Changes in Long-Term Care Methodology

On any given day, reports of abuse and neglect fill the newspapers and radio waves across America and even across the broad expanse of ocean waters. We hear about frail elderly folks being left to waste away in their own soiled beds, malnourished, under weight and dehydrated. As a people of compassion, Americans shake their heads and wonder why? How can this kind of assault to our loved ones take place? In the broad expanse of the medial field, it is no secret that the industry is plagued by high turn over and lack of qualified Nursing Assistants. While ". . . aids provide 80-90 percent of daily care. . ." to nursing home residents they earn wages that ". . . put them at poverty level. . ." (O’Connor and Schneider, 2002). By addressing the gross lack of qualified Nursing Assistants and the rate of turn over within a long-term care facility, the facility can boost profit, lower costs and dramatically improve the quality of living among residents.

The job of a Certified Nursing Assistant (CNA) is not an easy task. The physical and mental hardships and stresses, rate injuries in this field as being " . . . higher than those suffered in the steel and coal mining industries . . ." (St. Louis Dispatch, 2002). Many sources indicate that the main forms of injuries include needle sticks, medication errors, lifting injuries, patient falls and an increase in neglect and abuse situations (Europe Intelligence Wire, 2005). Adding to the situation is often an immense workload due to skeletal workforces being expected to maintain a high level of service to it’s often time helpless patients. It is not uncommon for a single CNA to be expected to insure quality care for over two dozen patients in a single eight-hour period. With these kinds of demands CNA’s are leaving the industry in search of better pay and less stress.

The elderly dependant on the mercy of others has directly felt the decline in the group of workers that provides the lion’s share of care to patients in Long-term care.

"It’s pitiful. It’s criminal. It is a sad commentary on our society that people are dying in our nursing homes because they need our help and aren’t getting it," said Catherine Hawes, professor and director of Texas A&M University’s Southwest Rural Health Research Center and a national authority in evaluating nursing home quality. "These preventable causes of death have been known for years, and in moments of despair those in the field ask why nothing has been done"(St. Louis Dispatch, 2002).

Often times left in deplorable conditions for hours at a time because the CNA on duty has to decide if patient A gets a drink of water or if patient B gets a dry bed pad, the elderly patient is treated as a problem rather than a valued human life in deservance of dignity and respect. When an over stressed, tired assistant does respond to a need and the patient is slow, or combative or simply needs more time than the CNA really has time to give, out of frustration grows the hostile potential for abusive situations to escalate. You, as a long-term care facility director/owner then see a decline in quality control, rise in cost of on the job accidents and face wrathful law suits from angry families who discover their loved one was improperly cared for while in your charge. Is it any wonder that long-term care facilities operate often times so close to the red tape of bankruptcy?

This seemingly hopeless battle for balanced care within a facility does indeed have answers. To get them however, one must step out of the box and look to other industries where high turn over has also been a problem and where solutions have been implemented with success. High turn over has a direct drain on costs by the time a facility pays for recruitment, supervision of new staff, over time hours worked by personnel covering shortages and the cost of training the new staff, it is estimated facilities "pay from $3000 to $7500 to replace once CNA" (Alzheimer’s Care Quarterly, 2004). The implementation of low cost employee incentive programs would boost staff retention. In her article Direct Care Workforce Crises in Long-Term Care; Susan Harmuth suggests the following staff retention programs:

Using welfare to work participants with proper training

Development of career ladder options

"Earn while you learn" programs

Giving monetary incentives for completing accredited training in exchange for agreeing to stay with the facility a pre-set amount of time after training is complete (Peete, 2004).

By striving to keep the staff you have and lower turn over long-term care facilities would " . . . reduce the millions of dollars high turn over costs . . ." and thereby boost potential profit making it possible to increase the current CNA’s pay, giving further incentive to remain with your facility (Harmuth, 2002). Many companies are forming Staff Retention Committees to help analyze facility needs and to come up with retention plans. These committees are made up of staff members from all levels and departments. One unique program implemented by a hospital suffering high stress among workers implemented a Drumming Program (Ivanhoe, 2004). Staff met one day every 2 weeks for a drumming lesson/session. It gave a unique outlet for staff to relieve stress and boosted moral. Companies are setting aside mood rooms for stressed staff to meditate and listen to soothing sounds and music on their breaks, choirs are being put together, any creative, innovative program will boost staff moral, motivate slacking, over exhausted staff, and draw new staff into the facility. The costs of these programs are minimal when compared to the costs of turn over already draining your bottom line.

Another very motivational reason to decrease your CNA’s on the job stress and boost quality staff retention is corruption in the workforce is costing your facility monies. An article by Alison Boyd according to a survey conducted by the International Communications Research in conjunction with the American Society of Chartered Life Underwriters and the Ethics Officer Association 56 percent surveyed admitted to acting in a corruptible manner.

As with any issue, there are many sides to be considered. The Nursing Assistant, the one expected to deal daily with the needs of others, as well as handle on the job stresses, and deal with irritated and often times upset family members relate their feelings. One CNA working in such conditions stated, "You do the bare necessities. You get them washed and dressed. You don’t have time to treat them like a person. They become just something to get done and you go on to the next" (Perry, Farrow, Gruss, McCann, 2004). Barbara Minner, a CNA described sitting at a U shaped table in the City Forest Manor trying to feed lunch to eight residents at one time. Using assembly line fashion, she went from client to client spooning food into each one’s mouth. There was no conversation, one patient kept their head buried in the crook of her arm and Minor tried speaking soothingly to them as a group (St. Louis Dispatch, 2002). Not all CNA’s are disgruntled. Most all your assistants knew before committing to this line of work they would not become rich and they knew it was a demanding field. Your assistants picked this line of work because they care, they have a heart of compassion and they want to help those who are in need of their nursing assistance. The easier you make it for them to do their jobs, the higher quality of service you are going to provide your residents and your going to find people who want to stay and work in your facilities. Not all facilities are riddled with poor communication, overloaded work schedules or irate workers and neglected residents. However, I am sure you would agree, there is always room for improvement and growth towards an ever more productive facility.

Often times, the voices of the patients go unheard, and they are the ones directly suffering. Lola Armstrong, an 81 year old resident of a nursing home, and life long writer spoke out. She told how someone used to being independent is loath to put themselves in the hands of someone else. According to Mrs. Armstrong, competence is the number one key factor in staff. "Their ability should be beyond any question of doubt" (Armstrong, 1984). To those already

lost and alone, spending what they know are their last days, Mrs. Armstrong tells what it is like to receive a cross look or sharp word from on over worked assistant and compared it to a "physical blow" (Armstrong, 1984). Above all else however, she pleads with CNA’s to keep residents clean. To find them selves incontinent is embarrassing and degrading.

The family members also have a point of view and it comes across often times in the form of hostility and defensive behaviors. Already feeling guilt, worry, and anxiety for placing their loved one in a facility they try to make up for that by being demanding and finding fault with even minor infractions. Yes, all too often serious issues do come into play...but it is the low man on the totem pole that gets the brunt of the hostility. You guessed it...the already over worked, over stressed CNA trying to get his/her job completed before the end of the shift.

The plight of our elderly and the declining number of qualified CNA workers has caught hardly a passing glance from our government. Their solution to the problem was to pass into effect the Nursing Home Staffing Improvement Act that "requires a resident get a minimum of 4.1 hours of nursing care each day" (St. Louis Dispatch, 2002). They ignored the fact that Medicaid is under funded by over 3 billion annually, and this, Dr. Charles H. Roadman II says is why facilities are operating so close to the margins. More than half of a facilities income is based on Medicaid / Medicare governmental re-imbursements and they are slow to pay the tabs. This indeed produces a problem for facilities needing to hire more workers.

In conclusion it is evident that facility owners will have to step up and take these unacceptable conditions within their businesses into their own hands. While it is easier for a non-profit facility to get grants and state funds there are programs out there for profit making facilities as well. Step out of the box of tried and true staff retention programs and be creative in finding solutions. The money you invest in retention programs is a small amount when compared to the money you save by not having to re-hire and train more staff as well as pay overtime for staff covering unfilled posts. And it is priceless to those residents in your care who depend on you and your Angels on staff tending to their daily needs.

References

Ivanhoe, (2004, May 22). Drumming Can Reduce Stress. News 8 Austin. Retrieved October 20, 2005 from, www.news8austin.com