“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.

“The care of our elderly is embarrassing, even in the finest facilities (and there are very few of those). My son works at a kennel and those dogs get better care than nursing home residents – and that is in no way an exaggeration. I also feel it is not the fault of the CNA’s, but the corporations and health care system that are making money off of our loved ones backs.”

Animals receive better care than do humans residing in nursing homes. This is what happens when the focus is on maximizing financial profit instead of providing the highest possible quality of care.

A very sobering example of the reality mentioned by EJH is the incredibly small amount of money for-profit nursing homes spend on resident food. An Extendicare-owned facility in Indiana reportedly “rewarded” their dietary staff with a dinner party for figuring out a way to reduce the cost of three meals and two snacks per day from around 85 cents per day down to barely 70 cents per day!

• How much does it cost for a one day supply of decent dog food these days?
• How much did you spend on food to feed yourself today?
• How much would it cost to adequately feed an elderly parent most days?

Remember that Extendicare and the other for-profit chains wont stop whining about how woefully underpaid they are for providing nursing home care.  Medicare, Medicaid, other insurance companies and even nursing home residents are billed upwards of $175.00 per DAY for a semi-private room in most parts of the United States. Yet these corporations, with executives earning hundreds of thousands of dollars (or more) annually, can’t afford to spend more than 70 cents per day to feed a resident? Something is seriously out of whack here — something is downright obscene and even evil – with the way these for-profit corporations divert profits away from resident care (care that includes how much they spend to feed their residents). Profits are diverted into such things as executives salaries, designer decor for their buildings and other business interests that have NOTHING whatsoever to do with providing care for their residents.

We must give the for-profit nursing home industry an ultimatum: Stop stealing from your residents or you will pay by losing your licenses that allow you to run your facilities!

“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.

So when the nursing home industry whines about needing more money to care from residents, make no mistake they are already earning enough money to provide a higher quality of care. The reality is that the executives and stock holders of these faccilities are (morally speaking) stealing from their residents by paying themselves handsomely and using their nursing home profits to fund other business investments.

Please click on the following link and learn the truth about the horrible impact of corporate greed on for-profit nursing homes: Low Staffing and Poor Quality of Care at Nation’s For-Profit Nursing Homes | www.ucsf.edu.

As the research study poinds out, “The 10 largest for-profit (nursing home) chains were cited for 36 percent more deficiencies and 41  percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents.” The 10 largest for-profit chains in 2008 were:

• HCR Manor Care,
• Golden Living,
• Life Care Centers of America,
• Kindred Healthcare,
• Genesis HealthCare Corporation,
• Sun Health Care Group, Inc.,
• SavaSeniorCare LLC,
• Extendicare Health Services, Inc.,
• National Health Care Corporation and
• Skilled HealthCare, LLC.

Note that the study clearly makes a connection between inadequate staffing levels among the largest for-profit nursing home chains and a higher incidence of state-issued citations for insufficient care: “From 2003 to 2008, these chains had fewer nurse ‘staffing hours’ than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.”

So here is solid evidence that the greed that runs virtually unchecked in for-profit nursing home corporations — and NOT lack of adequate payment for services — is undoubtly the single biggest factor cuasing a serious crisis in the quality of nursing home care! So when the nursing home industry comes begging for more money from state legislatures in terms of Medicaid reimbursement and telling their sob stories to US Senators and Congressmen as they plead for more money from Medicare, just remember that non-profit nursing homes (including those run by government agencies) are currently doing a BETTER job of providing care (by having higher nursing staffing levels) without a bigger handout from the government.

Take a moment to look over the list of the Top 10 For-Profit Nursing Home Chains listed above — print out the list if you like — and remember that these are nursing homes to be AVOIDED based on their inadequate staffing levels and the resulting increased problems cited with the so-called quality of care they offer. Tell your friends about these corporations and, if possible, don’t allow your loved one to live in one of these facilities!

Before I get into more specifics about the Iowa Governor’s role in protecting the nursing home industry, I wanted to share the following comment left on my blog from a CNA working in Iowa…

“I’m a CNA living and working in Iowa, currently studying to be Registered Nurse. I have been a CNA for nearly 10 years and have worked in many different settings, including nursing homes and assisted living facilities. Due to inadequate staffing levels, being a CNA at a nursing home is very hard, especially when it comes to working third shift (overnight). I’m currently dealing with a situation at an assisted living facility where most of my residents have dementia and need a more intense level of care, as provided in a nursing home setting.  I wonder how the state can allow this facility to continue operating while providing a much lower level of care than our residents need? All of the doors are alarmed and most residents require full care — even feeding. Just as in a nursing home, we are also required to wake up residents up on third shift in order to weigh them. I don’t understand how this is legal or ethical — but am having a hard time finding any laws or regulations to back me up. There needs to be rule that says staff can’t force resident to get out of bed before before 6:00am!”

Obviously this CNA’s comments point out several areas of concern about the situation in Iowa.

First, why does the state allow assisted living facilities to attempt to offer care they are neither staffed or qualified to offer? Oh wait: the assisted living industry also spends tens-of-thousands of dollars every year to lobby/influence the Governor and state legislators to do their bidding, which includes looking the other way when it comes to the types of residents allowed to live in an assisted living facility.

Second, no facility legally has the “right” to force residents to get out of bed at any time of the day or night. No nursing home and no assisted living facility can do this legally. Be it a nursing home or assisted living facility, nursing home residents have rights — including the right to refuse care. Why isn’t the state of Iowa doing something about this blatant abuse of resident’s rights? Again the people with the money (the industry) control the politicians and state employees (which are controlled by the politicians) to make sure that no serious infractions of state and federal regulation (like violating resident’s rights) are cited. After all, when a facility is cited for violating resident’s rights (or for not meeting other regulations), the state can assess and collect fines from the facilities. Of course the industry doesn’t want to part with one cent of their outrageous profits! So in Iowa you have a Governor-mandated cut in the number of inspectors and so fewer inspections take place and when they do, the overworked inspectors are much more likely to not have time to address all of the problems in the facility they are inspecting. The result is fewer problems identified, fewer fines assessed by the state, greater profit margins for the industry and even more inadequate care provided for residents.

Follow the money trail and you’ll clearly see who gets protected: the industry, not the residents. What can change this outcome so that resident care comes first? What must change is that we the people — instead of just the lobbyists who work for the filthy rich nursing home and assisted living industries — must be organized and have our voices heard by the politicians to let them know that they will “pay” (by losing our vote) if they fail to protect nursing home residents. “We the people” ultimately must make a difference!

What nurses working in the nursing home industry have shared…

Nursing in a nursing home setting is not  for the light hearted. I recently became a nurse. These days nursing can be a very sad profession to work in. While I frequently think about quitting, what keeps me going is the love I have for my residents. I truly enjoy the little bit of time I get to spend with these precious individuals.

I’m working for one of the all-powerful for-profit nursing home chains. In spite of the current economic hardships they manage to flourish financially. “How?” you may ask? One way is that they bring in headhunters to fire every employee they can – holdovers from previous owners. Then they bring in their own people to take care of the residents. These people are very business minded, but not very caring. They are more concerned about the (financial) bottom line than about providing quality care for their residents.

Meanwhile residents suffer. No friendly faces (with the revolving door employment situation). No one who knows how to make their tea or who has been around long enough to really know their personal preferences or interests. No one to position them just right so their arthritis doesn’t hurt while they are watching TV.

Further, these corporate suits come in and decrease staffing levels that were inadequate to begin with! In my facility they have one person over laundry, housekeeping and maintenance — eliminating two positions. This means that not enough staff are available to keep up the building. Rooms are dirtier when there is only one housekeeper for the whole building. Residents go without clean clothes when they have an accident. The laundry staff is lucky to get all the linens done and delivered for 200 residents with only two laundry aides, let alone doing resident’s laundry in a timely manner.

Nursing home management often insists on changing resident’s doctors, professionals who have been in place for years. These doctors know the residents and their medical history. Nursing homes often hire very young nurses and place them in positions of power.  New doctors and new nurses go along with the big corporation’s rules, placing corporate profits above compassionate care.

Then the nursing staff-to-resident ratio (for both nurses and CAN’s) in our state is a real problem. The nursing staff can’t keep up! Meanwhile this company is making money hand-over-fist, buying the administrative staff “iphones” and redecorating the facility. High tech gadgests and designer décor should never be more important than maintaining appropriate staffing levels! Cutting back the time that the nursing staff can spend with our residents is not good for resident care! Priorities, please!

With such horribly inadequate staffing levels, resident care truly suffers.  Taking care of that many needs of the residents, including knowing their medical diagnoses, allergies, keeping track of doctor appointments, their quirks and mannerisms, and their baseline behavior so I can tell if something is not right – all of these things along with doing the paperwork required by the state and facility – truly make for a heavy workload for the nursing staff.

An answer of “I don’t know, you see I didn’t get to spend much time with our residents because we are so busy due to short staffing” isn’t going to make a good impression in a court of law.

When the “priority” in running a nursing home is anything other than resident care, obviously nursing home residents suffer. The priority of maximizing financial profit is NOT compatible with the priority of providing quality care. Sadly, especially in for-profit facilities these days, the quality of care is bad to downright pathetic! Truly “bean counters”need to be run out of the nursing home industry!

The dedicated nurses, CNA’s and other nusing home staff also suffer when greed trumps care. Understaffing, clearly a problem rooted in corporate greed, adds to stress for those caregivers who want to provide quality care but aren’t given enough time to do their job right.

I received one such message from a former nursing home Administrator within the past few hours. She wrote…

I am a nursing home administrator who has left the field. Let me tell you why. I’ve gone into several buildings as the new administrator and I came in like a lion. The facilities were filthy, the care was substandard — even scary — and the staff was crude and rude.

I made the managers walk the halls and help the overworked nurses pass medications. I made the Certified Nurses Aide’s help activities to get residents to the cafeteria to enjoy the entertainment. I gardened, painted, spent my weekends there, dragged my husband in to mulch and fired a whole kitchen staff who were stealing.

Guess what? The managers made up stories about me to corporate. I wasn’t “liked” I was told. It is important that I be “liked” by the managers ,my corporate boss said. I was told to back “down” and “back off”. I was going too fast. I asked him to interview the residents to ask them if I was going “too fast”.

I changed buildings around and even got high fives from state officials as to improvements — but I got fired for riding managers to do their jobs.

Here are the facts. The good administrators leave, the bad ones stay. What do I mean by “bad”? They never leave their office, they listen with a smile as residents and families complain — then do nothing because they don’t want to make waves with nursing and management. Their job is to simply keep costs down . . . Period. The Director of Nursing really runs the building, which means she supports shortcuts for staff and management. If she didn’t she would be rode out the way a good administrator is.

When I went into the field I wanted to make the world a better place. Boy was I a fool.

In a word: WOW! This former administrator — truly one of the “good ones” — tells it like it is. I’ve known at  least one such “good administrator” (or at least one that went out of her way to improve the quality of her resident’s care). She too was HATED by her staff. How dare a nursing home administrator show up at 5:00 am to personally check out complaints she had received about third shift staff?!?  How dare she take seriously the concerns of family members about their loved one’s care?!?

The former administrator’s words give us true insight into the dysfunctional culture of the nursing home industry, serving as a reminder WHY we nursing home reform activists MUST keep the pressure on our legislators and the nursing industry.If we don’t keep u p the pressure on the corporate goons and politicians NOTHING will change for the better!

My father is in a nursing home in central Illinois. He suffers from several conditions that no longer allows my mother to be his caregiver as she was for many years. Because of repeatedly falling she had no choice but to have him admitted to a nursing home.

The nursing home we chose seemed to have a warm home feeling when we walked in. The administration talked up about how much they would take care of my father. The reality is this sales pitch was a bunch of BS!

My mother CONSTANTLY walks in and his catheter bag is not on right, therefore not draining properly. She constantly finds him with food all down the front of him because he has trouble feeding himself. Today (and several other times recently) he was wet and had urine running down his leg and on his sock and no one apparently was going to do anything about it until my mother said something.

My dad is falling out of bed more and more, so my mother asked if a CNA could stay in his room off and on through the night to make sure his is safe, The Administrator said no: CNA’s will not stay with any residents at night. Further she stated that if we didn’t think he was being properly taken care of that we can take him right on out of there. She appently has NO clue as to the detrimental affects to change the environment it could have on a individual with my father’s diagnoses.

Honestly I just want to yell and screem at nursing home management and ask them, when the day comes that they become a nursing home resident, would they want to sit in their own urine?  Do they want to go hungry because their condition prevents them from feeding themselves properly? What if they didn’t know how to use the call button and they crapped in their pants and sat in it for who knows how long! How would they feel?

Government needs to step in and make it mandatory to add more CNA’s and hold nursing homes accountable for the lack of staff, especially on weekends. Nursing home’s should train their staff better before allowing them to care for patients. I can’t tell you how many CNA’s taking care of my father do not know how to properly attach a leg catheter bag. That is pathetic!

Don’t get me wrong, there are several CNA’s that do take care of my dad and do a wonderful job and we praise and thank them every day they are working. I’m just so angry at the Administrator and the government for not putting higher standards in place.

My parents do not qualify for Mediciad and they are paying $148.00/day for my father’s care. We just want him properly taken care of. This is not too much to ask!

A few observations:

– While I don’t know of any nursing home that would provide a CNA to stay in a resident’s room throughout the night in order to make sure the resident is safe from falling (that would be cost prohibitive), nonetheless ALL nursing homes can do one or more of the following things to reduce the risk of resident falls and/or minimize the physical harm caused by falling out of bed:

1) Make sure the resident is attached to or lays on a bed alarm — and make sure it is tested regularly (if it is battery operated) to make sure the battery and alarm are working. These alarms can not prevent falls from taking place, but they can IMMEDIATELY alert staff as to when a resident has fallen or is at risk for falling. Nursing home staff must take seriously their responsibility to respond to bed alarms.
2) Provide the resident with what is commonly referred to as a “high-low bed” — this is a bed that can be lowered when the resident is sleeping so as to minimize the distance between the resident and the floor, thus significantly reducing the amount of physical injury the resident could experience if they do manage to fall out of bed. As always, it takes competent nursing home staff to remember to LOWER the bed when the resident is ready to sleep.
3) In addition to providing a bed alarm and high-low bed, some facilities will also have staff place a type of mattress on the floor next to one or both sides of the bed (next to one side if the bed is placed next to a wall on one side) to also reduce the potential of injury if a resident falls out of bed. However these mattresses are a potential hazard for nursing home staff and others as they can cause falling if they are not noticed. Many a person, CNA and otherwise, has been injured by tripping on these items.
4) If, for any reason, a nursing home resident is incapable of feeding themselves it is the responsibility of the facility to provide staff to assist with feeding. Failure to provide this assistance is criminal!

Above all, I want to encourage this family member to contact the local long-term care Ombudsman to report their concerns and — in the process of making their concerns known — speak to the Administrator to give them formal notice that the problems noted above have been documented by the family and must be addressed. If all else fails, then the family needs to (if they haven’t already) notify the Illinois state agency charged with nursing home regulation.

“I got my CNA license three months ago from a local certification program. Then I got my very first CNA job two weeks ago (August 2011) at a nursing home. I’m here to say that I am appalled at the conditions there in my new place of employment. I’m told by by co-workers that this situation is “normal.” As you read this information, try to imagine if your mother were a nursing home. My post here is a cry for help!

There are 35 residents on my floor, and during the 3-11 shift (my shift) we have only 4 CNA’a. One of the residents on our floor is paralyzed, requiring mechanical lifts –that means she cannot be lifted out of bed or out of a chair without the use of a sophisticated mechanical lift known as a “Hoyer Lift.” And the law mandates that whenever a mechanical lift is prescribed, such a resident gets designated as a “2-person assist” which means that resident will always require 2 CNA’s to lift him or her for whatever reason (showering, toileting, etc). The “2-person assist” is a serious designation! Major legalities apply here!

Meanwhile, another resident is permanently bedridden. Whenever he needs to use the bed pan (about 5 times a day) it likewise takes two people to toilet him there at the bedside. Another resident is semi-paralyzed, so she’s a 2-person assist to get her on and off of the 3-in-1 shower chair (portable comode) where she gets toileted. Another resident is moderately overweight, but is about 90 years old and has no strength in her legs, so she requires a different type of mechanical lift (a Vander Lift) when she needs to toilet. Once again that requires 2 people. That right there means four residents on our floor are designated as needing “2-person assistance.” And more than 80% of the remaining residents (26 of those other 31 residents) are classified as needing “1-person assistance,” which means 1 CNA must help them sit and stand and transfer from their beds to their wheelchairs to toilets, etc. The most frequent need of the 1-person assist residents is the need to be walked to the toilet.

Every time a CNA helps a “1-person assist” resident to toilet herself, that’s a time expenditure of no less than three minutes. An awful lot of tragic things can happen with the 34 other residents in three minutes. (Would you leave a young child alone for 3 minutes? If your answer is no, then why on Earth would you leave an 82-year-old alone for that long?) Every time two CNA’s help with a “2-person assist” resident, it ties them up for no less than 5 to 9 minutes, and only if they are very fast and very skilled. Trying to get an incapacitated person into a Hoyer Lift is VERY dangerous and time-consuming, but it MUST be done, and you don’t cut corners with a Hoyer! That’s 9 whole minutes. What if a pair of CNA’s are mid-way through a Hoyer Lift procedure right when 3 of the 1-assist residents on the same floor all ring their call bells at once because they each just happen to need to go pee at the exact same time? It happens. I have seen five call bells at once go off, but there are only four CNA’s on the floor, and half the time two of those CNA’s are tied up with a 2-person assist resident … for up to nine minutes.

So what do you imagine will happen if a 73-year-old lady needs to pee but no one answers her call bell? The answer is either a) she’ll pee in her pants, or b) she’ll try to walk to the bathroom on her own. The first answer is bad because peeing her pants can set her up for things like urinary tract infections and bed sores, not to mention that it’s just a horrible degrading thing to pee oneself. The second answer is worse because she might fall. If she falls she’ll likely break or even shatter a bone, and then that CNA is in a world of trouble and she could easily lose her license.

Does any of this sound fair to you? Is this fair to the resident? Is it fair to the CNA?

Helpless is helpless, no matter how old. I see many great strides take on behalf of childcare standards, but so little is done for elder-care standards.

A CNA will get in major trouble (as in get suspended or fired) for leaving a resident unattended in a Hoyer Lift. So once that CNA has a resident in a Hoyer, she cannot leave that Hoyer Lift resident for the sake of answering a call bell. Meanwhile, at the other end of the you’re-going-to-get-in-huge-trouble scale, a CNA will also get burned for not answering a call bell quickly enough. The call bells have timers, so as soon as a call bell gets activated, a computer records how many seconds (or minutes or hours) pass by before the bell gets answered. The facility can calculate the overall average of how long it takes for call bells on a given shift to get answered. So a CNA could get fired and lose her license for having a terrible average in her call bell response times.

Then there’s the threat of “decubitus ulcers,” — that’s the official medical term for “bed sores” (a/k/a “pressure sores”). Bed sores tend to form most often on the coccyx (tailbone), and sometimes on the elbows, knees, shoulders, anywhere on the spine, and even on the heels and the soles of the feet. Boney areas are the key here for figuring out where they’ll form. If you are lying around all day long, or sitting for 12 hours straight in a wheelchair all day, the constant pressure and lack of circulation start to degrade the tissues of those areas –and in a battle between bone and muscle, bone usually wins. The muscle and skin tissue slowly break down (that’s the beginning of a sore) and then the bone eventually starts to poke through. As any dentist can tell you “Bone CANNOT touch air!” Bed sores are very dangerous, prone to rapid infection, and can easily kill you. Once a bed sore is detected, the CNA’s and nurses MUST go on the offensive to combat that sore with a vengeance to prevent it from getting any bigger. Then they embark on the long, arduous process of healing it. Google for “decubitus ulcers” to see horrible photos of such sores. They can range in size from a few millimeters to over a foot in diameter. The big ones can maim and disfigure you for life. They can even kill you in mere weeks.

The way to prevent a decubitus ulcer from even happening is to engage in frequent and regular “reposition” an unmoving resident. Repositioning is done once every 2 hours. This relieves pressure, allows circulation to flow again, and the tissues that were being squashed can start breathing again. I was told during training: “It takes four hours for a bed sore to form and four weeks for it to heal.” The task of repositioning is a very straightforward one, sometimes requiring two people and about 1 to 2 minutes of their time. I have NEVER seen it done this fast at the nursing home where I work. Meanwhile we are supposed to fill out forms at the end of our shift where we record every instance of having repositioned someone. We all have to fill in the forms every night where we CLAIM that we did repositioning every 2 hours for every last one of our assigned residents. But we didn’t. None of us did. So those documents get falsified every time, every shift. I wish I had the time to do all these repositions during every shift.

I wish I had the time to do a thorough skin examination of each resident assigned to my care during every shift. But I do not. None of us do. I accidentally discovered a blank form last week called a “CNA Skin Sheet.” I’d never seen it before (no one showed it to me during my training period). The form has a simple drawing of a naked human body, front and back, on which we CNA’s are supposed to record places we see skin problems on a resident. It’s kind of like “mapping” their skin anomalies. The other CNA’s said “No one does those anymore.” (Because no one does skin checks anymore.) So now I’m waiting for the day when we all get the memo that a resident came down with a massive decubitus ulcer. The best I can hope for is that maybe the other shifts have time to do checks. But I doubt it.

It breaks my heart to know I’ve no time to care for the residents the way they should be. It kills me whenever I see a call bell go unanswered for almost 15 minutes.

Every time a CNA in my facility clocks-in at the start of her shift, she’s taking the risk that something will happen where someone might get injured or killed, and she herself might lose her license. Meanwhile, the other CNA’s likewise hate this insipid reality we have to deal with, but they’ve been here a long time and tell me it’ll never get any better. They’ve all developed a dark, jaded attitude. “You’ll learn” they mutter.

Nursing home understaffing is considered by many to be “normal” — as long as facilities can continue to get away with it. It all comes down to money. Why have six CNA’s on the clock when you can get away with just four?

Meanwhile, if there’s an MBA-trained number-cruncher reading this — the kind of 26-year-old snot-nosed kid who wears a suit and never once had the privilege to put on a latex glove, and who does nothing but look at PowerPoint graphs of employee cost analysis — YOU are to blame here! YOU are the most culpable party in this whole shameful debacle! If you are one of those MBA-holding snobs who stands smugly behind your laptop, pointing at a screen while saying: “According to the parameters of this particular matrix, which is a fine chart laid out by the American Nurses Association, 4 CNA’s should be enough,” then this is on your head –4 CNA’s is NOT enough to handle 35 people, especially when 4 of them are 2-assists, 26 of them are 1-assists, and three of them are chronic wanderers!

If there are any journalists or politicians reading this, you NEED to take notice of this crisis–and it IS a crisis. It’s a risk-management crisis akin to the BP Gulf of Mexico disaster of 2010. BP had a reputation for decades in the oil industry as being one of the worst offenders of safety violations out there. But they got away with it for so long because of lax oversight, extreme cost-cutting, and 7-digit bonuses for the suits at the head office if they could squeeze an extra basis point out of each quarter. This situation with too few CNA’s in American nursing homes is exactly the same. Different industry, same problem.

Just like BP, nursing homes suffer from all of the following: deficient safety standards, poor oversight, bonuses for “the suits” for cutting staff to the bone, and a false security found in the sheer luck of having not yet had an accident severe enough to garner worldwide attention.

Just one fall. Just one overlooked laceration. Just one accidental strangulation. Just one covertly executed suicide attempt. Any one of these can easily happen in the span of just three minutes while some poor overworked CNA is helping an old lady use a toilet.

The nurses in nursing homes are in just as bad a situation because they also are overworked and understaffed. Their liability is twice that of the CNA. But in a nursing home setting, the CNA is the true point-person when it comes to providing adequate one-on-one care (in a hospital setting it’s the nurses who are the key).

I MUST tender my resignation. I can’t in good conscience continue to take part in this horrible management-spawned scandal of neglect and fraud. I have had nightmares about my place of work and I’ve only been there since August 24th. Perhaps I will go into private duty. There are no benefits to private duty, but at least I will be able to sleep at night. This decision to resign is my own effort at risk-analysis here –I am weighing out the risk between A) staying at this place with benefits where I am undermining my heath and running the daily risk of losing my license, vs. B) going into a more rational work environment with no job security and benefits. I’ll take the latter.

I hope to see reform in the industry soon, and if it comes, I’ll gladly return to nursing home work. But I hope it won’t take a world-famous BP-style tragedy to trigger such reform. However, I fear that’s the ONLY thing that can bring it about. The politics of American policy-making has always tended toward a reactionary mindset, never a proscriptive one.

I hope someone with even a small modicum of power can read this thread and help to bring about the changes needed. I am a ………

Shocked & Awed CNA (Massachusetts)”

Occasionally I receive comments from nursing home staff members (administrators, nurses, CNAs and others) that scold me for daring to point out problems involving abusive, negligent and/or dishonest nursing home staff members. They assume that I have used my blog to condemn all staff members. In reality I have NEVER accused ALL nursing home staff members of bad behavior. In fact, I have occasionally pointed out that many nursing home staff members (particularly nurses and CNAs) are great people doing wonderful things for their residents. I even devoted one post to discuss the intense pressure that administrators face, showing that while I’ve often found things to criticize about nursing home management that I nonetheless am sensitive to the pressures management personnel face that discourage them from doing the right (let alone honest) thing in dealing with problems in their facility.

So if you (nursing home staff reading this blog) want to mischaracterize my comments, go ahead. If you aren’t doing so to manipulate me into becoming silent, I respectfully suggest that you take some time and look over the many entries I’ve written over the past few years so as to get a fairer perspective of what NursingHomeReality is all about.

Allow me to point out that the nursing home industry — proving their intensely evil nature — does everything it can to silence it’s critics. A more mature approach would be to have enough integrity to be introspective enough to learn and grow from their critics. But instead, they just want all of us to shut up and go away.

MY RESPONSE TO THE CORRUPT NURSING HOME  INDUSTRY: I WONT SHUT UP. I WONT STOP POSTING TO THIS BLOG ABOUT THE OBVIOUSLY BAD THINGS THAT GO ON IN NURSING HOMES. You can’t make me shut up and I wont shut up. I wont be silenced by the “soft fascism” of your evil attempts to silence your critics. If this blog were to ever shut down, I’d have no problem immediately finding another webhost that would respect and protect my freedom of speech.

What does it tell you about an industry when they feel that they are above criticism? It makes me think they have LOTS to hide.