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One of my favorite quips I see posted regularly on social media websites describes a reaction one can have to something that is offensive — whether in poor taste or is otherwise obnoxious. Pardon my posting this phrase, since it describes something that is not pleasant, but it goes, “I think I just puked a little in one of the corners of my mouth!”

Earlier today I got a message from a self-identified holder of a “PhD” degree who claims to have worked for the nursing home industry for many years. She was attacking this website and me personally (Why is it that ONLY persons who receive a paycheck from the nursing home industry attack my website? Imagine that! Oh wait, some of the strongest defended of this website are persons who currently or previously worked for the nursing home industry. Fascinating!). All of her comments were pathetic, but one was particularly troubling. She claimed that the nursing home industry isn’t paid enough by Medicaid (the government health insurance program that pays for most nursing home care in this country). This totally false claim really did make me want to PUKEa little in one of the corners of my mouth!” Allow me to set the record straight. Allow me to shed some light on what I call a “double-sided lie” spread by “Ms PhD” and other paid mouthpieces for the obscenely rich for-profit nursing home industry.

When it comes to for-profit nursing homes (and the corporations that own them) they ARE making money and NOT losing money. They ARE making an obscene profit off of Medicaid, Medicare, private pay and all other forms of payment they accept!  How do I know they are making money and earning a profit, despite the horribly pathetic level of “care” many for-profit nursing homes provide?

DO THE MATH! It is a matter of public record than many nursing home CEOs have annual salaries and benefits in excess of $1 Million! If they can offer that kind of compensation to even one of their corporate executives, they are making money hand over fist!

Again I say: DO THE MATH! Since it also a matter of public record, you can discover for yourself how many hundreds of thousands of dollars these corporations are donating to state and federal politicians year after year! You should also factor in the salaries and benefits of their “corporate whores” (Sorry, I meant to type “lobbyists”) who work for them year round to pressure legislators to support their self-centered political agenda!

The nursing home industry earns lots of money.  They have obscenely huge profits. This is the absolute truth.

The other side of this truth about the for-profit nursing home industry is that the spending I’ve pointed out indicates a clear pattern of mis-spending of your tax money (and that of their self-pay residents and that of the residents who have private insurance). Too much money is spent on feeding their greed and influence peddling that they can’t afford to adequately care for their residents!

So the real problem is NOT that they aren’t compensated enough, but that they desperately need to have appropriate priorities for how they spend your/our money! They are totally out-of-control and that’s why we must pro-actively suggest and support legislation that forces them to spend more of their money where it really should be spend that allows for proper resident care. This properly-focused spending begins with spending more money for nursing staff (nurses and CNAs)!

In a nutshell: When the caregiver is “for-profit” the level of care suffers…especially without appropriate government-sanctioned regulation. If ever an industry needed such regulating, it is the nursing home industry!

agendaNearly every state’s legislature begins their 2014 session this month. So January is the appropriate month to offer my five point agenda for nursing home reform. I believe that these five points can, at a reasonable cost to taxpayers and to nursing homes, help improve the quality of the care provided to residents.

Suggestion #1: Have each state mandate an INCREASE in the percentage of inspections (commonly referred to as “surveys’) that MUST take place outside of regular business hours on weekdays. This standard should apply to both annual inspections (inspections the state conducts approximately once each year at all licensed nursing homes) as well as to surprise inspections (these are inspections that take place in response to complaints the state receives about a particular nursing home.

In most states a minimum of 10% of nursing home annual inspections 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. I believe that if state law would mandate a minimum of 25% – 33% of inspections begin on weekends and during hours when administrators are not normally at work the inspectors would get a more accurate view of the low quality of care that goes on in nursing homes on weekends, 2nd and 3rd shift and on holidays — the times when administrators are rarely on the job.

As a family member of a nursing home resident, it was “after hours” that my mother experienced the worst neglect by her caregivers. These are the hours when staffing levels are usually at their lowest and when management isn’t present to see for themselves what’s going on.

Suggestion #2: Require management personnel to work staggered shits ALL THE TIME, not just when state inspectors are 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. 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 nursing homes are too small to be able to afford an Assistant Administrator. Yet even these facilities MUST have a full-time Director of Nursing on staff. In these nursing homes the same “staggered shifts” rule should be in place for the Administrator and Director of Nursing.

Why suggest this legislative mandate? For much of the same reason that I made my 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). One third shift nursing staff member at an Indiana facility where my mother lived admitted to me that she “preferred” to work overnight so “the big shots” couldn’t get in her way of doing her job the way she wanted to do it. Scary! One of CNAs who worked with this individual on third shift shared with me that this nurse took an average of seven (7) smoke breaks — OFF THE UNIT — PER HOUR! This clearly would not be allowed by either the state inspectors or sane nursing home management — but how could the state or management know this was problem existed if they aren’t in the building at at times other than when management is in the building? Residents with dementia are likely incapable of reporting such problems. Family members can’t stay with their loved one 24’7 non-stop to monitor the situations. Placement of a “Granny Cam” inside the room is incapable of documenting problems that take place outside of the resident’s rooms (example: documenting a lack of staffing at the nurse’s station caused by staff taking an excessive number of smoke breaks).

If it is impossible to have management in the building 24/7, then the state should mandate 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 type of inspection (annual or in response to a complaint) the inspectors (a/k/a “surveyors”) should IMMEDIATELY seize payroll data (before it can be altered) to verify staffing levels for the 14 continuous days immediately prior to the inspection. With this information in hand, inspectors should have the legal authority to insist that while they are in the building that the staffing level can NOT exceed the average staffing level for the previous 14 days.

Why do I believe this issue requires a legislative intervention? Because calling in off-duty nursing staff during an inspection or even bringing in temporary employees is one of the biggest (and most deceptive) things nursing home management does to make it appear 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 inspectors are not around. “Putting on a show” for state inspectors should be against the law! Inspectors should see and judge the quality of care based on the REALITY of ACTUAL staffing levels.

Suggestion #4: Pass legislation that prohibits nursing homes from either outright banning or limiting visits of residents by their family and friends. Once  nursing home staff identify a resident’s family member(s) or friend(s) as a “trouble maker” (e.g., that we really have the courage to report their facility to the state, as is our LEGAL RIGHT AND MORAL RESPONSIBILITY TO DO) then you can count on the facility to begin devising schemes to make it look appear that we are the bad guy, thus justifying prohibiting (or at least limiting) our visits. Some facilities have even limited visits from family and friends from taking place on the unit where the resident resides — allowing, for instance, visits to only take place in the lobby. This way family and friends can’t observe the substandard care the resident is receiving, thus preventing them from being able to observe (and thus report to the state) problems with care.

Attempts to prevent family and friends from visiting nursing home residents (when no harm is being caused to the resident as the result of the visit and when the resident wants to receive visits from such individuals) is clearly a violation of nursing home resident’s civil rights! We activists must get through to these corrupt nursing home owners and managers that their facility is the HOME of the resident and therefore the SAME rights of visitation residents had at their house, apartment on condo apply inside the nursing home facilityStrongly worded legislation is clearly the only hope we have to prevent nursing homes from taking their residents hostage!

Suggestion #5: We need legislation that will mandate increased fines against nursing homes that are found guilty of abusing resident’s rights, especially with regard to forcing residents to move to another facility. Many nursing home residents find themselves being forced out of their facility as retaliation against the resident or their family for sticking up for their rights. This type of abuse of resident’s rights must stop! It is truly a twisted, dysfunctional way of thinking when a nursing home’s only way of handling it’s problems is to punish their residents (or the resident’s family) by forcing the resident to leave their facility. How many residents must suffer “eviction” before a facility is finally forced to look inside itself and make the changes needed to resolve their real problems?

How can you help to make these five changes happen within the state where you reside? Contacting your state legislators would be a good start. Also request the support of your local or state Long-Term Care Ombudsman to help promote this reform agenda. If your area or state doesn’t have a nursing home reform organization then start one! I’ll be glad to help you start and promote such an organization.

I believe that together we CAN make meaningful, important and positive changes take place within the nursing home industry. While the industry clearly has the big bucks to spend on maintaining the status quo, we have more than enough individuals on our side to make change HAPPEN!

Nursing Home News Watch

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