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What Will It Take To Correct Nursing Home Woes? The SeniorScape™

A few weeks ago, I wrote a blogpost about what's stopping nursing home health care workers from “sticking their neck out”; from standing up and speaking out about the tragic nursing home ills they experience almost every day. In that article I proposed that it was fear of retribution from higher ups and/or the need to keep their job.

Speaking up within a building is something I’ve always done. Speaking up to everyone and anyone who will listen: a director of rehabilitation, a director of nursing, an administrator, corporate level personnel.

However, it goes beyond speaking up inside the building. We are all mandated reporters. Through the years, I’ve oftentimes questioned myself on this subject. From the late 1990’s when a rehabilitation director told me I should call the state if I really thought someone would be harmed, to the present, I’ve seen many situations that would warrant a call to the state.

A recent situation is one that would likely be considered reportable. Patient A, who was at the tail end of his COVID quarantine, was being moved into a room with a newly admitted patient who was COVID positive. This fully alert and verbal patient adamantly objected and refused to be moved into the room with the patient who was COVID positive. Staff who was aware of the situation, advocated for the patient the entire day: calling everyone who had any authority over the room change situation. The following day it was learned that the patient remained in his chair and slept in the hallway the entire night. Everyone was shocked and dismayed. This falls in the category of patient abuse.

Other incidents constitute neglect and abuse. A resident reported to a colleague that she hadn’t received a shower in 10 days. Who among us would tolerate not having a shower for that length of time? The explanation given to the new resident was that she changed rooms and shower days are assigned based on rooms. Therefore, as the resident was at the tail end of her stay in one room prior to the transfer to the new one, her shower days fell between the cracks. While ten days without a shower seemed egregious enough, a few days later I heard staff members in that same facility discussing a gentleman who hadn’t received a shower in almost 3 weeks based on that same room change issue. That resident was not sufficiently alert or verbal to advocate for himself. I’m not aware whether or not that resident had family. Both of these situations occurred on a short-term rehabilitation unit where the prevailing thinking is that patients receive a higher level of care.

These situations may sound shocking, my hunch is they are not unique. Of the over 50 buildings in which I’ve worked it’s a little more of this, a little less of that; or a little less of this and a little more of that.

But it’s not only staff who are reluctant reporters. Recently a family member wanted his loved one's name crossed off the meal ticket showing incorrect food items and consistencies which are potentials for causing harm. The reason he gave was that he feared retribution. Of course, he was assured him this would not be the case. This situation would be used as the basis for staff education on the importance of residents receiving correct foods and consistencies.

As disturbing as these stories are is another that I've heard about whereby a regional admissions director, despite the objections and concerns of other corporate personnel, stated that staffing levels, or lack thereof, was not a consideration when bringing admissions into a building. The owners who sat silently during the conversation were considered to be in tacit agreement. Other members of the organization were both shocked and dismayed. There is ample evidentiary research and countless examples whereby staff shortages result in less than optimal care; the examples above are only a few.

The Centers for Medicare & Medicaid Services recently indicated that nursing home compare, the database that rates Medicare and Medicaid certified nursing homes, will now include staffing levels in their rating scale.

While on face value this sounds like a step in a positive direction, the reality is while it may affect a few people who do their due diligence before making decisions about nursing home placement, there are countless other people who do not have the time, knowledge, or where with all, especially when the need to find a nursing home is imminent. This typical scenario occurs when a crisis results in an unexpected hospitalization. Oftentimes within days, family is informed of an impending discharge to a nursing home, usually for purposes of rehabilitation. Countless others don’t have family or access to the nursing home compare website. Staffing levels are reported based on payroll records. However, I wonder if there will be loopholes which would result in a less than accurate representation of staffing levels. What kind of care would one expect to receive in a nursing home that has only 1 nurse or 2 certified nurse aides caring for 40 patients or residents? Who among us would make the decision to choose such a place?

Staffing shortages have become an industry-wide issue, the reasons for which are many. Additionally, without a federal staffing ratio mandate, despite the shortages of health care workers, a great number of providers caring more for their bottom line than the level of care provided, will continue to hire the lowest possible number of care staff. Additionally, if the nursing home in a specific geographic area all have similar undesirable staffing ratios, or ones with better staffing ratios don’t have bed availability, the rating scale will not benefit the consumer.

What are we doing wrong that people are afraid to speak up for what is obvious abuse or neglect? it’s not only the responsibility of health care workers; a family member can also report these abuses. What are the reasons these situations are not being reported? I’ve heard countless family members complain to nurses, social workers, nursing home administrators. Why do they not go beyond the nursing home level and report these situations to the state?

· Do they also fear retribution towards their loved one who is in the nursing home?

· Once they themselves or their loved ones leaves the nursing home, do they no longer care about the countless patients or residents remaining in a situation where they receive less than adequate care?

· Does it fall into an out-of-sight out-of-mind situation?

· Are they aware there is an anonymous state hotline to report complaints?

· Do they feel it is futile and nothing will change?

· Is it rooted in ageist attitudes deeply rooted in our society? The age demographic of people in nursing homes covers a wide range.

· Is the prevailing view that people in nursing homes are no longer valuable contributors to our society and thus, the care they receive is not of any consequence?

is this the best we expect for our tax dollars?

Are baby boomers going to accept this for ourselves in our later years? Will our children accept this for us? Is this the best we can expect for our tax dollars? What are realistic changes that will impact the care people receive in our nations nursing homes?

What is it going to take for us all to stand up and say, in the words of the Howard Beale character in the movie Network, "I’m as mad as hell and I'm not going to take it anymore.”?

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