Bulletins Regarding Nursing Homes

Home is Not in Nursing Home -- I am employed in a nursing home as a Customer Care Representative. I find that the biggest adjustment for residents is making the transition from home to the facility. At home one is able to control the temperature of his/her room; control the volume of his/her television, control when he/she wants to eat, control over when he/she wants to go to bed or wake up, control over things that you or myself might take for granted. In a nursing home typically the resident shares a room with 1 or more roommates. There are arguments over temp. control, television/radio volume, visitors, bathroom privilages, you name it. The resident is used to living alone or with a desired companion. In a nursing facility there isn't always room to choose who might be a desired roommate for the new resident. I think family and staff need to recognize the fact that the resident is thinking "This is the last stop before I meet my Maker" and try to make their stay as pleasant as possible. After all someday you too maybe entering a nursing facility. Wouldn't you want somenone to show you some compassion? From independence to sometimes total dependence. -- "CHRIS M FRAVEL" CHRIP@prodigy.net
What's The Problem With Nursing Homes? -By T. B. --I'm doing some research on nursing homes, not because my parents need to be in one, but because I know there are problems, major problems associated with the nursing home industry.
First, state and federal regulations and inspections have brought nursing homes a long way from what they used to be. Years ago, residents were severely restrained by straps, belts, or whatever was handy, to chairs or beds. If those didn't work, chemical restraining always did the trick. The result was severe malnutrition, severe contractures, severe bed sores, and more. This is not to say all facilities were this bad, and even one is too many, but many, many were of very poor quality. So why did were they allowed to go on this way?
Nobody was watching. Nobody was advocating. Families put an elderly member in them and left them there, forgotten. Fortunately, the government did finally step in and said that this must stop. Maybe things aren't perfect yet, but there has been some improvement. It certainly is not enough improvement yet, there is no arguement there. However, one thing has struck me about some comments from family members, and that is their grumbling about having to provide some of the care, to have to stay on top of things, to be the advocate.
What do these people want? To leave mother in the nursing home and forget about her? Perhaps part of the solution to the nursing home problem is for more families to be more involved with their loved ones instead of dropping them off at the door and driving away. I have been involved with the healthcare industry for 15 years and just from what I have seen, less than 25% of the residents in nursing homes have regular visitors. Of that percentage, less than half are greater than once a month. People are throwing away their parents, too busy to care for them, too busy to visit them.
The nursing home industry has a long way to go, there is no question about that. Staffing is and will continue to be a problem. If a family member thinks it is difficult to take care of one mother, how difficult do they think it is for one nurse aid to take care of 10, 15, or even 20 mothers and fathers with dementia and severe physical disabilities? The work is back breaking as well as mind breaking. If there is neglect, whose fault is it? The nurse aid? The nurse? The corporation? The state? The family? All the above, none of the above? I can guarantee that the nurse aids and the nurses are not the ones who will be able to solve the problems. Taking the best trained and performing people and placing them in a short staff situation will eventually lead to problems. Their energy and morale can only last so long. An occassional shortage is doable, but day in and day out, it is draining and this leaves things open to problems. So who is left? Who can do something about it?
I don't have the answers. All I know is our elderly are not treated with the dignity and respect that they should be...across the board. Maybe if we weren't so busy being soccer moms all day, every day, we could take some time to see to it that the people who took care of us are better taken care of. If we could be more involved with the politics associated with nursing homes, to use our voices to tell corporations and the government that this is unacceptable. But we won't. We are too busy. We have other things to do. We have a life to live and can't be burdened with worrying about mom and dad. Put them in a nursing home, the nursing home can deal with it, we don't have the time...nor the compassion...in our society.
NURSING HOME STAFF IS NOT TO BLAME FOR POOR CARE!!!!!!! It's the lousy money hungry corporations that are to blame and the state regulators who decide how many staff is to be present on each shift!!!!!! These politicians use head counts for the patient/nursing staff ratios! Quality care is not met like this. Head count should be thrown out! It should be patient load! Every patient is different. When are people going to realize that falls will decrease, complaints will decrease, and over all residents will be happy when there is enough staff on the floor! These corporations need to stop being greedy and put enough staff on the floor! BLAME CORPORATIONS AND STATE REPRESENTATIVES FOR THE LACK OF CARE IN NURSING HOMES! BLAME CORPORATIONS AND STATE REPRESENTATIVES FOR THE LACK OF CARE IN NURSING HOMES! BLAME CORPORATIONS AND STATE REPRESENTATIVES FOR THE LACK OF CARE IN NURSING HOMES!!!!!!! -- Barbara Marquez
Subject: Article on Myths and Reality - hmcobe . The most outrageous collection of non-facts to come along in quite a while are those under "myths and reality"about nursing homes. Obviously, this nonsense was written either by: a) a nursing home administrator or owner; b) a flack for the nursing home lobby; or c) someone who has never set foot in a nursing home.
The items considered "myths" are reality. Having worked as a volunteer in seven nursing homes, I have seen all sorts of neglect, abuse and demeaning treatment on the part of staff. The odors in the best nursing homes are nothing to rave about; in the others they can make you sick to your stomach. I have investigated cigarette burns on the arms of residents, choke marks, and all sorts of vicious behavior by staff. The residents' "bill of rights" is ignored and neglect is prevalent. In one home, supported by hospitals with religious affiliations, the medical director quit because he couldn't stand the treatment of folks. The same facility has gone through six administrators and four DON's in the last four years.
The good nursing home is the exception, not the rule. Any person who has spent time as a visitor or volunteer realizes that the "myths and reality" about nursing homes posed by the writer is nonsense! hmcobe@ix.netcom.com
One of the biggest problems in LTC is the industry's practice of terminating patient advocates. -- I was a RN charge nurse in a facility and reported abuse and neglect to the owner of my nursing home and was immediately terminated, March 1994. I filed a wrongful termination lawsuit in 1996 and just settled out of court April 1998.
I have documentation to show how our licensing agency (The Indiana Dept of Health) protected this owner. The owner had his nursing consultants review my allegations. They valided so many issues that they recommended the DON be fired for failure to ensure resident safety and protection. Yet I was the only person fired. She did not even receive a reprimand according to the owners deposition.
This is common practice in LTC. So no matter how hard we work to tighten enforcement if staff are intimidated not to document abuse and neglect the evidence does not exist.
I have letters from the dept of health denying any violations yet, the abuses were documented and addressed by the owner's own nursing consultants. My allegations were validated to the point the consultants recommended the DON be fired also for failure to ensure protection of the residents.
Yet, no one other then me was fired. I have the owner's deposition to show no one else was even given a reprimand!
This common practice of: SHOOT THE MESSENGER IF YOU DON'T LIKE THE MESSAGE helps allow the cycle of abuse and neglect to continue. Staff are afraid to speak out or even to document the abuses and neglect which we witness. We can be fired for this also.
The problem is compounded by our revered nursing journals. Pick up issues of Nursing 98 or RN magazine. Read advice such as articles written by attorneys: "Seven Things You Never Chart" "How to Fill Out An Incident Report" "Never chart incident report filed- this opens the document up for discovery! Only place information such as witness names in the incident report not the chart.
We are brainwashed into thinking this is patient advocacy(?) when in reality we are charting to protect employers not our patients any longer!
It took me two years to locate an attorney willing to take my case. I now know my owner had little to fear from terminating me. Especially since he had communication with our dept of health and knew ahead of time they would not validate my allegations. But he did not know how persistent I would be.
My termination sent a message to the entire community of caregivers- you report you will be fired! This is common practice nationwide.
Please understand this is why we are putting the cart before the horse. We must first start to protect staff who follow the law and report violations. Only them will we see more and more staff coming forward to report staff who are (working without a criminal record) abusing the residents.
Plese find a way to use my personal experience to help other staff who are currently working in LTC and are afraid to report abuse and neglect.This is not patient advocacy!!! When we are removed from the workforce the industy has little to fear. Sandra Ketterman RN, 53 Metamora Rd., Brookville, In 47012 sketter@bonwell.com
Nursing homes - A disgrace -- After three years of volunteer work as ombudsmen at nursing homes, my wife and I gave up this activity recently because of the emotional stress and frustration we were experiencing. This was not because we couldn't cope with the problems we encountered. We had made a great many friends among the residents of these homes. In fact, my wife and I were the winners of an outstanding ombudsman award in 1996.
During our years working with residents we encountered all sorts of problems, ranging from what we believed to be neglect to instances where we felt that the possibility of abuse existed. In all, we filed more than 20 formal complaints in behalf of residents.
In addition to the above, we reported instances where residents were not bathed, where they were left unchanged, where they were not fed -- all the "routine" complains that are endemic in nursing homes.
It would be nice to report that our efforts made a difference. Unfortunately, this was not the case. It seems to us that nursing homes are structured so that the people who are the least knowledgeable and are paid the minimum provide the overwhelming amount of hands-on assistance. We also feel there are varying standards of care, with the people who have medicaid getting very little other than custodial care.
Earlier this week I was speaking with our physician, who said that he had given up his responsibilities as medical director of one of the "better" nursing homes in our area. Although he is a young man, he told me that he felt no one really cares what happens to the elderly. "It's sad, but most people wish the elderly would just go away," he said.
And this is the point of this communication. I would venture that most everyone reading this has visited a nursing home. I don't have to tell you that the nursing home problem isn't going away. Sure, many people in nursing homes suffer some dementia (and maybe that's a blessing), while others can be offensive in a number of ways. But the fact remains that they deserve more than they get. Since many of us may one day have no alternative but to enter a nursing home, it would seem that the improvement in care of those in nursing homes should be one of the top priorities of seniors, even if only for selfish reasons. Senior groups should be taking the lead in this activity. What say others ? -- hmcobe hmcobe@ix.netcom.com
My name is Allison Hantschel, and I'm a reporter working on a story for a weekly newspaper in Madison, Wisconsin on for-profit and non-profit nursing homes. I'm attempting to find some information about whether or not there is a trend in nursing homes going towards for-profit ownership by corporations, and whether any individuals or advocacy groups are concerned about the quality of care being offered in for-profit homes. Any information you could provide would be very helpful. I can be most reliably reached via email, but my phone number is 608/286-9219. Thank you. Sincerely, E-mail Allison Hantschel amhantsc@young.cardinal.wisc.edu
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I am the social service director in a 62 bed intermediate facility in Illinois. I have enjoyed visiting your site. I believe staff should offer as much as possible in the way of emotional assistance to both resident, family and themselves in the task of meeting everyone's needs. This can be difficult when the facility's focus is only on the medical needs. I am interested in talking with other SW's who find it an uphill battle to see that the mental health of resident's are addressed appropriately and timely and that nursing department sees mental health professionals as part of the team. Any suggestions where I can connect to? thank you. E-mail Sharon Kopina -- slk1950@techinter.com
Medical Care in Nursing Homes -- I am glad to see some common sense in the area. I am a physician who works full time in the nursing home environment. The group with whom I practice, Long Term Care Physicians, is one of the largest group practices in the US devoted to full time nursing home care. I would be glad to correspond with anyone having general medical questions regarding the physician in the Nursing home environment. Keep up the good work. E-mail John T. Legowik M.D. -- johnlego@worldnet.att.net -- (800) 535-3256
I am a physician, PM&R specialty, with elderly parents, one with Alzheimers, and the other with a recent stroke affecting speech and recall. Both insist on staying in their apartment, and have fired the live in help I had enlisted for them. I have heard of services who monitor such situations, with phone calls several times a day, weekly nursing visits to check medication use and set up the following week medications, aides to help with cleaning and shopping, and coordinating care with the personal physician. If there is such a service in the Los Angeles area, or if you have had experience, good or bad, with these services, please contact me. E-mail Paul Leonard, M.D. -- thanks.
I have started a free new internet service, of interest to all nursing home residents and their families. The service is entirely free with no strings attached. It is to put persons in touch with each other for the purpose of visiting nursing home resididents. Please take a look at it at: http://members.tripod.com/~tbohacek/index.html Again, this is a totally FREE service, done just to show that there are good things that can be done for people on the world wide web. The service is NEW and just getting started. -- thank you Tom Bohacek tbohacek@pop.erols.com
My father passed away in a Nursing Home in Cleveland, Ohio. He had the finest of care. Of course, there was a price attached to this wonder- ful care. His monthly cost for room and board was $4500.00 This is a Jewish Nursing home, complete with Rabbi and use of Kosher food. One of the greatest contrilbutors to this Home is Irving Stone from American Greeting Cards. My father received wonderful care, but more importantly, he was treated with respect and reverance by the staff. I have nothing but praise for this institution. If anyone in Northern Ohio, who is looking for a Jewish Home, I heartily recommend Menorah Park in Cleveland. -- Natalie Gordon, Tucson, Arizona ngordon@azstarnet.com
Nursing Home Visitor -- I have started a free new internet service, of interest to all nursing home residents and their families. The service is entirely free with no strings attached. It is to put persons in touch with each other for the purpose of visiting nursing home residents. Please take a look at it at: http://members.tripod.com/~tbohacek/index.html E-mail Tom Bohacek
Activities: reality orientation and validation therapy -- Found your comments on nursing home activities most interesting and appropriate. Would like to suggest you add a paragraph about validation therapy, used primarily with residents who suffer from Alzheimer's disease and related dementias. As a Certified Activity Consultant (ACC), a teacher of both the basic and advanced activity courses (10 years) and the President of the Mass. Council of Activity Professionals, I feel this additional information would be most helpful:
For client's with Alzheimer's and related dementias, reality orientation may not be appropriate, as every time they hear something, it's as though they are hearing it for the first time (due to memory loss.) Thus a client crying for her mother, will grieve all over again when learning the parent is deceased. Redirecting the client to reminisce about her mother will provide the warm, comforting feeling she is really seeking. (There are many books on the subject of validation.) I hope you find this information informative and of some interest. -- Thanks to Jayna L. Glemby, A.C.C. E-mail jayna@hey.net
20 Jul 1996 -- Nursing Home Reform Texas Bill HB 2644 --- HB 2644 is a bill that was passed in the last session that favored nursing homes. Among other things, it made it harder for private citizens to get in evidence of wrongdoing in private lawsuits against nursing homes. It lowered the state rule standards to the federal standards. It also gave the nursing home the right to arbitrate a case that the state attorney general brought for civil penalties. Our next sesssion begins in January. The bill is under intense scrutiny currently and the Texas Attorney General, Dan Morales, has publicly opposed it. Your group should watch Texas in the following months through May of 97 -- which is when our next session ends. Nursing home reform will be a highly debated topic. Thanks. E-mail George C. Noelke -- geo25@juno.com