Issues in Nursing Homes

Everyone has an opinion about nursing homes. These opinions stem from a variety of sources. Some people form opinions about them from what they hear on the news, almost always negative. Others can attest from personal experiences, which usually become public knowledge because something negative happened. Many nursing home workers are stressed and overburdened thus leaving them feeling less than positive about their jobs. And then there are people who are just clueless or could care less.

If you are a member of the last group mentioned - please try to learn something about nursing homes, just get an idea of what they are all about and prepare yourself in the event you or a loved one may need those services. Also, understand that these facilities are a very necessary part of our community and a portion of your tax dollars fund the programs that pay for the services provided. So you should show some interest in them.

Those who have had a negative experience relating to a nursing home I would like to hear the circumstance on why the negative issue arose. And the horror stories in the news - what were the causes? I am betting that most of these incidents will boil down to a primary issue...Staffing.

Lay people need to know that the government programs of Medicare and Medicaid - your tax dollars - are the primary payment sources for residents in nursing homes. The government spends an indecent amount of tax money to pay themselves for committee meetings, committees to oversee the committees, paperwork, regulating - more meetings, new forms, new regulations...and so on. These committees must continue to come up with reasons that their existence is necessary...to justify them sitting on their asses to trump up issues that 'need' regulating or revising "to insure that our seniors are getting proper care" and the 'proper' amount of dollars to do so. OK, they need a paycheck! This over expenditure of tax dollars could be better used to help facilities afford the appropriate amount of staff it requires to provide quality care.

Maybe it could be a good idea to mandate that all nursing home administrators are federal or state employees that would be accountable to the capitol for the lawful and efficient management of these facilities from a non-company connected standpoint. Good administrators know what it takes to provide excellent care. All those tax dollars wasted on the clueless stuffed shirts sitting around bickering about cutting medical payments would be better used to pay these government-hired administrators, thus saving the nursing homes that salary to afford more staff, and also saving the government money in the long run. These administrators could be set up regionally and required to meet one day a month with the Department of Health to review the status of their facilities ...quality assurance meetings. They work in the nursing home trenches and are the best at determining the real life strengths and weaknesses of the regulations. Along with this would be assurance of hiring competent supervisors and department heads who would be responsible for the work of the line staff. Some people may have great credentials but suck at management. Training and accountability are key, and this applies to everyone from the dietary aide to the Director of Nursing.

Nursing homes with good management in general are most likely not to blame for the incidental incidents that occur in facilities. Granted accidents do happen - especially when you have residents with mental health problems. But facilities - whether profit or non profit - must generate enough revenue to cover operational costs. When there are financial problems (like this present recession) staffing often takes a hard hit and that work gets put on the remaining employees. Now consider this - OK, say you have a 100 bed nursing home and the medical supplies coordinator gets axed and all of that work is mandated to the medical records employee...now shuffling papers AND supplying bedpans - important but not so crucial to the hands on quality care. Now let's go to one of the nursing units that has 35 residents and should have three nurses and four nursing assistants to provide wonderful care - take away a nurse and a nurse aide from the unit...providing medications, treatments, personal hygiene, meal assistance, and supervision for these residents...quality of care components. With being down two staff, although still remaining in the state required staff to resident ratio, that work must get reassigned to the remaining employees...now we aren't talking about records and toothpaste...we're talking about human beings. They are not going to get the same level of attention as previous because the staff has more work to do and are less able to oversee everyone as they did before. Less supervision increases the opportunity for incidents to happen. This causes the staff frustration as they exhaust themselves trying to do the extra work. Those that care become angry and saddened because they just can't do it all they way it should be done, thus breeding apathy and indifference and the care suffers. A good management staff should be able to see (and care) who is really working and who is not and replace those who are not working up to par. No matter how beautiful and fancy a facility may be the bottom line is it must have truly adequate staffing in order to provide real quality care. And in order to do that facilities must get reimbursed enough money to cover the cost of that true number of needed staff.


What can you do?

1) Become familiar with one of your local facilities, volunteer an hour a week, just get in there. Don't become an overzealous do-gooder until you have taken the opportunity to really see what life and care is really like in a nursing home. Honest and factual feedback is important to facilities to generate changes needed. But first you must understand what it is like to work there, there is nothing more annoying to people trying to do their jobs than getting clueless criticism.

2) If you have a loved one in a nursing home make sure you are visiting at varying days and times...don't think the staff doesn't pay attention to know that you always visit on Tuesdays at 5:30pm! If an issue with the care arises stay calm and discuss it with the nursing supervisor - who should immediately try to address the problem as able, and then go on to inform the director of nursing and the administrator. Follow up with a call or visit to the administration to see if they have been made aware of your concern. Always try to resolve issues with the administration before finding a lawyer to sue. Also, spend quality time with your loved one to enable the staff to feel comfortable to leave you to visit while they can go attend to someone else.

3) Write to your elected officials and relate your factual concerns to them.

Negative opinions, while possibly justified at times, must be backed by factual information and experiences. There is so much good that does occur in nursing homes, but it is not usual to read or hear about that. There are many wonderful workers in nursing homes that really care and do good work. Working in a nursing home is a very demanding job and it takes special people to do it well. The interest and involvement from 'outsiders' could very well be the answer to resolving some of the issues in nursing homes. Such involvement would hopefully encourage a better public opinion about the care in nursing homes. And if more people were aware of how inadequate staffing affects the quality of care for the nursing home residents and strived to do something about it the government would have to listen.

Nursing Home Abuse

This article did not address the horrific issue of resident abuse by staff. Though a very important subject needing attention, it will require another article!

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Comments 6 comments

RTalloni profile image

RTalloni 6 years ago from the short journey

The issues are very complicated, but your article is well-written. I want to consider it a while and come back. Thanks!


Seeker7 profile image

Seeker7 5 years ago from Fife, Scotland

Hi excellent hub.

As a nurse I have worked in nursing homes - good ones and bad ones. I walked out on one after only 2 hours! Your article has hit on so many valid points. And although I'm from Scotland, not the USA, it is interesting to see that the issues that affect your nursing homes are the same as ours.

One thing I have always debated hotly is this: Who the hell made up these nurse/carer ratios to residents? I honestly feel they are the main cause of so many problems in any kind of care establishment. Basically what ratios do is treat every person requiring care as a packet of meat to be washed, dressed, sat down and fed. It does not take account of the other - very essential - work of nurturing the residents social requirements, mental health requirements and spiritual requirements etc. Anyone can wash and dress another person, this is not care. Care is the ability to give the all important holistic approach that makes the person feel that they still have a life worth living. Ratios take no account of this. It turns people who require care into a number rather than seeing them as a human being with complex needs.

Really enjoyed your hub, very well written and great arguments. Thanks for sharing.


GoGranny profile image

GoGranny 5 years ago from Southeastern PA Author

Hey Thanks for being a fan Seeker7. Your question about the ratio is a very good one. I often wonder the same. Here in Pennsylvania the minimum is 1:20! While no facility in its right mind would do that, it does give lee-way when short staffing is a problem. And thanks for being a caring nurse... I love good nurses!!


RTalloni profile image

RTalloni 5 years ago from the short journey

Hi again! Would like to link this hub to two of mine--cause and effect, and elder care attorney, if you don't mind. Thanks!


andralynnRN profile image

andralynnRN 3 years ago from Suffield, Ohio

Thank you for writing this!! I am a DON at a innercity facility in Akron. I see the negative stigmas daily. My building is old but my staff is wonderful. Thats what makes it work


GoGranny profile image

GoGranny 3 years ago from Southeastern PA Author

Thanks for reading and leaving the comment andralynnRN. You seem like an awesome DON if you can make such a positive comment about your staff. Good for you and your residents!

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