I’ve posted quite a bit of information recently concerning a bill (House Bill 157) that is currently being held hostage by Kentucky Rep. Tom Burch (Democrat – south-central Louisville) that woud mandate minimum staffing standards for nursing homes in the Commonwealth. Kentucky and neighboring Indiana are two of only 13 states that do not yet have staffing standards in place, but instead rely on irritatingly vague federal standard that simply requires that nursing homes must be “adequately staffed” at all times.  Unfortunately when the twisted mindset of corporate greed is given the freedom to interpret the phrase “adequately staffed”, the result is almost always a staffing level woefully inadequate to meet the bare basic needs of residents — hence the very real need for this proposed legislation.  (You’ll find out how to contact Rep. Burch elsewhere on this blog. If you are a registered voter residing in Kentucky, I ask you to contact him, requesting that he allow HB 157 to come up for discussion and a vote in his Health & Welfare Committee.)

In the meantime, I’ve “done the math” on this bill and I do not believe for a moment that it would require nursing homes to spend an excessive or unreasonable amount on staffing to meet the needs of their residents. As the son of a now-deceased nursing home resident, I know for a fact that the current policy of allowing a very subjective interpretation of “adequately staffed” does NOT allow for quality care of residents!!! 

Regarding toileting, here is a real life example of the problems caused by inadequate staffing: At nursing homes in both Indiana and Kentucky, my wheelchair-bound, legally blind mother who was diagnosed with dementia regularly had to wait an average of 45 minutes for CNA’s to respond to her call light and take her to the rest room!  At more than one nursing home I personally wittnessed my mother waiting for up to TWO and even TWO AND ONE-HALF HOURS for a nursing staff member to toilet her.  On more than one occasion she ended up soiling herself, hence she was mis-diagnosed as being “incontent”. I’m sure that I’d be “incontent” too if I had to wait two hours (or more) to need to take a dump or whiz!  “Adequately staffed”?  Not quite!

You might wonder why I (If I really loved my mother) didn’t personally take her to the toilet.  Apart from the fact that it wasn’t something I was trained to do, the reality is that I frequently BEGGED the facilities where my mother lived to let ME handle her need to be toileted.  But in every nursing home where my mother lived, I was told point-blank that for reasons of “legal liability” I was not allowed to assit in meeting my mother’s toilet needs.  So please don’t think for a moment that I didn’t try, because I did regularly and repeatedly BEG nursing home staff to let me help. One facility even went so far as to claim that for me, as a family member, to attempt to toilet my mother would place her in “serious risk of injury”.  I asked repeatedly for training, but only one facility offered to help in this regard — and then I still wasn’t allowed to help with toileting where my mother lived, but was only allowed to toilet her if/when I took her out of the nursing home.

Like I said,  I’ve “done the math” on resident-to-CNA ratio mandated by HB 157* and when it comes to the bill, this is what I found…

First Shift: Nursing homes must have one CNA for every nine residents.  This means, minus time for legally required paid breaks, that each nursing home resident would receive care for an average of 50 minutes over the course of an eight hour shift.  Excessive?  Hardly!  First shift CNA’s often times have to…

1:  Get residents out of bed.
2:  Bathe each resident.
3:  Assist many residents with putting on clean clothes for the day.
4:  Deliver breakfast trays.
5:  Assist with feeding residents breakfast.
6:  Pick up breakfast trays.
7:  Provide fresh water and snacks twice: (between breakfast and lunch and again between lunch and dinner).
6:  Deliver lunch trays.
7:  Assist with feeding residents lunch.
8:  Pick up lunch trays.
9:  Transport wheelchair-bound residents to/from group activities.
10:  Toilet/Offer to toilet each resident an average once every two hours (= 4 times per shift).
11: Chart the food intake of each resident cared for.
12: Chart the “restroom output” of each resident cared for.

This is a LOT of hard work for one person to do — and yet most CNA’s barely earn above minimum wage!  Does any intelligent, compassionate person really believe that allowing residents 50 minutes of care to do all of the things listed above, over an eight hour shift, reflects anything close to an “excessive” let alone “burdensome” level of staffing?

I personally observed my mother living in facilities that scheduled no more than one CNA for every 12 residents during first shift.  One facility where my mother resided only schedled one CNA for every 19 residents during first shift!

Assuming all five CNA’s showed up for work (let alone arrived on time) at the nursing home where my mother lived on a unit with 60 residents, this means that (during first shift) each resident had an average of just 37 1/2 minutes care spread out over an eight hour shift.  At this facility, as few as two, three or four CNA’s would routinely show up for their shift and many were frequently 15 minutes or more late for work.

On more than one occasion I personally observed only two of the five CNA’s show up for work on this unit with 60 residents!  That means that each resident had an average of only 15 minutes of direct care during an eight hour period.  When only two CNA’s would show up, it wasn’t uncommon for my mother (and many other residents on this particular unit) to be left in bed for both breakfast and lunch (indeed for most all of the first shift).  They would set her meal tray beside her bed, but not where she could reach it, let alone see it (“Your momma must not be hungry today!” I heard on more than one occassion) — yet wouldn’t even provide her with the assistance she needed to be fed.  And yes, as soon as I figured out that this nonsense was going on, I made sure that I was present at both lunch and dinner (often spending 6 – to 8 hours per day with my mother) so at least I could feed her (despite objections from nursing home staff that I take part in this area of her care).

As I write this, I just want to SCREAM OBSCENITIES at the nursing home ownership, management and staff where my spent most of the last five years of her earthly life!!!  This lack of adequately staffing is obscene and provides clear evidence that the corporate greed that rules nursing homes in Indiana and Kentucky (and other states as well) MUST be challenged with legislation like HB 157*.

* HB 157 = House Bill 157.