I worked at a nursing home/rehab center in Florida two years ago. I had read the article, "Overview: Health Care and the Aging Population: What are Today's Challenges?" (author: Ella Kick, DNSc, RN) on OJIN. An issue was not addressed. Yes, work still needs to be done to provide quality nursing care, but let's not forget the institutionalized older adult. They're the ones that cannot speak for themselves, and they have no advocate to keep tabs on their welfare; they are left at the mercy of a low patient to staff ratio. This I believe, is related to 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. The facility proudly displayed "A 4-Star Facility!" banner at its entrance which gives the public the impression that, this must be a wonderful place for recovery or end of life care. In reality, it means that the the facility has followed the Medicare minimum guidelines for staffing, and their other logistics numbers are in sync, nothing more.
It is quite commonplace for beds to be filled quickly by clients who are mentally unstable and/ or decompensated. Some often presented an immediate danger to themselves, other residents, and the staff shortly after admission. Thus, it was common to chemically sedate them, until they become compliant, and a select few may become productive in the coming weeks. The patient to CNA ratio was reduced to 5:68 in this particular facility.
Unfortunately on evening shift, the nurse often had to place challenging residents on one-on-one supervision, because there were not enough staff during evening hours. The CNA's were ordered to take hourly turns "watching" the new resident, and this may go on for several days. This takes precious time away from staff who are already juggling a full workload and reduces the time spent with the other residents. Because of the rise in ambulatory residents with psychiatric issues, the "starlight program" was eliminated. A trained CNA in starlight, use to entertain and keep sun-downing residents busy with activities, and other meaningful distractions during the evening shift. Now, these confused older adults have to sit by the nurses station to be watched during evening shift to ensure their safety. Which by the way, is common in all nursing homes today. Other older adults who are still alert, oriented and mobile, end up staying in their room or seek out a private space by choice, (like the patio), because frankly it was depressing to observe or hear their sun-downing, mentally unstable or just plain angry neighbors crying out, use profanity, or sit alone looking sad for 3-5 hours. Can you imagine their thought, "this is my home now". This is not living with dignity.
Nurses do there best to re-direct, distract, and entertain residents in addition to their other duties. A priority was to get out of work on time to avoid the wrath of being verbally reprimanded for over-time.
Let's face it, nursing home/ rehab centers are just another business. They should be profitable in spite of laws and guidelines. I didn't realize until recently, that most of these facilities are owned by large corporations like, "Formation Capitol", based in Alpharetta, GA. for example.
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 Capitol "flips" or sells it 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. I believe there is a connection.
One year, administration 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 only attended half of the first day of class and did not attend the second day. I refused to 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. Just recently 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 Capitol" turn a blind eye to their health facility management companies, as long as their goal is met?
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 "LaVie" (not the name of the nursing home), was selling, he stated "oh no, that's not who owns this place". He had to go to "public records" to find out who is the owner of the 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 Capitol was the buildings owner.
If a capitalist's company has a goal that interferes with the healthcare needs of the aging population and who's management interferes with staff who should be able 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, finding the root cause for nurse burn-out and low staff to patient ratio in this field must be addressed. The public must be made aware of the true nature of the nursing home business.