yet it points out a reality that the nursing home industry needs to face: No matter how much money they spend to buy legislator’s votes to support such a bill and to run deceptive commercials to promote their agenda to the public, they do NOT have the truth or decency on their side. Thankfully, so far at least when it comes to Senate Bill 9, all of their money and lies could not force their hideous agenda on nursing home residents. Truth won. Greed lost. Amen.
I want to offer a few reminders about this blog…
– As I’ve mentioned before, I’m very familiar with how nursing homes operate in Kentucky and Indiana, due to my late mother’s experiences in facilities located in both of these states. But I never claimed to be knowledgeable about nursing home rules and regulations in any other states.
– Since I’m not an attorney, nor am I employed by any government agency that regulates nursing homes I ask that you do not contact me for help resolving a problem with any nursing home, especially if they aren’t located in either Kentucky or Indiana. Instead, I urge you to focus on contacting either your local long-term care ombudsman and/or the agency that regulates nursing home in your state (the agency name varies from state to state, but this is information you can find at your local library or from your state legislators). These are the people you need to contact. With access to Google and other Internet search engines, you can likely find their contact information quite easily. If you can’t find the information online, then (as mentioned previously) contact your local library and/or state legislator for this information. In both Kentucky and Indiana all nursing homes MUST (as a matter of law and/or regulation) provide anyone who asks (resident, family member or friend) for their
– While I do publish from time to time comments readers leave on this blog having to do with nursing home problems they’ve experienced, please remember that I reserve the right to edit your comments. I edit these comments to protect the identity of the nursing home resident, the author of the comment and I never include the name of the facility involved. Given the tendency for nursing homes to retaliate against residents and their friends and families, it should be obvious why this information is omitted. I also don’t feel comfortable naming a nursing home accused of neglect or abuse of their residents unless this is a matter of public record (e.g., it involves a situation that has been the subject of a lawsuit).
Please DO keep share your story with me and with our readers! I believe it is therapeutic to share the horror of one’s stories with others and it is helpful for others to be reminded they are not alone and that others have faced the same nursing home crap they have!
Remember: Truth Won. Greed Lost. If it can happen in Kentucky (and it did during our 2013 legislative session) it can also happen in your corner of the world!
A visitor to this blog shared the following comment a few days ago. I think her comment speaks directly to the issue of corporate greed and that leads to both the neglect of nursing home residents as well as mistreatment of nursing staff. A nurse wrote:
“At one time I worked in a nursing home that was so understaffed that I dreaded work every day. I provided care to 24 residents at one time (on a unit with a total of 48 residents). On my shift there were just two CNAs and two nurses for 48 residents.
One time I was forced to work while having the flu and a 102 degree fever. Management told me that I would be fired if I didn’t report to work and they would demand the state revoke my licence for abandonment. It is really sad what happens in these nursing homes.”
Many important issues are touched on here.
- Clearly nursing home management had NO regard for the residents by insisting that a staff member with a fever of 102 and a diagnosis of the flu report to work — or else! True, most all nursing home residents are given a flu vaccine shot each year, but that is NO guarantee of protection from every strain of the flu. Given the severe health problems most nursing home residents have in the first place, the last thing that needs to happen is for them to be exposed to the flu! The flu can be deadly for elderly persons and others who suffer from serious health problems.
- Clearly nursing home management had NO respect for their staff member in this case. Someone sick with the flu, without question, should be allowed to stay home from work. Nurses and all caregivers have a RIGHT to take care of themselves and their health!
- Clearly nursing home management ignored their option to bring out one (or more, if needed) temporary employee(s) to cover the shift(s) of the nurse sick with the flu — assuming no other qualified staff members were available to cover her shift(s). Oh wait, temporary employment agencies charge for providing staff. Which means that would be a threat to the bottom line for the nursing home involved in this situation! We certainly have greed taking priority over respecting the health of residents and treating their nursing staff with dignity! Indeed GREED MUST ALWAYS rule the day with the nursing home industry! Sad. Truly sad.
- One nurse and one CNA per shift for 24 nursing home residents. Do the math: how many minutes PER RESIDENT can the nursing staff provide EACH resident over the course of an 8 hour shift? When I do the math it comes out to 20 minutes per resident/per staff member. Generous? Hardly! Especially considering how much time is spent by both nurses and CNAs to do things like clean up messes caused by sick residents (including helping a resident change out of soiled clothing and changing bed clothing), taking infirm residents to and from the bathroom, giving showers, serving food and feeding infirm residents, preparing medications, etc. — on top of doing all of the paperwork required to document resident care!
- One nurse and CNA per 12 residents would be able to provide a lot better quality of care than one each per 48 residents, don’t you think? Remember most CNAs barely earn above minimum wage and many don’t work enough hours to qualify for health insurance or other company benefits! So nursing homes can’t afford to hire more CNAs yet the owners, administrators and other management people (who never — or hardly ever — provide direct resident care make five, six-or-more-figure annual salaries! It isn’t fair. It isn’t just. The priorities regarding financial compensation for staff are all wrong!
Some people who read this blog assume that I am against nurses and CNAs who care for nursing home residents. I have no respect or use for staff who abuse and/or neglect the residents charged to their care. At the same time, I would never assume that most or all nurses abuse of neglect their residents. No, the real evil here clearly goes back to ownership and management. The fault for corporate greed begins and ends with them.
We know that abuse and neglect of nursing home residents is all too common. Make no mistake that nursing home management and ownership routinely psychologically abuse both the residents and family members of residents who confront abuse, neglect and other problems (including fraudulent billing) that takes place!
One such family member of a nursing home resident who has visited this blog wrote the following earlier today, “I just got a copy of a bill submitted to Medicare for $8,000 worth of therapies never done for my father by nursing home staff. Their fraudulent billing was so bold as to list therapies done on CHRISTMAS, a day when he was asleep 95% of the day!” When confronted by the family member, what did the nursing home’s administrator do? The family member continues, “When I disputed the bill, the administrator told me perhaps it was time to move my father!”
THIS TYPE OF PSYCHOLOGICAL RETALIATION MUST STOP!!! It is NOT a crime or a bad thing to confront fraudulent nursing home billing! It is NOT fair to retaliate against a nursing home resident because their family member points out a legitimate problem! It is NEVER wrong to point out possible insurance fraud!
How is suggesting moving a family member to another nursing home a type of “psychological retaliation”? Because it is NOT in any way, shape or form an appropriate suggestion. Claims of possible fraudulent billing by a family member (or resident) isn’t something that should cause a nursing home administrator to even suggest a resident should be moved. The problem is the FRAUD committed by the facility and NOT reporting the possible fraud! The “sub-text” of this type of “suggestion” is actually a THREAT to involuntarily FORCE a resident to be moved as a way to punish the person concerned about fraudulent billing. Involuntary discharge from a nursing home because a resident or their family member reports possible fraud is ILLEGAL. Nursing homes are masterful in how they can cook up FALSE reasons (through lies and false charting of resident information) to make it appear that involuntary discharge is for legal reasons. Think of the stress inflicted upon the resident and/or family member to have to defend themselves against false claims. Think of the stress caused a family member when a nursing home resident, for no good reason, is forced to move to a different facility — some residents end up being moved literally hundreds of miles from their family member in order to find a facility that takes Medicare payment that will accept the resident. It isn’t easy to place a resident when the discharging facility has falsely documented problems about the resident in order to justify kicking them out.
If possible insurance fraud involves Medicare, as in the case of this reader, the official Medicare website (www.medicare.gov) offers the following information about how to report fraud…
First, if you even suspect that Medicare is being charged for a service or supply that wasn’t provided your loved one (or a friend, or yourself), call toll-free 1-800-MEDICARE.
It will help to have the following information handy at the time you report fraud:
- The provider’s name and any identifying number you may have.
- The service or item you’re questioning.
- The date the service or item was supposedly given or delivered.
- The payment amount approved and paid by Medicare.
- The name and Medicare number of the person the service or supplies were alegedly provided to.
- The reason you think Medicare shouldn’t have paid.
- Any other information you have showing why Medicare shouldn’t have paid for a service or item
Under certain circumstances fighting Medicare fraud can pay up to $1,000! You may be eligible for a reward of up to $1,000 if all of these 5 conditions are met:
- You report the suspected Medicare fraud. The allegation must be specific, not general.
- The suspected Medicare fraud you report must be confirmed as potential fraud by the Program Safeguard Contractor, the Zone Program Integrity Contractor, or the Medicare Drug Integrity Contractor (the Medicare contractors responsible for investigating potential fraud and abuse) and formally referred as part of a case by one of the contractors to the Office of Inspector General for further investigation.
- You aren’t an “excluded individual.” (Example: You didn’t participate in the fraud offense being reported. Or, there isn’t another reward that you qualify for under another government program).
- The person or organization you’re reporting isn’t already under investigation by law enforcement.
- Your report leads directly to the recovery of at least $100 of Medicare money. The incentive reward can’t exceed 10% of the overpayments recovered in the case or $1,000, whichever is less. If multiple individuals qualify for a reward, the reward is shared among them.
If you want to know more about Medicare’s Incentive Reward Program, call toll-free 1-800-MEDICARE.
My prayer is that nursing home residents and their family members may never again be subjected to psychological abuse in retaliation for telling the truth.
Earlier tonight one of my readers shared about a very disturbing thing her mother, a nursing home resident, experienced this weekend. While waiting for one hour for a CNA or nurse to assist her with using a bed pan, the resident eventually soiled herself. To add insult to injury, the CNA who finally responded to the resident’s plea for help made a judgmental comment to the resident — which of course is beyond inappropriate!
The situation with this reader reminded of my own late mother’s many experiences of waiting 15, 30, 60 minutes…even over TWO HOURS for nursing home staff to respond to her call light. She wasn’t able to toilet herself and I wasn’t allowed to assist her. All she could do was remain in her bed, miserable with the urgent need to use the restroom. On many occasions she ended up soiling herself before nursing staff arrived. In many cases I was told by nursing home staff that it was not only OK for my mother to soil herself, but probably this was even a good thing!
“Good” for who? Not my mother. Not for the mother of the reader. Indeed the longer a person sits in their feces and/or urine, the greater the likelihood they will develop BED SORES. Along with being horribly painful, bed sores can even ultimately be deadly!
During the time my mother was a nursing home resident she was taking Lasix, a powerful diuretic medication. And, well duh…Diuretics make a person HAVE TO PEE! Lasix can make a person HAVE TO PEE every hour for up to six hours after administered to the patient (FYI: “Lasix” is shorthand for “lasts six”, meaning it can make a person HAVE TO PEE for up to six hours after they take it). Yet my mother and myself were repeated verbally berated by nurses and CNAs over the years with comments like, “Well I just took her to the restroom two hours ago!” (What part of “EVERY hour for up to six hours” don’t they understand?)
As if not providing adequate staffing so a nursing home resident can be toileted regularly after being given Lasix isn’t bad enough, all of the nursing homes where my mother resided eventually noted in her chart that she was “incontinent”, inferring she was incapable of controlling her bowel and/or bladder function. Hmmm…Who wouldn’t be INcapable of controlling their bathroom functions if 1) they were given a medication that caused them to need to urinate and/or defecate hourly for several consecutive hours and 2) despite being unable to take themselves to and from the bathroom (for whatever reason) they weren’t given the nursing assistance — in a timely manner — needed to get to (and from) a toilet?!?
Sadly, what often happens to nursing home residents after they’ve been charted as being “incontinent” is this designation makes it more difficult for the resident to be accepted by a different nursing home — if and when the resident needs to move. Not being toileted regularly (let alone as needed) is a very good reason to want move to a different nursing home!
Incontinence is a reality for many persons, nursing home residents and otherwise. But when, as is often the case, incontinence can be PREVENTED by providing adequate staffing to assist residents who need help with toileting…that certainly could be a matter of criminal neglect.
Nearly every state’s legislature will begin their 2013 session this month. So January is the appropriate month to offer my five point agenda for nursing home reform. My hope is that state nursing home reform groups and individuals concerned with nursing home problems will lobby their legislators about these matters. My belief is that these five points can, at a reasonable cost to taxpayers and to nursing homes, help improve the quality of the care provided to residents.
Suggestion #1: Have each state mandate an INCREASE in the percentage of inspections (more frequently known as “surveys’) that MUST take place outside of regular business hours on weekdays. This standard should apply to both annual inspections (inspections the state conducts approximately once each year at all licensed nursing homes) as well as to surprise inspections (these are inspections that take place in response to complaints the state receives about a particular nursing home.
In many states at least 10% of nursing home inspections must begin at night or on the weekend. That means that 90% of inspections are likely done during 23% of time that accounts for regular weekday business hours. I believe that if state law would mandate a minimum of 25% – 33% of inspections begin on weekends and during hours when administrators are not normally at work the inspectors would get a more accurate view of the low quality of care that goes on in nursing homes on weekends, 2nd and 3rd shift and on holidays — the times when administrators are rarely on the job. As a family member of a nursing home resident, it was “after hours” that my mother experienced the worst neglect by her caregivers. These are the hours when the staffing levels are usually at their lowest and when management isn’t present to see for themselves what’s going on.
Inspections that take place during weekday first shift hours get a skewed picture of the care being offered. When nursing home owners and management get the message that the state CAN and WILL be showing up UNexpectedly more often, then I believe we’ll see improved staffing levels on second and third shift and on weekends and holidays.
Suggestion #2: Require management personnel to work staggered shits ALL THE TIME, not just when state inspectors are in their building. In large facilities that have an Assistant Administrator (or equivalent position), the state should mandate that the Administrator and their assistant must not be allowed to work identical shifts. In fact, I believe the state should require that the shifts for management can not overlap more than four hours per day (Example: Administrator works 8:00am – 4:30pm, while the Assistant Administrator is scheduled to work 12:30pm – 9:00pm).
The majority of nursing homes are too small to be able to afford an Assistant Administrator. Yet even these facilities MUST have a full-time Director of Nursing on staff. In these nursing homes the same “staggered shifts” rule should be in place for the Administrator and Director of Nursing.
Why suggest this legislative mandate? For much of the same reason that I made my first suggestion: after management is out of the building the quality of care given often suffers. As the cliche goes, “When the cat is away, the mouse will play!” And “play” they often do (e.g., taking excessive smoke breaks, ignoring call lights, talking on their personal cell phone instead of checking on or responding to their residents). One third shift nursing staff member at an Indiana facility where my mother lived admitted to me that she “preferred” to work overnight so “the big shots” couldn’t get in her way of doing her job the way she wanted to do it. Scary! One of CNAs who worked with this individual on third shift shared with me that this nurse took an average of seven (7) smoke breaks, OFF THE UNIT, per hour! This clearly wouldn’t be allowed by either the state or sane nursing home management — but how could the state or management know this was problem existed if they aren’t in the building at night? Residents with dementia likely aren’t capable of reporting such problems. Family members can’t stay with their loved one 24’7 non-stop to monitor this. Placement of a “Granny Cam” inside the room is incapable of documenting problems that take place outside of the resident’s rooms (as in documenting a lack of staffing at the nurse’s station caused by staff taking an excessive number of smoke breaks).
If it is impossible to have management in the building 24/7, then the state should mandate their presence a minimum of 12 hours per day on non-holiday weekdays and 4 hours (or more) per day on holidays and weekends.
Suggestion #3: When the state shows up for an any type of inspection (annual or in response to a complaint) the inspectors (a/k/a “surveyors”) should IMMEDIATELY seize payroll data to (before it can be altered) to verify staffing levels for the 14 continuous days immediately prior to the inspection. With this information in hand, inspectors should have the legal authority to insist that while they are in the building that the staffing level can NOT exceed the average staffing level for the previous 14 days.
Why would I suggest this issue requires a legislative intervention? Because calling in off-duty nursing staff during an inspection or even bring in temporary employees is one of the biggest (and most deceptive) things nursing home management does to make it appear that resident needs are being taken care of in a timely and appropriate manner — when the reality is that they aren’t being responded to in either a timely and/or appropriate manner when the state inspectors are not around. “Putting on a show” for state inspectors should be against the law! Inspectors should see and judge the quality of care based on the REALITY of ACTUAL staffing levels.
Suggestion #4: Pass legislation that prohibits nursing homes from either outright banning or limiting visits of residents by their family and friends. Once nursing home staff identify a resident’s family member(s) or friend(s) as a “trouble maker” (e.g., that we really have the courage to report their facility to the state, as is our LEGAL RIGHT AND MORAL RESPONSIBILITY TO DO) then you can count on the facility to begin setting traps (coming up with schemes) to make it look like we are the bad guy), thus justifying prohibiting (or at least limiting) visits. Some facilities have even limited visits from family and friends from taking place on the unit where the resident resides — allowing, for instance, visits to only take place in the lobby. This way family and friends can’t observe the substandard care the resident is receiving, thus preventing them from being able to observe (and thus report to the state) problems with care.
Attempts to prevent family and friends from visiting nursing home residents (when no harm is being caused to the resident as the result of the visit and when the resident wants to receive visits from such individuals) is clearly a violation of nursing home resident’s civil rights! We activists must get through to these corrupt nursing home owners and managers that their facility is the HOME of the resident and therefore the SAME rights of visitation residents had at their house, apartment on condo apply inside the nursing home facility! Strongly worded legislation is clearly the only hope we have to prevent nursing homes from taking their residents hostage!
Suggestion #5: We need legislation that will mandate increased fines against nursing homes that are found guilty of abusing resident’s rights, especially with regard to forcing residents to move to another facility. Many nursing home residents find themselves being forced out of their facility as retaliation against the resident or their family for sticking up for their rights. This type of abuse of resident’s rights must stop! It is truly a twisted, dysfunctional way of thinking when a nursing home’s only way of handling it’s problems is to punish their residents (or the resident’s family) by forcing the resident to leave their facility. How many residents must suffer “eviction” before a facility is finally forced to look inside itself and make the changes needed to resolve their real problems?
How can you help to make these five changes happen within the state where you reside? Contacting your state legislators would be a good start. Also request the support of your local or state Long-Term Care Ombudsman to help promote this reform agenda. If your area or state doesn’t have a nursing home reform organization then start one! I’ll be glad to help you start and promote such an organization.
I believe that together we CAN make meaningful, important and positive changes take place within the nursing home industry. While the industry clearly has the big bucks to spend on maintaining the status quo, we have more than enough individuals on our side to make change HAPPEN!
Earlier this afternoon I received a very important reminder from an individual who inspects (a/k/a surveys) nursing homes. Each state has a “survey agency” that is in charge of inspecting nursing homes. The name of the agency is different in each state (in Kentucky this agency works through the Office of Inspector General, while in Indiana and many other states this agency is part of the state Board of Health). Whatever they call this agency in your state, these folks need to hear from family members of nursing home residents and nursing home staff regarding unsafe staffing level and any other care concerns. Your calls to your state agency (and regional Long-Term Care Ombudsman) are essential in order for problems to be identified and corrective action to be taken! The state survey manager who contacted me wrote,
“When you (and this goes for both families of nursing home residents and nursing home staff) have concerns about the care of a resident or unsafe staffing levels, be sure to CALL your state survey agency! Their number is REQUIRED to be posted in all Medicare / Medicaid-certified nursing homes. We surveyors (inspectors) are here to protect the residents of nursing homes and assure they are getting quality care.
We surveyors (inspectors) are on the side of the residents and staff. Although we are constantly lied to by facility staff and Administrators, we can get to the truth.
In addition to contacting your state survey agency, be sure to get the Ombudsmen involved too! They can be a great resource.
The bottom line is that if we (regulators) don’t know about your concerns, we may not be able to pick up on these issues. Complain to your State survey agency to get your issues investigated and also help prevent others from receiving poor care!”
Some nursing homes have signs posted that ask family members to speak to the facilities administrator when they have concerns (I’ve seen one such sign that practically begged family members to NOT call the state survey agency before talking to the administrator). While this is an appropriate action to take in most circumstances, I believe the state survey agency and Ombudsman should be contacted FIRST when resident safety and well-being is at risk. If speaking to the nursing home’s administrator doesn’t resolve your concern, then by all means call the state agency and Ombudsman!
I’m always amazed when I get comments from individuals who defend the evil of corporate greed as it exists within the nursing home industry. Corporate greed is truly evil wherever it manifests itself. It is an extreme form of evil when (as it does within the nursing home industry) it jeopardizes, compromises and outright prevents quality care from being provided to nursing home residents. “Care” and “for-profit” don’t belong in the same sentence.
Corporate greed is the culprit behind under-staffing of nursing homes. It is the underlying cause of nursing homes lacking essential supplies to properly care for their residents. It is the reason “corporate bean counters”, instead of nursing professionals, are allowed to determine the quality (or lack thereof) of care given to nursing home residents.
One person who sent me a message a few months ago blew off the problem of corporate greed by claiming if it was a problem in a particular nursing facility that the nursing home would “not be around for long”. Yet anyone who knows anything about how states regulate nursing homes is aware that it can be very difficult for state surveyors (inspectors) to catch even the most serious problems within a facility — let alone document those issues to the point that the nursing home is fined, let alone has it’s license revoked. Nursing home executives are experts at spinning (e.g., lying) to the state, to their employees, to their residents and their resident’s families…anything to avoid being caught doing the wrong thing. Anything to avoid from being found out to be comprising resident safety and care because the pursuit of financial profit comes before providing quality resident care.
Now an example of something written by a person who really does not understand the harm caused by corporate greed within the nursing home industry. The anonymous comment claimed, “Saying for-profit is bad means you would have to make every for-profit business bad. So don’t eat at any restaurant since every one of them are for-profit.”
My response is that being for-profit in and of itself isn’t the real issue. Corporate greed is the problem. Within the past six months two research reports have been released that prove that a much higher percentage of for-profit nursing homes have lower resident-to-staff ratios than non-profit facilities. Inadequate staffing levels are clearly the number one cause for inadequate care. Non-profit facilities, staffed at higher levels than their for-profit counterpart, consistently provided better quality care than for-profit nursing homes.
I would love it if every nursing home on this planet were non-profit. But until that day comes (and I don’t see it happening ever), then we in the Nursing Home Reform movement must continue to put pressure on state nursing home regulators to do a better job of catching and penalizing nursing homes for providing inadequate care — realizing that is most often corporate greed that creates the crisis of substandard care in the first place.
I received the following comment a few days ago written by a recently licensed nurse who, after barely four months, has had her fill of the cheapness and dysfunctionality of for-profit nursing homes. The nurse writes…
“I graduated from nursing school during the summer of 2011. I started my professional career full of excitement — looking forward to start working in a field that is not only a passion of mine but one that I believed would be fulfilling as well.
When I first started in this (for-profit) nursing home, working third shift, I saw a lot of problems that needed to be addressed. So with much energy I went about fixing them every shift that I worked. I did baths. I changed filthy linens. I gave everyone the meds they needed and also for pain in between so they could sleep.
I met with the aides and other staff members about fall and abuse prevention, ulcer prevention, and care for special needs. I left letters and notes to the Director of Nursing (DON) and the administrator so things would get done. In my mind, they system was broken but I was going to do everything in my power to fix it.
Fast forward several months later…A resident known to have unstable diabetes cannot be given orange juice or food because the kitchenette is locked, so his blood sugar drops into the 50′s. No point in looking in the medication room for a glucagon shot or sugar pills in my cart, since this facility refuses to order emergency supplies for diabetics! It turns out that management considers an”unnecessary expense”. So for this resident who had the dangerously low blood sugar I went to a nearby store on my lunch break and bought him a soda and rushed back to the facility as fast as I could.
The very next week another nurse gives a scheduled insulin shot to one of her residents and comes to me scared out of her mind because we have no test strips to test blood sugar in the building, so she had to guess as to whether this resident’s blood sugar was stable enough for insulin. This for-profit nursing home went without any test strips for an entire week! During this same period of time two residents were sent to the ER due to shock/coma from hypoglycemia because nurses had no way of guessing their blood sugar.
At the facility where I work we have have 80 or more residents. It is quite normal for several aides to call in sick or not be scheduled by management for their shift. On some shifts we end up having only two aides for 80 or more residents! This means that 40 residents have one person to clean them, answer their lights and help them. Two nights ago, only one aide came to work. For 80 residents! Everyone was called, including the adminstrator, at midnight. He said, and I quote, “this topic doesn’t come up when state inspectors are in the building! One aide is adequate – the nurses will pitch in (they already do the aide’s work as well as treatments, meds, and anything else) –and stop threatening the aides with a write-up or termination for not coming in, because we don’t want to anger them which will cause them to not show up for work even more often!”
Yes, we do have some excellent CNAs. I found one aide in tears in a linen closet last week because she had run out of wipes, toilet paper, diapers, chuck pads, and trash bag liners. She went to change a resident, and found him soiled all the way to the mattress. She used a shirt out of his closet, to wipe him clean, and laid him back down on the feces encrusted mattress to sleep. The shirt was left on the floor because laundry locked the housekeeping door and the linen garbage was overflowing with urine soaked laundry.
This is just a sampling of my experience in nursing home care. I could share much, much more.
I pray as I punch in the clock at night that nobody would fall and hit their heads because it could be hours before somebody would notice. I pray for patience, not for the horrors of my job, but for the restraint not to find the administrator and punch him in the face. I’m not a nurse where I work, I’m a faceless pair of legs. And the faster I walk, the bigger corporate’s wallets grow.
I’ve become incredibly discouraged and have contemplated turning in my resignation and walking off the floor. For all those of you facing the difficult situation of putting a parent in a care facility, please, please consider a not-for profit…and NOT a for-profit nursing home! Even if you must move out of state, find a way, any way, to keep your loved ones from places like these. Trust me, you will find it to the best answer.”
There you have it. Another first-person account of the harm caused by outrageous corporate greed within the for-profit nursing home industry! No test strips. No emergency supplies to respond to the needs of insulin-dependent diabetics. No clean linens available so a resident wont have to sleep in their own urine and feces!!! This intentional refusal to meet the basic needs of nursing home residents is beyond disgusting — it is in every sense of the word CRIMINAL!!!
As I’ve stated many times on this blog, do NOT believe the for-profit nursing home spin that they need Medicare and Medicaid to INCREASE the amount they pay for nursing home care. This is a LIE! As documented by a scholarly study conducted by the University of California at San Francisco — released in late 2011 — the quality of care offered by non-profit nursing homes almost always exceeds the quality of the care offered by for-profit facilities! Non-profits invest a larger percentage of their income in providing resident care than do for-profit nursing home corporations. For pr0fit facilities use their profits to line the pockets of stockholders and private investors instead of putting the money back where it belongs.
“For profit” and “care” can not co-exist. “For profit” always means that the nursing home residents will suffer.
I find that most of the comments left on this website are worthy of being the focus of a new journal entry, instead of just a comment tacked on to at the bottom of a previously published entry. Such is certainly the care of what a reader identified as “L.C.” thoughfully wrote a few weeks ago. Remember this is a person who has worked in the nursing home industry, so her comments are based on her personal experience and first-hand observations. She writes…
“For almost 20 years I worked in nursing homes as a Restorative Aide. I began my career and received training in a wonderful facility in another state. We had a staffing ratio of 1 aide for every 5 residents. The facility was clean and bright and the staff was there to make sure those last years were the best they could make them. Even more surprising (in hindsight) was how well the management cared for the staff. We received the training, support and time we needed to give great care. I was proud to be working there.
Then I moved to another state where the acceptable ratios were 1 aide for every 10 residents (first shift),1 aide for every 15 residents (second shift) and 1 aide for every 25 residents (third shift). The focus at this facility clearly was (finaincial) profit. The poorest quality supplies, never enough time, staff that was tired and discouraged…all of this leading to very poor care.
I remember starting to feed a sweet little lady one morning and wondering what she was chewing on. I cleaned her mouth with a toothette and found it was BOWEL MOVEMENT! No morning staff had any time to do oral care, so who knows how long she had this in her mouth. I felt so bad for her. This was just one example of the kind of thing that happens when staff does not have the time to do their jobs.
I remember one nursing home resident saying that no staff member took the time to look at her face. How awful is that!
I made it my mission to hug and talk to every resident I was with, but it was never enough. I feel that the aides I worked with did their best, often missing breaks and their own lunch time to take care of residents. I saw aides spend their own money on residents at holiday time, buying little gifts for someone because they needed a little extra attention.
It is so important to feel special and loved every day and aides try to fill that gap when family is not able to be there. They do all this without any help or support from the people who own and run these places. Owners rely on the goodness of the staff to make it look better than it actually is, yet the ones who pay the price for this are always the residents and the staff who struggle to care for them.
I eventually retired from the work. It just got too hard to do both physically and emotionally. Now we are trying to keep our own parents at home (in their 80′s) because we know what the world of nursing homes is like. I hope a truck hits me before I need a nursing home.”
What a powerful testimonial to the horrible nature of the corporate greed that controls the for-profit sector of the nursing home industry when someone with nearly 20 years job experience states she is doing everything she can to prevent her parents from ever needing to live in a nursing home AND that should would rather die than live in a nursing home!
My mother, who passed away on January 1, 2011, would scream at me — ordering me to leave her apartment on the occasions when I asked her to just consider living in a nursing home. She had seen the problems associated with the care of her own family members (problems that I hadn’t even noticed), so she knew that living in a nursing home would be a pathetic experience. For her it was. The corporate greed that lead to undestaffing of the facilities where my mother lived for nearly the last five years of her earthly life caused my mother new and more severe health problems than the diagnosis of dementia that lead to her first nursing home admission. My mother clearly knew what she was talking about and so does “L.C.”. Nursing homes that place finanical profit above quality resident care should be avoided at all costs.