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The for-profit nursing home industry is quick to claim that they can’t afford to hire more nursing staff (nurses or CNAs) in order to improve to the quality of nursing home care. What a total crock of nonsense! It is widely known that most executives of the major nursing home corporations (e.g., companies that own multiple dozens of facilities in multiple states) make annual salaries in excess of one million dollars (not to mention live in million dollar homes) so they obviously have PLENTY of money to hire additional nursing staff and still have lots of money leftover to pay nice dividends to their stockholders.

In Kentucky, Indiana and the other eleven stats that don’t have minimum  staffing standards for nursing home in place, the nursing home industry cry babies…er, I mean their lobbyists, have state legislators fooled into believing their lie about being “too poor” to improve the quality of care.  Fine. Let the industry continue to perpetuate the fraud that they can’t afford to make things better (at least for now, they are getting away with this deception), because in the meantime here are three things that CAN be done to improve the quality of nursing home care withOUT forcing the nursing home industry to significantly increase the cost of doing business.  The only expense to the facilities would involve paying a “shift differential” to staff working outside of first shift hours.

Suggestion #1: Have each state mandate an INCREASE in the percentage of surprise inspections (more frequently known as “surveys’) that MUST take place outside of regular business hours on weekdays.

For example, in Indiana, I was told by a gentleman who works for the Indiana Board of Health that at least 10% of inspections each year 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.  Me thinks that mandating more like  minimum of 25% – 33% of inspections should be required to begin on weekends and during hours when administrators are not normally at work.

Why suggest this change? Because as those of us who are family members of nursing home residents know only too well, the quality of care provided residents often goes downhill considerably when management isn’t around. For nursing staff who have  an outstanding work ethic, this isn’t an issue. But for the caregivers who don’t really much care about their residents, many of us have witnessed the negative impact on care when management isn’t in the building.

When the greedy nursing home industry finally gets 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. These are the times that staffing is at it’s lowest level in most facilities — which means these are the times when the quality of care is at it’s lowest.

Suggestion #2: Require management personnel to work staggered shifts ALL THE TIME, not just when the state is 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 facilities are too small to justify the existence of an Assistant Administrator — yet ALL nursing homes (regardless of their size) MUST have a Director of Nursing on staff.  In these facilities then the same rule should be in place: staggered shifts must be scheduled for the Administrator and Director of Nursing.

Why suggest this change? For much of the same reason that we made the 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).  If it is impossible to have management in the building 24/7, then the least the state should mandate is 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 kind 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 AND insist that while they are in the building that NO additional staff can be called in.

Why suggest this change? Because calling in off-duty nursing staff during an inspection is one of the biggest (and most deceptive) things nursing home management does to make it appear to the state 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 folks aren’t around.  “Putting on a show” for state inspectors should be against the law! Inspectors should see and inspect and judge the quality of care based on the REALITY of ACTUAL staffing levels.

How can we make these three changes happen in our corner of the world?  Contacting your state legislators would be a good start. Contact your local or state Long-Term Care Ombudsman to find the contact information for the agency in your  state that regulates and inspects nursing homes.  And if your area or state doesn’t have a nursing home reform organization, start one!

Together we CAN make meaningful, important and positive changes take place within the nursing home industry. They clearly have the big bucks to spend on maintaining the status quo, but we have the numbers of individuals on our side to make change HAPPEN!


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