STAFF:
Our company regularly goes into local nursing homes. We evaluate care,
develop plans to improve situations and provide information on options. The
system is broken. Until the general population demands changes, it will remain
broken.
I firmly believe the nurses and aides employed by nursing homes usually do
want to provide better care. Granted some nursing homes try to keep us out, but
many welcome our input and observations.
The staff, for many reasons, has its hands tied when it comes to quality
care. When medicines are not delivered until 15 hours after someone returns
from a hospital, you get poor care. When nurses are emotionally and physically
exhausted from working too many double shifts, you get poor care. When beds and
wheelchairs are broken, drinking cups are locked away and paperwork is sloppy,
you get poor care. Nurses constantly complain about paperwork, but without it
there is decreased communication and poor care.
People who live in nursing homes are typically very old, with multiple
medical problems and handicaps. Their health care is not easy. Subtle
differences, even an increase in confusion for a dementia resident, can signal
a life-threatening, but curable, condition that needs medical attention. When
minor symptoms are not addressed because temporary staff doesn't know the
resident, problems can escalate until they are indeed life threatening.
Changes in the taste buds and a decreased thirst sensation are part of
normal aging. Some diseases also affect nutrition and hydration indirectly.
When you add multiple pills, loose dentures and an unappetizing atmosphere, the
enjoyment of eating is lost. It takes edible food, social conversation and time
to encourage people to eat and drink; but many nursing homes don't have this
when staff is already struggling just to get everyone out of bed in time for
meals. Once dehydration and malnutrition are established, there is a rapid
decline toward bedsores, multiple organ shutdown and death.
Looking for suggestions? First, go back to mandatory minimal staffing
levels. As long as nursing homes are allowed to police themselves and determine
their own staffing levels, the problems will continue.
Second, give the director of nursing the authority to make needed decisions
regarding the nursing care of residents. Nursing homes are supposed to be about
nursing care, not financial care. If a nursing home can't afford to stay in
business, then I say, get out! Several nursing homes in town do a good job and
stay afloat financially.
Last, staffing problems and poor retention must be addressed by providing a
reasonable living wage and benefit package in addition to recognition, ongoing
quality education and longevity awards. Without good staff, a nursing home is
no better than its cathedral ceilings and fancy wallpaper.
Inspectors, no matter how many or few, can only address issues that are
covered by regulation. If we are outraged by these articles and want to truly
improve nursing home care, we must convince our politicians to tighten the
state regulations and stand up to the strong lobby interests of the nursing
home industry.
A FORUM FOR OTHER VOICES, IDEAS AND OPINIONS\
Julie T. Hess, R.N., is chief executive and president of Autonomous Case
Management, St. Louis.
