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Even though the state and federal governments have regulations that facilities must follow, they do not always keep a close watch. A great number of nursing homes do not follow many of these policies, though it seems so, on paper. Residents suffer from abuse in many nursing facilities, even under the watchful eye of the government. Most forms of this abuse falls under the category of neglect. Federal regulations state each skilled nursing facility should have, on day-shift one aide for every five residents, one licensed nurse for every 15 residents, and one registered nurse for every 25 residents. A Director of Nurses should also be on duty for at least eight hours. On the evening shift, there should be one aide for every ten residents, one licensed nurse for every 25 residents, and one registered nurse for every 35 residents. Night shift should have one aide for every 15 residents, one licensed nurse for every 35 residents, and one registered nurse for every 50 residents. The registered nurses are the charge nurses. In a facility with 59 or less residents, one registered nurse is allowed. (Report to Congress, July 2000) Aides should have at least 120 hours of training, should be certified and be listed in the state's registry. The facility should conduct a thorough background check on applicants, conduct random testing for drugs, and have regular orientation. The aide must be motivated to do this kind of work. They should, ideally, be kind and considerate, have a love of the elderly, and be very patient people. Unfortunately, these things do not always happen. (Consensus Statement on the Staffing Crisis in Nursing Homes) Silent Abuse 3 In an article on NewsRX.com, Dr. Charlene Harrington, PhD, states: "Low staffing and high turnover rates contribute to poor quality care. Low staffing led to 78% of nursing homes not complying with federal care and safety regulations during mandatory inspection." Pay is less in nursing homes than in hospitals, there are no retirement benefits, and the insurance is unaffordable. This means aides are assigned too many residents, because the facility is understaffed. (Consensus Statement on the Staffing Crisis in Nursing Homes) Healthcare administrators tend to work their facilities at state minimum, which is often not nearly enough, and cannot afford to pay their aides well, because the budgets are too low. They claim Medicaid/Medicare reimbursements are too low and complain about the recent reductions in funding. However, in a Report to Congress, in December 2002, the United States General Accounting Office states, "Medicaid's spending for skilled nursing facility care rose at an average annual rate of 30 %". Some administrators are so afraid of losing money; they listen to what the family wants, over the needs of the resident. This is often not in the resident's best interests. Many families tend to put extra pressure on aides, to take better care of certain residents, which, in turn, puts pressure on the administrator to push nurses and aides harder. (Administrative Ethics, Dec. 31, 1998) Sometimes staff does not do in-service training properly, because the facility is so short-staffed. Aides and nurses do not learn enough. The presentations are rushed or simply overlooked. There just would not be enough people on the floor to conduct a proper training session. Silent Abuse 4 The state inspectors do not see these things. It is all on paper that these things are done, when, in fact, the documents have been "doctored". Staffing requirements are often overlooked, if things appear to be running smoothly, in a facility. Federal regulations require state inspectors to do a standard survey at least every nine months, and not longer than 15 months. This is the simple survey to see if residents are comfortable, happy, and well cared for. This standard survey is completed, within four days. Because these inspections are so regular, most facilities know approximately when they will be there and can prepare for them. (Nursing Homes: Overview of State Regulations) They will hire extra workers for a temporary staff, to make it appear they are working at full staff requirements. This is when these facilities put out the "good" sheets, and ensure the linen closets are fully stocked. The bedpans and bath pans are thrown out, and replaced with new ones. Aides and other workers are encouraged to avoid inspectors. Usually, they are told what to say, if approached. Federal Nursing Staff Requirements states: "Surveyors do not collect any information on nursing staff levels as part of off-site preparation for the survey. More detailed review of nursing staff sufficiency does not occur under the federal protocol unless serious quality-of care problems are identified prior to or during the annual survey process, of it a complaint about inadequate nursing staff is received." Silent Abuse 5 If, by chance, the inspectors find that the quality of care is below standard, they fine the facility. The inspectors send a report on the problems found, and give the facility a chance to correct the deficiencies. The facility is watched more closely, at this point, and then the inspectors do an extended survey. This is a more detailed inspection. All records are thoroughly reviewed, and families, as well as the residents are interviewed. (Nursing Homes: Overview of State Regulations) This can sometimes cycle many times through. A facility can be found, many times over, to produce substandard quality of care; but, as long as they pay the fines, and correct the deficiencies, they can continue doing business for another year. This continues, year after year, with so many facilities. As long as they continue to pay the fines and continue to seem to "clean up their act", they stay in business. The results of all this are the serious health risks to the residents. If they are not properly turned and positioned, there is the risk of pressure ulcers, more commonly called "bed sores". Sometimes, the facility is so short-staffed, there is no time to pass out the ice water, which these people desperately need. This should be done at the beginning of each shift. Aides can actually be told, at these times, not to pass the ice. There is the risk of dehydration, especially if the caretakers do not take the time to encourage them to drink the water. Some caregivers tend to force-feed residents, to hurry through mealtimes, risking aspiration pneumonia, for those residents who have problems swallowing. The residents are pressured into eating faster, or not allowed to finish the food on their plates. There is also the serious risk of spread of infectious diseases. Caregivers, who are hurried, tend to hurry through or skip residents' showers. The best time to check a resident for skin tears and new bruises is lost, because rushing through reduces the chances of catching these. An open wound is a magnet for bacteria. Some aides tend to skip oral care, as well. This can lead to many problems. Silent Abuse 6 A caregiver in a hurry will throw dirty linens on the floor, while changing the beds. This causes many germs to be spread. The most problematic is not following Universal Precautions. Caregivers in such a hurry they do not wear gloves, do not change gloves between patients, do not wash their hands after every patient. Nearly all infectious diseases spread in a facility is spread from this simple problem. (Centers for Disease Control and Prevention) It all goes back to overworked and underpaid staff. When a facility is understaffed, there is no teamwork. One shift works against the next, instead of working together for the sake of the residents. Aides do not work together as a team, and must lift residents alone, sometimes without proper mechanical lifts. This leads to many on-the-job injuries, as well as injuries to the resident. In the end, these cost a facility more money than if they had simply hired workers that are more qualified. There are many very good facilities out there, but there are so many that are not. They just appear to be, on paper, and to those who are watching. Many workers are not as kind and caring as they appear to be, when they are being watched. There are so many stories in the news, today, about the obvious abuse: the physical, sexual, emotional. It is what is not seen that can also seriously affect these residents: neglect. It is the silent abuse. It can be things most overlook, because they do not know it is abuse. Sometimes, in nursing homes, things are not what they seem to be, to the uninformed. More people need to get involved and learn what really goes on in some of these places, learn what steps can be taken to prevent the neglect of the elderly. Learn the standards a facility uses to hire employees. Contact the state and federal government, to help stop the Medicaid/Medicare cutbacks, which prevent facilities from hiring qualified employees. Silent Abuse 7 References Aroskar, Mila Ann, RN, EdD, FAAN (Dec. 31, 1998). Administrative Ethics: Perspectives on Patients and Community-Based Care. Online Journal of Issues in Nursing. Retrieved August 06, 2004, from http://www.nursingworld.org/ojin/topic8/topic8_4.htm Centers for Disease Control and Prevention. Perspectives in Disease Prevention and Health Promotion Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other Blood borne Pathogens in Health-Care Settings. Retrieved on August 16, 2004 from http://www.cdc.gov/mmwr/preview/mmwrhtml/00000039.htm Harrington, Charlene, PhD. Retrieved on August 05, 2004 from http://www.NewsRX.com HCFA, Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Report to Congress, July 2000. Retrieved August 05, 2004, from http://www.cga.state.ct.us/pri/archives/2000sireportchap2.htm Markinson, Ari J. (November/December 2003). Nursing Homes: Overview of State Regulation. State Bar News. Retrieved August 07, 2004, from http://ebglaw.com/article_924.html National Citizen's Coalition for Nursing Home Reform. Consensus Statement on the Staffing Crisis in Nursing Homes. Retrieved August 06, 2004, from http://www.nccnhr.org/govpolicy/51_162_701.cfm Office of Inspector General. Publication of the OIG Compliance Program Guidance for Nursing Facilities. (March 16, 2000). Notice. Federal Register, Vol. 65, No. 52. |
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