On a recent Saturday evening, after spending several hours visiting my mother who now lives in a nursing home located in south-central Indiana, I discovered a sight that was quite disturbing. If what I’m about to share doesn’t upset you, it really should!

Standing outside the main entrance to the nursing facility were ALL THREE of the nurses aides who were on duty at that time. They were standing outside taking their smoke break together! Inside was JUST ONE nurse, in the middle of distributing medications, responsible for a unit with approximately 35 residents! Only one caregiver for 35 residents is, to my way of thinking, a case of neglect. For the nearly three dozen residents what I observed is (at best) a serious injury just waiting to happen!

At worst the situation I’ve described is a potentially (harmful or even fatal) medication error waiting to happen. Besides it certainly seems totally unfair to expect JUST ONE nurse to be responsible for responding to all wheelchair alarms, bed alarms and patient call lights — while distributing medication to the residents.

And obviously this situation was unfair to my mother and the nursing home residents.

Is it “unfair” to demand that smokers take their smoke breatks outside the building? After all it hasn’t been all that long ago that smoking employees were allowed to smoke inside nursing homes (not to mention hospitals). Because of the risk associated with second-hand smoke, I don’t find it unfair to require all smokers (both staff and residents) to smoke outside the building.

This incident that took place in June 2008 was NOT the first time that I’ve witnessed first hand this kind of criminal neglect in a nursing facility. EVERY long-term care facility where my mother has lived over the past four-plus years  (e.g., 5 nursing homes and one assisted living facility) have had employees who smok that have left their residents with inadequate staffing levels for several minutes at a time!

One nursing home unit where my mother lived had a nurse who averaged three smoke breaks per HOUR (per the observation of a newly-hired nurses aid)! Many of the times this particular nurse was on duty (night shift: 7:00pm – 7:00am), she was the ONLY staff member on what was a “locked unit” — meaning that if a resident’s alarm were to sound, NO other staff member in the building could have heard it, let alone responded to it!

If I didn’t know any better, I’d think that the caregivers in question (both nurses and nurses aids) think that they are PAID TO SMOKE (OUTSIDE the building), rather than take care of residents (who live INSIDE the building).

I’ve also witnessed many of these same caregivers answering PERSONAL (non-emergency) cell phone calls while caring for my mother (including while they were supposed to be “transfering” my mother from her wheelchair to the toilet, which is NO time to risk a resident’s safety!).

I’ve also personally witnessed still other nursing staff members act as if they are paid to do nothing but sit on their butt and gossip with co-workers! Can they not gossip on their own personal time?

As of this writing my mother has lived in long-term care facilities in two states: Kentucky and Indiana. These are two of the 17 states that have not yet mandated a minimum staffing level to care for nursing home residents. Indiana and Kentucky leave it up to each facility to interpret the wrecklessly-written federal regulation that reguires these facilities to provide an “adequate” staffing level to care for their residents.

Does ONE caregiver for 35 residents sound “adequate” to you? I hope not!

Whatever happened to a decent work ethic? Whatever happened to to having (and ENFORCING) a rule for smokers that ONLY ONE staff member can be outside the building (for any reason) at any given time? Oh wait, ALL of the nursing homes where this smoking concern has been observed already HAVE such a rule in place. The problem: either most supervisors are themselves smokers (who breat the rule themselves) OR don’t want to anger their smoking employees by enforcing an UNpopular rule.

It seems to me that nursing homes should have a policy to NOT hire management who smoke and/or hire non-smokers only. While these might sound like radical concepts, until the day comes when the legislators of Indiana and Kentucky grow a spine and require sensible minimum staffing levels, nursing homes should become part of the growing number of businesses that LEGALLY discriminate against smokers.

Which is more ethical: discriminating in hiring against a smoker or allowing inadequate staffing levels that endanger nursing home residents?

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