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My thanks to “J”, a certified nurses aide (CNA) who works at a nursing home in central Indiana, for sharing the following thoughts about her experience as it relates to the problem of understaffing and other issues of concern (like a lack of adequate training for CNAs, etc.). Her identity is not being revealed in order to protect her from retaliation from management (although if “Stuart R.” reads this, he might be paranoid enough to fire every CNA who works in his chain of nursing homes who’s first name starts with “J”.  Wait, what if “J” were actually a male?)  🙂

I’m a new CNA. I don’t feel that I received adequate training in school or upon hiring. I’m feeling shattered and overwhelmed. I’ve just landed my first-ever CNA job (at an Indiana nursing home). I found out during training that I love the residents and the very nature of this work. My teacher predicted I would fall in love. And I did.

I love my residents. I understand they probably ran circles around me when they were my age. Unlike them, I don’t know how to make apple pie from scratch, stay married to the same person for 50 years, raise eight cloth-diapered children, harvest 10 acres each of corn and wheat, or milk six cows and collect the eggs from 2 dozen hens before sunrise and then butcher, pluck, and fry one of these aforementioned hens for Sunday dinner! I’m fond of them, I care about them and I respect them.

My facility pays exceptionally well (to make up for being chronically understaffed, perhaps?). I’m inexperienced and slow and flying by the seat of my pants. I’m honestly doing the best I can and still I don’t feel I’m doing right by any of them and I don’t know what to do about it. My assignment for the past two shifts has been 29 residents, the majority of whom I haven’t had time to become familiar with. This boils down to roughly 15 minutes of individual care per resident spread out over eight hours. Two minutes per resident is shaved off due to reasons that could have been avoided by a little forethought on the part of those in authority. Stupid reasons, such as having to chase down rubber gloves, wipes, clean linens and briefs, or read 20 charts because I’m in charge of the health and safety of people I know nothing about and any uninformed decision or action on my part has the potential to kill someone.

A few of the 29 residents I care for are pretty self-sufficient, while the rest of them require and DESERVE way more than the remaining 13 minutes of hands-on care. These are people’s mothers and fathers. They could be my parents. The quality of care I have time to give each resident is inadequate, and certainly far below that which I would expect if they were my own parents. I feel like they’re being neglected. Neglected by me, despite that I don’t have an idle moment and usually end up working off the clock.

When I finally fall asleep after I get home, I have nightmares. I don’t believe that even the most experienced and proficient of aides can provide *adequate* care to that many residents singlehandedly. I’m probably going to get fired for not charting. Because I can’t bring myself to ignore a call light and humiliate one of my beloved residents into soiling herself so that I can go make a note that someone else “eliminated” and how much and whether or not it was in a brief or in the toilet, while someone is begging *right now* to be taken to the toilet to eliminate like the adult that she is.

So there’s this nurse who is counted among THE PEOPLE WHO ARE OFFICIALLY CARING FOR YOUR MOM OR DAD. Because she’s there at the same time as I am, the facility gets to count her as someone who is providing hands-on care. Except all she does is administer medications.  She’s “above” doing what she can to make sure your mother isn’t having her skin digested by the enzymes in her diarrhea. She can see that I’m already up to my elbows in seven different cases of diarrhea, yet she’ll sit and chitchat with the other nurse about what’s on sale at K-Mart and still see fit to remind me about all these other call lights that are on, rather than step up herself and care for a resident who is suffering from the caustic germs that’s eating the skin off his nether regions.

I just wanted to propose the possibility that for every aide you encounter who seems jaded and apathetic, there’s another one who wishes she had a button to stop time and make sure absolutely everyone’s every need is met, so that she could go home and rest easy feeling that her best was good enough by her own standards. I don’t know who to hate more, myself for not knowing how not to fail my residents, or the greedy powers that be at the facility for failing all of us. There’s a very high turnover rate for CNAs. I had to become one to understand why.

Please know that it breaks my heart to see you or your mom or your dad suffer and I will do everything in my power to prevent that, but that my power is very, very limited. Please understand that I have to feed my kids and this is the only way I know how to do it. Please keep in mind that the people with the least authority and power are most likely the ones who are the most emotionally invested in your mom’s or dad’s happiness and well-being.

Anyway, I just wanted you to know how much a lot of us care and how much some of us are up against.

May God richly bless every loving, hard working CNA like “J”!  May God give them the strength (physically and otherwise) to provide excellent care like “J” obviously provides to her residents.  May God provide nurses (unlike the one referred to in “J”‘s comments) who will conscientiously lend a hand to her hard working CNAs (instead of talking on their cell phones at work, or talking about the latest sale at K-Mart, etc.).

My opinion is that, in a more perfect (nursing home) world, CNAs would be paid better, be allowed to be involved in the care planning of their residents (something few facilities currently allow) and be treated with much more respect by the nurses they work with.


According to information released this week by a division of the California State Senate. problems with a computer database maintained by state officials has  exposed elderly residents in facilities other than nursing homes (such as assisted living facilities) to dangerous caregivers (in particular nurses aides) that had been banned from working in nursing homes. While the database was correctly tracking nursing staff that had been found guilty of abuse, neglect and/or theft of nursing home residents, it wasn’t able to check background records maintained by other state agencies. At least 20 nursing assistants banned from nursing home employment since a law creating the database was enacted in 2006 had managed to find jobs in other facilities that care for the elderly.

“There is no excuse for allowing people with known histories of abuse to work in residential care facilities for the elderly or as caregivers in any other setting”, Michael Connors, long-term care advocate for California Advocates for Nursing Home Reform, said in response to the report’s findings.

In all of these cases studied, state Social Services employees were unaware of the earlier misconduct. Although it obtained criminal histories on applicants, the department did not check to see if they had been sanctioned by other state entities that oversee health care and human service workers.

With the potential for frail nursing home residents to be harmed by their caregivers, I believe family members should be legally allowed to install hidden cameras (a/k/a “granny cams”) to keep an eye on their loved ones.  Some states allow them, while others do not. Securing the right to protect nursing home residents with hidden cameras should be another item on the agenda to promote positive nursing home.

At least government officials in Texas, Illinois and Iowa haven’t totally sold old to the big bucks of the nursing home industry (like some have in Kentucky and Indiana)!  Kudos go to three states that have recently made progress in terms of advancing the nursing home reform agenda.

The Texas Department of Aging and Disability Services (DADS), that state’s agency charged with oversight of the nursing home industry, recognized the urgent need for more investigators to address a backlog of complaints facilities.

DADS has a record of responding to 99 percent of the most serious complaints about nursing homes within 24 hours. But the agency has only been able to respond to one-third of the less serious complaints within the 14 days required by state guidelines. Still, a DADS spokesman acknowledged to the media recently that even “less serious” complaints included the potentially dangerous issue of inappropriate care of bed sores.

To speed response to nursing home complaints, 35 new investigators (a 10% increase) are being hired this month. The agency also plans to complete 1,550 investigations during a two-week statewide blitz to help catch up on the backlog of complaints until the new inspectors can be hired and trained.

Governor Pat Quinn recently received a final report that contains many recommendations to ensure improved safety of nursing home residents in Illinois. Among the Nursing Home Safety Task Force recommendations:

  • Reform the admissions and assessment of people in need of care to ensure they are referred to the residential setting most appropriate to their individual needs.
  • Raise and enforce higher standards of treatment in all residential settings.
  • Expand residential options and services in home and community-based settings to allow each individual to achieve his or her highest level of independent functioning and ensure that only those people who require 24-hour care are placed in nursing homes.

It’s now up to state legislators to translate report findings into new regulations for nursing homes located in Illinois.  So if you live in Illinois, please contact your state senator and state representative to make sure report findings are followed.

One of the big changes coming to Illinois nursing homes, thanks in part to the study report and pressure from the public and Chicago news media, is that thousands of mentally ill individuals who have been housed alongside elderly nursing home residents will now be given the opportunity to be placed in facilities more appropriate to meeting their unique needs. Tragically it took several incidents of elderly nursing home residents being beaten by mentally ill individuals before this problem (and other concerns) were addressed by the Governor’s study commission.

State nursing home regulators are finally getting serious about imposing stiff fines against Iowa facilities that have been found guilty of retaliating against caregivers who have the courage to report problems.

Two Iowa nursing homes have each been fined $5,000 by the Department of Inspections and Appeals. An assisted living center was also recently fined $1,000. The three facilities were accused of threatening, demoting or firing employees who reported concerns about resident care to the inspections department.

Iowa’s mandatory reporter law, which is designed to protect the state’s 40,000 care facility residents, makes it a crime for caregivers to keep silent about suspected abuse or neglect. Retaliation against whistle-blowers is barred by law, but advocates for seniors have complained that care facilities are rarely if ever penalized for the offense.

If I were living in Iowa I would contact the Department of Inspections and Appeals and demand that they be consistent in enforcing the laws already in place.  Sure, they are to be commended for finally taking appropriate action, but we have to wonder what took them so long?

Some recent comments this blog has received from individuals who are employed as nursing home administrators lead me to believe that I’ve offended some of these folks, let alone possibly hurt some feelings.  Perhaps an explanation and disclaimer are needed at this point.

First, let me be clear that I do not “hate” nursing home administrators.  However because of my experience with several administrators during the time my mother lived in various nursing homes, I must also state that I ended up being very disappointed by the vast majority of them and would have a very hard time trusting an administrator any time soon!  When you are lied to, when your loved one’s rights are violated, when you are screamed at and threatened in retaliation for going to the state with concerns, when you told that your going to the state has created a “hostile working environment” and when problems with your loved one’s care aren’t really fixed (or aren’t fixed for more than a few days at a time)…Well, I think it only appropriate and good self-care to be slowwwww to administrators ever again.

Do I think that all nursing home administrators are “bad people” or “more bad than most other people”?  I’ll let God answer these kinds of questions, on an individual basis, as I believe God is the ultimate judge of people’s hearts and intentions. All I know is that of the nursing home administrators I’ve personally dealt with, most seem to lack integrity — let alone compassion — for the residents they serve and the family members they deal with.

At the same time I will offer a word of compassion for nursing home administrators as it seems that many of them are clearly under enormous pressure as they deal with residents, family members, owners, state regulations and state inspectors (a/k/a “surveyors”) and employees.  Probably many of them work enough hours each week and are under such a mountain of stress that they likely deserve every penny they earn.  I have a feeling that some administrators would do a much better job if the nursing home owners would stop trying to micromanage them and let them do their job!

Speaking of “pennies that are earned”, the people who seem to me to be most deserving of a raise are the certified nurese’s aides — truly these people are the front line caregiver in a nursing home setting — yet they are typically the lowest paid of all nursing home employees.  This isn’t just!  They deserve to earn more money (while being held accountable for their job performance) and nurses should treat their CNAs with more respect than I’ve seen them treated with.

While I don’t know about the cost for nursing home care in your corner of the USA, here in Louisville, Kentucky, the average cost of a semi-private room is around $150.00 per day.  This is the room rate and does not include the cost of medications or other incidentals.

For-profit nursing homes can’t seem to stop whining that need/deserve an increase in the amount that is paid to them by Medicare and Medicaid. In fact, many nursing home industry lobbyists tell our Kentucky legislators that they can’t possibly improve their staff-to-resident ratio without a significant increase in their daily rate.  Really?!?  Well I beg to disagree.

The last time I checked, the average salary for nursing home administrators in the United States was nearly $80,000 per year.  The average annual salary for a nursing home Director of Nursing is nearly $70,000. Many COOs, CEOs and CFOs of for-profit nursing home chains command annual salaries of hundreds of thousands of dollars, while some earn more $1 million per year!

What do residents of for-profit nursing homes get for their money?  Not much to boast about…

— Staff-to-resident ratios far below those of non-profit facilities.
— The average amount spent on nursing home meals: around $1.00 per meal.  One Canadian-based nursing home chain, with facilities in both the USA and Canada, recently celebrated when they discovered a way to cut the cost of their average meal to less than 80 cents!
— Wheelchairs that lack working breaks and beds that can’t be adjusted like they were designed to be because they need repaired or replaced.

All of this proof that the money from Medicare and Medicaid is not going into resident care and yet …
— In Kentucky the nursing home industry spent more than $250,000 during a 10 year period to bribe (sorry, we should say “influence”) legislators so as to prevent nursing home reform legislation (including minimum staffing standards) to be enacted into law.
— An east coast nursing home owner pumped most of his profits into running a recording studio for a friend who is a popular country music artist.
— And then there’s the Indianapolis-based nursing home chain that can’t stop putting every available penny of profit into gobbling up even more nursing homes.
— Oh yeah, don’t forget about the many large nursing home chains that have to pay out a hefty dividend to their stockholders.

In my opinion, for-profit nursing homes don’t need one cent of increase in their daily rate.  Instead what they need is a CONSCIOUS that will guide them to put all of their profit into improving resident care!

Before you think for one moment that for-profit nursing homes “need” increased reimbursement from Medicare and Medicaid to increase the staff-to-resident ratio, consider the overwhelming body of evidence that non-profit nursing homes (they also receive Medicare and Medicaid payments) have far better staffing ratios than the for-profit facilities.

It is time to stand up to corporate greed and their mismanagement of public (and private) funds and insist that the money intended for resident care go for that purpose and that purpose alone!

I want to take a moment to salute those members of the news media who have the courage to expose the truth about the reality of problems within the nursing home industry! It must be more difficult to buy the silence of the news media (not to mention us blog owners) than it is to come up with enough money to bribe some state politicians!

Recent articles published in the Boston Herald, Louisville Courier-Journal, Lexington (Kentucky) Herald-Leader and Indianapolis Star newspapers have shed much light into the truly frightening reality of many nursing homes.  The Indianapolis Star investigative report (published this past Sunday, March 7, 2009) makes clear that (at least when it comes to nursing homes within the state of Indiana, which is the focus of the article) the following equations are clearly at play within the nursing home monopoly:

* Staff-to-resident ratios in for-profit nursing homes are much lower than in non-profit facilites.
* While for-profit facilities claim they can’t afford to hire more nursing staff, their CEO’s make much more money than do executives of non-profit nursing homes.
* The lower the staff-to-resident ratio = the lower the quality of care = increased health problems for nursing home residents.

Ya’ think?!?  And to think that some readers wonder why I rail against corporate greed on this blog as often as I do!?! It all goes back to the Biblical expression, “The love of money is the root of all evil.”  And evil (as I understand the nature of real evil) is all-too-present within the for-profit sectior (which is by far the largest sector) of the nursing home industry. Nursing home “evil” places the safety and care of residents below the craving for increased earnings by CEOs and COOs who often earn literally millions of dollars per year, while the Certified Nurses Aides (the front line caregivers) barely more than minimum wage!

(Update: Saturday, 3/20/10: I was able to find out the direct website address for The Indianpolis News’ excellent investigative feature that focused on problems with nursing homes in Indiana. You find the link to view Crisis of Care Among State Nursing Homes under the Blogroll feature on the left side of this page.)

For those of you who live in Indiana, please contact your state legislators to ask them to pass minimum staffing regulations for nursing homes within the state!  Indiana and Kentucky are among only 13 states that are dumb (or corrupt) enough to not have nursing staff-to-resident minimums in place.

Nursing Home News Watch

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