Kentucky Nursing Home Reform

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    EEditorial From Cathy Stein, State Representative

    You seldom see people loudly complaining about poor treatment in nursing homes, but poor treatment is present in many nursing homes and is a growing nationwide problem. Kentucky is no exception. The population grows older by the day, and nursing homes are more and more going to play a crucial role in caring for these elderly Kentuckians.

    The reason you don't hear people complaining more is that because the people being harmed -- residents of nursing homes - cannot, for the most part, speak for themselves. They are too weak. They are frail, elderly, scared people. More than half of them have dementia or Alzheimer's Disease. The ones in nursing homes who are still able to speak out are afraid that if they do complain the staff will take it out on them and the service will be even worse. That may not be true about the staff, but the residents and their families don't want to take the chances.

    That leaves citizen advocates and lawmakers to speak out fearlessly. I have observed first-hand the maltreatment in nursing homes. It comes in various forms of abuse. There is the sensational abuse that you read about under glaring newspaper headlines or see on television; once in a while even 60 Minutes will do an expose on nursing homes and the poor treatment they give.

    But the more diabolical abuse is the quiet, silent abuse in nursing homes. It is usually in the form of abuse by neglect -- neglect in answering residents' call bells for aid of some kind, neglect by failing to turn residents in their beds and thus letting them develop painful bedsores, neglect by not feeding residents properly and allowing malnutrition to be a way of life.

    The bottom line: you have to be a resident of a nursing home, or a family member who visits the nursing home frequently to become acquainted with the little, quiet forms of neglect. Don't be misled by the beautiful trappings in some nursing homes -- thick carpets, soft music and gorgeous draperies.

    Most of the neglect occurs because there are too few front-line caregivers -- the nurses' aides who give direct care to residents. Their official designation in nursing homes is certified nursing assistant.
    Nursing home front-line caregivers are often getting a bad rap. They might be the people who fail to give adequate care, but many of them have little chance to do so. When a certified nursing assistant has to see to the needs of 12 to 15 residents during an eight to 12-hour work shift, it is impossible to give good care. They wear out. They get very tired. They wish they worked at a fast-food restaurant where the work is much easier and the pay better.

    The ration of residents to caregivers ought to be more like five to one or eight to one. Moreover, the caregivers are compensated poorly. Most of them leave for easier jobs. Turnover in nursing homes often is terribly high.

    Such conditions in long-term care facilities are fast reaching the crisis stage, and we must do something about it soon. In the 2003 session I introduced legislation in the Kentucky General Assembly to help improve conditions in nursing homes specifically by requiring more staff. I worked with an advocate for nursing home reform. I worked with anyone in the House and Senate who was open to my legislation to improve conditions in nursing homes, and there were several who listened. While the legislation failed, mostly because of the tight budget situation, I was consoled that many people got a first-hand look at the problem with long-term care in Kentucky. I'll be back in the 2004 session to introduce legislation again.

    One of the most important bills would force nursing homes to set quality staffing standards whenever they received from the state an increase over the previous year in Medicaid reimbursement money. They would have to use that money to put more front-line staff people in nursing homes. The staffing standards would be set by a commission made up of representatives of the nursing home industry, governmental officials and advocates for nursing home reform.

    You can help this happen. First of all, demand that your candidate for governor of Kentucky support legislation that would tie future increases in funding to nursing homes to quality staffing standards. Secondly, tell your legislator to vote for such legislation. It is not right for people to suffer unnecessarily in nursing homes. I think we will see the day when long-term care of the elderly is reformed, and hopefully that day will be before someone we love falls victim to today's standards. I hope you will be there with me supporting that reform.
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