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In hospitals & NHs a good deal of time and money for redundant administrative personnel whose only job is to do the paperwork required by Fed Regs.....I was on the staff of a small hosp that was forced to close in the early 80s due to those increased regs/decreased reimbursement changes....When I first went on staff there, the Policies & Procedures "manual" was three mimeographed pages wrinkled, creased and coffee stained and stuffed behind the chart rack....Ten years later it had grown to be a binder hundreds of pages long outlining every step and breathe to be taken by every employee all day long...
Dealing with the Feds is merely a paper chase. They need the documentation to account for their programs. It doesn't make any difference if anything is actually accomplished or not.
Another longer term problem here is that many of our imported staff are Asian, often from India and Nepal. Not a problem in the shorter term, as they very often are wonderful carers. The Indian lady who spent a lot of time with my Italian MIL was really loved by her, who said she treated her as you would treat a mother.
But in the longer term there is no way that these immigrants want their own kids to do the same work. So this Indian lady was so proud when her daughter headed off to university, understandably so. Of course, they are more than happy if the kids want to be doctors, less so RNs but no way nursing aids.
Which means you are needing a constant supply of people coming in the short and the longer term.
My hope is that our voluntary dying laws will be extended to allow dementia to qualify, as there is so much dementia in my family. But as these laws are quite new, I am not too hopeful.
I too worked in an industry subject to inspections, but ours were often unannounced.
The inspectors would sweep into the lobby in the morning with a list of documents they wanted to review and a list of people they wanted to interview.
Then they would randomly go to a file cabinet and pull files.
During all of this we would roll our eyes.
And like your inspections, the inspectors would always find something that was amiss. We would generally have 30-60 days to fix the problem. We would send them our "revised" written procedures and they would go away happy.
They rarely found the real "bad actors" in the business. More's the pity.
They don't tell is in advance, but everyone knows, because they do an entire area or county at a time. So once they get to the first one in the area, word gets out and everyone starts to panic and prepare, and we have to undergo re-trainings in hand washing and fire procedures and all that stuff in case we get quizzed, and make sure we are wearing name tags.
I agree though that most panic for nothing. Even if they find an non-care related infraction, you just have to correct it, it's not the end of the world. They didn't like the strip we used to plug in one of our machines in the gym, so we got an infraction, but then maintenance just replaced it and it was fine. At one facility, they gave an infraction because I had a balloon tied to a sprinkler on the gym ceiling (so residents could stand up and bat it for a balance activity). They just said "untie it, you can't have it there" and I untied it, and it was fine. They aren't out to get anyone.
In almost 30 years, I have only worked at one facility that actually got closed to new admissions after a state inspection (which means the residents already there can stay but they couldn't accept any new rehab or long term patients for a certain period). That was a Manor Care, my first job, late 90's, and it was because they (the state inspectors) weighed a couple people and they didn't match the weights listed in their charts, then they weighed a whole bunch of people and found the weights didn't match what was recorded in the charts for almost all of them. Weight loss and falls are huge areas they don't mess around with.
But every year, they run around like Chicken Little waiting for the end of the world, at all facilities I've ever worked in. They very rarely bother therapy at all, it is mostly nursing they concentrate on, and safety with fire codes, chemicals labeled, etc. But my boss still was in a panic and trying to make us do all sorts of things that weren't necessary due to the panic.
Another longer term problem here is that many of our imported staff are Asian, often from India and Nepal. Not a problem in the shorter term, as they very often are wonderful carers. The Indian lady who spent a lot of time with my Italian MIL was really loved by her, who said she treated her as you would treat a mother.
But in the longer term there is no way that these immigrants want their own kids to do the same work. So this Indian lady was so proud when her daughter headed off to university, understandably so. Of course, they are more than happy if the kids want to be doctors, less so RNs but no way nursing aids.
Which means you are needing a constant supply of people coming in the short and the longer term.
My hope is that our voluntary dying laws will be extended to allow dementia to qualify, as there is so much dementia in my family. But as these laws are quite new, I am not too hopeful.
We don't have Indian aides or nurses, but many Filipino. Philippines is Like India, where they steer their kids toward health care and medicine. A lot of Nurses, PTs and OTs here are Filipino. Some of the CNAs are actually RNs in the Philippines, but the licensing requirements here make it hard for them to transfer their credentials to be licensed here. They often have to take additional courses. So they work as CNAs while going to school, or decide not to bother trying to get their nursing license and continue to work as CNAs. In a facility I worked at a few years ago, our rehab aide was an RN back home.
Others are kids who couldn't get into PT, OT or nursing programs in the Philippines (it is harder to get accepted there as there are fewer programs) but the parents wanted them to be able to come to the US anyway, and they can do that as a CNA because it's so in demand. Many of them are really good and caring and hard workers, but we have a couple who have become a little too "Americanized" when it comes to work ethic, too.
I hope we can expand those laws, too. It would be much better than people having to take things into their own hands, like Robin Williams did (he had a very aggressive form of dementia, Lewy Body, which affects not just memory, but mood and movement too (he originally was misdiagnosed with Parkinson's).
Medicaid is the primary payer for about 2/3rds of nursing homes. They really don't pay enough to meet the current level of care which is pretty poor. You can mandate all you want but when you make unfunded mandates it doesn't mean you're going to get the results.
Government could start running nursing homes as one solution. If they can't get the quality of care they want from the private sector because they don't pay enough for it, DIY. Or pay more.
Government could start running nursing homes as one solution. .
I take it you've never dealt with the feds.
The problem with ANY govt program is that the standards issued initially and meant to be minimum standards quickly dissipate to become THE standard procedure and guarantee that no better than mediocrity is ever achieved.
The solution to this particular problem is to relax standards for the minute to minute efforts of custodial care. You don't need four years of medical school and a residency at Mass Gen to help a little old lady out of bed to get her to the bathroom in a timely manner...We could be using 15y/o kids to achieve some of the baby sitting chores in a NH to not only solve the man power problem but also to give kids an exposure to the industry and encourage hem to pursue more training.
Simply paying more will resukt in a few more people wanting a job as a CNA but fewer jobs will be offered. Look at what higher min wages is doing to the fast food employment picture. ..They're just throwing an extra fish to fewer employees. Counter-productive.
The problem with ANY govt program is that the standards issued initially and meant to be minimum standards quickly dissipate to become THE standard procedure and guarantee that no better than mediocrity is ever achieved.
The solution to this particular problem is to relax standards for the minute to minute efforts of custodial care. You don't need four years of medical school and a residency at Mass Gen to help a little old lady out of bed to get her to the bathroom in a timely manner...We could be using 15y/o kids to achieve some of the baby sitting chores in a NH to not only solve the man power problem but also to give kids an exposure to the industry and encourage hem to pursue more training.
Simply paying more will resukt in a few more people wanting a job as a CNA but fewer jobs will be offered. Look at what higher min wages is doing to the fast food employment picture. ..They're just throwing an extra fish to fewer employees. Counter-productive.
You can’t have 15 year olds doing it. These are people with medical issues and often psychological ones too. And you can get injured easily, too. And I don’t think many residents would be comfortable with a young teen wiping their butts. It is far from babysitting. It doesn’t require a degree to be a CNA though, it’s a few week certification course. Not sure where you are getting information that a degree is needed. Many homes offer the certificate for free in exchange for working at the facility for a specified time.
I disagree about government run homes. No one said they had to be Federally run though. The county run homes I’ve worked in have been far better than privately run homes, because county jobs have good benefits and a pension so the staff don’t job hop for greener pastures like they do in privately run homes. You get workers who have been there 20, 25 years and develop relationships with each other and residents.
If you're workd in NHs you would know that many of the accidental falls occur when unobserved pts with poor insight decide they can climb over bed siderails or get up from chairs in the day room etc...Having young (or older) poorly paid workers or volunteers available as eyes & ears & chaperones would relieve more highly trained personnel for more important work....Liability concerns and poorly thought out "just throw more money at it" central planning solutions prevent this course now.
Amazing that you worked at a county home that was better than a private one. You should submit it's name to Ripley's.
If you're workd in NHs you would know that many of the accidental falls occur when unobserved pts with poor insight decide they can climb over bed siderails or get up from chairs in the day room etc...Having young (or older) poorly paid workers or volunteers available as eyes & ears & chaperones would relieve more highly trained personnel for more important work....Liability concerns and poorly thought out "just throw more money at it" central planning solutions prevent this course now.
Amazing that you worked at a county home that was better than a private one. You should submit it's name to Ripley's.
Why is it amazing? What is your own experience with county homes? Why would it be hard to believe that when you pay people and give them good benefits and a pension, that they stick around and care more about the job than workers at a private facility with crappy pay and benefits and no pension? Has that been your experience in jobs? People do a better job when given poorer pay and benefits and zero job security?
We have alarms for people who try to get OOB or get up. A volunteer (would be great if we had them but the only places I ever saw them in numbers is United Methodist Homes). All a volunteer or a paid worker who is not a CNA, would be allowed to do, is say "Mrs Jones is trying to get out of bed", they wouldn't be allowed to help them physically. And the alarms do the same thing.
The teens would be allowed to work in activities department, that would be more appropriate than the nursing floor. It would be more fun for them too.
And where are all these kids coming from? We can't even find enough kids down here to operate the Merry Go Round or hand out ice cream at the shore, they have to go overseas to staff, and businesses were offering $12 an hour even 15 years ago (much higher than min wage) So where are all these kids who are dying to do what would be a “watching paint dry” boring job in a depressing nursing home, for min wage?
We don’t have that many falls as you might think. Months go by without falls, and the majority are residents who are allowed to be mobile, or those who need the bathroom and don’t wait for help, and someone without training (as in CNA) wouldn’t be allowed to help them with that (nor do I think many would want to).
Last edited by ocnjgirl; Today at 08:04 AM..
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