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Here’s another unsolicited testimony from a nursing home staff member who lost her job for doing the right thing by caring for her residents and being ethical in the area of maintaining medical records for residents. This nurse (an LPN) from Kentucky writes…

“I’m so glad I found this blog. I too have experienced some of the horrors detailed in several of these postings. I am a licensed nurse with well over 12 years experience. I began my health care career working as a Certified Nurse’s Aide (CNA) for more than 20 years.

While working for a nursing home in Kentucky for more than a decade I truly loved my job, my residents and my co-workers. I began as a CNA for this company, and after a while, the administration thought enough of me to send me to school to become a nurse on a scholarship program. I worked as a CNA, a floor nurse, a unit manager, and eventually a “MDS nurse“. MDS nurses are responsible for assessing patients and billing Medicare and Medicaid.

I always felt good about the care I delivered to my residents, but as time went on and the company had been bought out, things began to change. Profit became the main concern and the care we provided declined dramatically. The local nursing home ombudsman proved to be of no help as this person was friends with the administrator. They even attended the same church.

I’m certain someone tipped off the administrator just before State Surveyors would arrive to inspect our building. Why would I say this? Because our administrator NEVER arrived for work before 8:00am any day of the week UNLESS an inspection was imminent. I reported this issue to the state ombudsman only to be scolded for calling into question “the morals and ethics of this fine woman” (the local ombudsman).

Several cases of abuse were covered up or barely investigated without anyone ever held accountable. One of my co-worker and I reported some findings we discovered while assessing patients as part of our job duties. We immediately reported these findings of neglect that directly caused the deaths of three residents to the Director of Nursing and the Administrator. Our concerns were met with defensive comments, such as ‘We are covered…we contacted the MD’, etc. The nursing home staff had ignored severe signs and symptoms of urinary tract infections (UTIs) in three elderly patients, two of them went without any testing for over three weeks. These concerns had been reported to the Director of Nursing and administrator several times. Eventually proper treatment were given to these residents, but by the time they received treatment, they had become septic which contributed to their death. If the nursing home does too much testing for UTIs, it makes their infection control reports look bad on the public websites. So in essence, they ignore the symptoms and refuse to test! Three weeks after reporting our findings in these resident’s charts, my co-worker and I were both without jobs. We were told we were “not good team members” and were let go.

I have no recourse at this point as I am not considered a whistleblower, as I basically blew the whistle after I was fired. I was trying to get the administration to understand that we, as a company, had a problem that needed to be addressed. A sad, sad situation for all involved.

I have trouble sleeping thinking I should have stepped up sooner. I contacted Kentucky’s Office of Inspector General who seemed to take my complaint seriously, but after going to investigate,the Surveyors were told to write a few small tags, with no fines or oversight involved. The nursing home got away with everything, and I simply don’t understand how this is allowed to happen. This company is now involved in several lawsuits and one of them involves the family of one of the residents I complained to the administration about. I hope to one day find a company that will appreciate a strong patient advocate as I have no plans to change who I am!”

It would seem, sadly, that the definition of a “good team member” within the nursing home industry is a reference to a person without a conscious, without integrity and without the courage it takes to do the right thing. That’s a “team” that must go away!

A reader from central Illinois shared the following nursing home horror story with us.  A few details have been removed from the following account in order to protect the resident (the writer’s father) from being involuntarily evicted from the facility. Many nursing homes over the years have falsifed resident’s chart entries and other documentation in order to justify kicking a resident out — this is all done in retaliation for reporting problems to the state, news media and other sources (like this blog) for telling the truth about the shameful abuse, abandonment, neglect and outright negligence that goes on in nursing homes.

My father is in a nursing home in central Illinois. He suffers from several conditions that no longer allows my mother to be his caregiver as she was for many years. Because of repeatedly falling she had no choice but to have him admitted to a nursing home.

The nursing home we chose seemed to have a warm home feeling when we walked in. The administration talked up about how much they would take care of my father. The reality is this sales pitch was a bunch of BS!

My mother CONSTANTLY walks in and his catheter bag is not on right, therefore not draining properly. She constantly finds him with food all down the front of him because he has trouble feeding himself. Today (and several other times recently) he was wet and had urine running down his leg and on his sock and no one apparently was going to do anything about it until my mother said something.

My dad is falling out of bed more and more, so my mother asked if a CNA could stay in his room off and on through the night to make sure his is safe, The Administrator said no: CNA’s will not stay with any residents at night. Further she stated that if we didn’t think he was being properly taken care of that we can take him right on out of there. She appently has NO clue as to the detrimental affects to change the environment it could have on a individual with my father’s diagnoses.

Honestly I just want to yell and screem at nursing home management and ask them, when the day comes that they become a nursing home resident, would they want to sit in their own urine?  Do they want to go hungry because their condition prevents them from feeding themselves properly? What if they didn’t know how to use the call button and they crapped in their pants and sat in it for who knows how long! How would they feel?

Government needs to step in and make it mandatory to add more CNA’s and hold nursing homes accountable for the lack of staff, especially on weekends. Nursing home’s should train their staff better before allowing them to care for patients. I can’t tell you how many CNA’s taking care of my father do not know how to properly attach a leg catheter bag. That is pathetic!

Don’t get me wrong, there are several CNA’s that do take care of my dad and do a wonderful job and we praise and thank them every day they are working. I’m just so angry at the Administrator and the government for not putting higher standards in place.

My parents do not qualify for Mediciad and they are paying $148.00/day for my father’s care. We just want him properly taken care of. This is not too much to ask!

A few observations:

— While I don’t know of any nursing home that would provide a CNA to stay in a resident’s room throughout the night in order to make sure the resident is safe from falling (that would be cost prohibitive), nonetheless ALL nursing homes can do one or more of the following things to reduce the risk of resident falls and/or minimize the physical harm caused by falling out of bed:

1) Make sure the resident is attached to or lays on a bed alarm — and make sure it is tested regularly (if it is battery operated) to make sure the battery and alarm are working. These alarms can not prevent falls from taking place, but they can IMMEDIATELY alert staff as to when a resident has fallen or is at risk for falling. Nursing home staff must take seriously their responsibility to respond to bed alarms.
2) Provide the resident with what is commonly referred to as a “high-low bed” — this is a bed that can be lowered when the resident is sleeping so as to minimize the distance between the resident and the floor, thus significantly reducing the amount of physical injury the resident could experience if they do manage to fall out of bed. As always, it takes competent nursing home staff to remember to LOWER the bed when the resident is ready to sleep.
3) In addition to providing a bed alarm and high-low bed, some facilities will also have staff place a type of mattress on the floor next to one or both sides of the bed (next to one side if the bed is placed next to a wall on one side) to also reduce the potential of injury if a resident falls out of bed. However these mattresses are a potential hazard for nursing home staff and others as they can cause falling if they are not noticed. Many a person, CNA and otherwise, has been injured by tripping on these items.
4) If, for any reason, a nursing home resident is incapable of feeding themselves it is the responsibility of the facility to provide staff to assist with feeding. Failure to provide this assistance is criminal!

Above all, I want to encourage this family member to contact the local long-term care Ombudsman to report their concerns and — in the process of making their concerns known — speak to the Administrator to give them formal notice that the problems noted above have been documented by the family and must be addressed. If all else fails, then the family needs to (if they haven’t already) notify the Illinois state agency charged with nursing home regulation.

I know, from the content of the headline for this journal entry, many of you are assuming that I’m about to do a major bashing of nursing home administrators.  Would I ever do such a thing?!?  I only bash them when they deserve it (which, sadly, it seems many of them do deserve it early and often). In balance though, 1/3 of this post will actually involve DEFENDING nursing home administrators. But first some much-deserved bashing…

LIARS
Several years ago, when discussing the numerous lies many nursing home administrators had told me over the years my mother lived in long-term care facilities, a fellow reform activist commented something to the effect, “I think they all must have a book they study that helps them sharpen their skills to lie as fast as they can think!” That would also be my experience as well.

At the very least, my observation is that most administrators seem willing to tell family members, residents and concerned others what they think we want to hear…and then do whatever the heck they choose to do about the situation they’ve been presented with. From what I’ve observed and heard from nursing home staff, administrators and other management types lie to them almost as often as they do to the rest of us. They may do it with a smile. They usually do it while looking you right in the eye. But they lie.

What can be done to change this culture of corporate deception?  Confrontation — as scary as it can be to do — is the only hope of turning administrators into honest professionals. Confrontation comes with some very scary consequences, as noted within the CONTROL FREAKS portion of this post. But ignoring the problem of dishonesty wont solve anything and will just enable inappropriate behavior. CLUE: Lying is NOT appropriate and therefore lying is NEVER acceptable.

CONTROL FREAKS
Guarantee: If you directly confront most nursing home administrators about their deception, sooner or later, they will invite you (gently or under threat to take action with the force of the state) to move your loved one to a different facility. They would rather deny or ignore problems within their own facility than face the possible pain (or financial consequences) of making needed changes. This is so sad!

When those of us with a back bone refused to have our loved one’s civil rights raped and insist on their right to remain where they are AND insist positive changes take place in the facility where our loved ones currently live,  we have found administrators taking their status of “control freak” to new lows by attempting to ban us from their facilities!  They have been known to attempt to do this to family members, friends and even nursing home Ombudsmen! Of course this kind of banning is almost always ILLEGAL, but it surely is also very stressful.

I found out the hard way about this extremely controlling tactic when my mother lived several years ago at a nursing home in Jeffersonville, Indiana.  The administrator’s order to bar me from the property (so I could not visit my own mother!) lasted a little under two hours.  One call from me to the Ombudsman lead that person to call Adult Protective Services APS).  The APS staff person then read the riot act to both the nursing home owner and administrator! Why did they try to ban me?  The letter ordering me off the property (which, again, was ILLEGAL and overturned in LESS than two hours!) stated that I had “created a hostile working environment” where nursing staff were afraid that I would cause them to loose their credentials because of the many times I had reported the facility to the state.  The Adult Protective Services work had a precious response to their nonsense, “Tell your staff to suck it up!…If they are doing a good job, they have nothing to fear.”

Nursing home administrators will often show their control freak side to the residents as well, through attempts to (often illegally) micromanage their care.  They will often stop at nothing to harass a resident into moving out once the resident presents a threat to their inappropriate control.

CORPORATE PUPPETS
This is the part of this journal entry when I will attempt to show compassion to at least some nursing home administrators. Please pay close attention as I don’t do this sort of thing very often!  🙂

I have become convinced over the years that at least some percentage (1/3?) of nursing home administrators would NOT lie or act out as control freaks were it not for fear of loosing their job. My observation is that most of the folks who own the large nursing home corporations have far less integrity than most administrators!

Consider the central Indiana nursing home mentioned in a previous NursingHomeReality entry in which I stated that nearly twenty (20) administrators had come and gone from the one facility in barely 10 years! This high rate of turnover is NOT uncommon within the industry. I believe that most administrators are under tremendous pressure and experience a great deal of emotional distress because of the toxic nature of the sociopaths who supervise them!

I would like to believe that in a more ethical, saner corporate environment most administrators would behave far better than they currently do. Yet I’m sure that things wont improve until and unless we (you and me) insist on nursing home industry reform and insist on it taking place NOW!!!

I can’t speak for foreign countries, but here in the United States every part of every state has someone (sometimes several persons) to help nuring home residents and concerned loved ones to assist when concerns about nursing home care (or lack of care) arrise.  These helpful individuals, known as long-term care ombudsmen, are often times underpaid and overworked.  Some ombudsmen are  unpaid volunteers who are supervised by paid ombudsmen.   Their service is FREE to nursing home residents, family members and concerned friends of residents.

When is it appropriate to contact an ombudsman?  In a non-emergency situation, it is best to contact them after the concerned party has been unable to resolve their concerns with nursing home management.

If you feel you have an urgent or emergency situation involving the safety or welfare of a nursing home resident, then immediately contacting an ombudsman (without trying to resolve matters with the facility) may be entirely appropriate.  However when you have an emergency situation and time is of the essence, the best place to turn for help is the state agency responsible for regulating nursing homes within their jurisdictions (in Indiana the agency is the state Board of Health, within Kentucky it is the Office of the Inspector General — all nursing homes must provide those who ask with contact information for the state agency responsible for regulating them.  Nursing homes must also provide the phone number for the nearest long-term care ombudsman.  Most states require nursing homes post this information in a prominent place, such as near the main entrance of a facility or at/near a nurse’s station.  The bottom line is that if you ask facility staff for contact information for the ombudsman or state nursing home regulatory agency, they MUST provide you with that information, which should include a phone number.

In many states it is also entirely appropriate to contact the local office of Adult Protective Services when you feel the safety, rights or welfare of a nursing home resident is threatened.  Call your local police or sheriff’s department to find the number for the Adult Protective Services office that serves your area.

My experience (and that of many other loved ones of nursing home residents) is that nursing home staff and management will often feel threatened and become overtly hostile when they become aware that an ombudsman, state regulartory agency or an Adult Protective Services office has been contacted about problems at their facility.  Big deal!  If they (e.g., nursing home staff and managment) are doing their job (let alone doing it correctly), then they have NO reason to fear the state’s intervention!  Please don’t allow nursing home staff or management to intimidate you into silence!  You have a legal right and a moral responsibility to request state intervention on behalf of a nursing home resident!

To find contact information for the Long-Term Care Ombudsman in your corner of the United States, please visit the website of the National Citizen’s Coalition for Nursing Home Reform (www.nccnhr.org). On the left side of every major page of their website you’ll find a button with the words “Locate An Ombudsman”. Click on that button to find the information you need. In addition to ombudsmen, you’ll also find listings for each state’s nursing home regulatory agency and other agencies that respond to concerns related to nursing home care.

I need to point out that while ombudsmen are available to investigate concerns and offer advice, they do not have the legal authority to force nursing homes to do anything. Only the state agency entrusted with long-term care facility oversight has such power.  Adult Protective Services employees also have legal authority that ombudsmen do not have. At the same time, ombudsmen will be able to render a responsible opinion regarding when it is appropriate to contact the state, in case you aren’t sure if this the right option to pursue.  Their wisdom and experience is an invaluable tool in protecting your loved one.

Nursing Home News Watch

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