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After working in a nursing home for over two years, I continue to struggle with the realization, that nurses today can no longer offer consistent quality care to our institutionalized older adults, at no fault of their own. These are the patient's who often cannot speak for themselves, many have no advocate to keep tabs on their welfare, and are left at the mercy of a low patient to staff ratio, and the corporate owners of these homes.
This I believe, is part of the root cause for patient neglect, whether intentional or not. Neglect comes in many forms, but often it is caused from a too low patient to staff ratio and administrative interference with resident quality of life. I first heard the term "nursing home flipping", from the son of a resident, who visited his frail mother, (at least twice daily). He stated that the DON told him that the facility would be getting a new owner again, and then hopefully "things would get better; to hang in there". When I mentioned I hadn't heard that the current owner; a healthcare management company (not the name of the nursing home), was selling, he stated "oh no, that's not who owns this place". This family member had decided to go to "public records" and ask, "who owns this building"? He stated he suspected something wasn't right when his inquiries about his mothers care were unsatisfactorily answered. In public records, it stated that Formation Capital was the buildings owner. Let's face it, nursing home and rehabilitation centers are just another business. They should be profitable in spite of laws and guidelines. I didn't realize until recently, that most of our nursing homes and centers, are owned by large investment corporations like, "Formation Capital", who is based in Alpharetta, GA.
This company, from what I understand is one of the many like it, that buys up financially strapped facilities, in many states, and then makes that facility profitable again by contracting a health care management company to run it, (like "La Vie" or "Seacrest"). Once profitable, Formation Capital has the option to "flip" or sell the facility for higher profit. In the mean time, while a facility is being slowly pulled out of debt, the full-time nurses complained that they have not gotten a raise in three years and staff turnover was high due to burn-out.
This particular facility proudly displayed "A 4-Star Facility!" banner at its entrance which gave the public the impression that, this must be a wonderful place for recovery or end of life care. In reality, it meant that the the facility had followed the Medicare minimum guidelines for staffing, and their other logistics numbers are in sync, nothing more.
It was quite commonplace for beds to be filled quickly by clients who were mentally unstable or decompensated. Some often presented an immediate danger to themselves, other residents, and the staff. Thus, it was common to chemically sedate them, until they became compliant, instead of sending them out. Transferring a patient out meant a bed on hold and profits lost. Is profit more important than risking a patient or staff member from getting injured in this situation?
All fall-risk adults must sit by the nurses station to be monitored during evening shift, to ensure their safety whether they want to or not. Other older adults who are still alert, oriented and mobile, end up staying in their room by choice, because frankly it is depressing to observe or hear their sun-downing, mentally unstable or just plain angry neighbors crying out, use profanity, or sitting alone looking sad for 3-5 hours. Can you imagine their thought, "this is my home now". As a hospice nurse, this surely is not living with dignity; I continue to see it everywhere in centers to this day. I am in awe of our elders who have learned to become humble and complacent to survive; not everyone has that ability.
Nurses did and continue to do their best to re-direct, distract, and entertain residents in addition to their many other duties. Nurses should not be verbally reprimanded for not clocking out on time, because then the management company has to pay them over-time. Nurses shouldn't have to minimize time spent to care for their residents in a safe manner to save a company money.
One year, administration in the facility I had worked for, had the nurses, both RN and LPN, take a two-day ACLS course. Only one floor nurse had been ACLS certified before. Upon completion of a 2 day course, the nurses were tested to become ACLS certified. I was told the test was easy. I attended half of the first day of class and did not attend the second day. I was told by a nurse that we really would not be getting telemetry type patients anyway, and that administration was only doing this for marketing. A few weeks later, I was given my ACLS card as if I had attended and passed the course! I refused to sign it. I had a conversation with a colleague in California, who is familiar with Medicare rules. She told me that the reason my facility had haphazardly certified our nurses in ACLS, was to get more money from the state or Medicare. In other words, If the facility is trained and shows proof that they are skilled to accept acute care patients, they can get more money. This is fraudulent. I wonder how many nursing homes do this. Does "Formation Capital, LLC " turn a blind eye to the practices of their healthcare facility management companies, as long as their profits are met?
If an investment company has a goal that interferes with the physical, emotional, and spiritual needs of the aging population, and who's management interferes with staff to work in a ethically and morally responsible manner, then they must be held responsible for any discrepancies or law suits. If change is to be made, addressing all the reasons for low staff to patient ratio, and nurse burn-out is a must. The public must be made aware of the true nature of the nursing home business. An investment company's profit is not more important than safety, comfort and compassion.
I've been in the business for years. I have never heard that we woukd get paid more for having nurses who were ACLS certified. We get paid based on the MDS which is supposed to reflect the clinical complexity of the patient not the skills of the nurse.