A State of Affairs




STATE IS IN THE BUILDING! No one announced it on a bullhorn, but the sudden appearance of management all over the floor and intense level of anxiety in the air may as well have been a billboard advertisement. Voices suddenly dropped as my residents whispered among themselves at the new faces in the building.

       I’m not one to fly into a panic when regulatory agencies come into my facility. Other than my ordinary uncomfortableness of being surrounded by people who are uncomfortable, I tend not to sweat it. Sure, it’s weird having someone look over my shoulder, but I do my best every day and if I’m doing something incorrectly or if there is a better way to perform a task, I’d like to know it in order to improve. That has always been my reasoning. Besides, other than a question or two and some mild observations, they don’t interact very much with the caregivers, in my experience. And that is part of the problem.

       Charts. Documentation. Medication. THAT is the sum and substance of what interests them. Not our daily care notes, or the antiquated call bell system, or the shower room with drains that don’t drain. They don’t ask us about the supplies or if the doors are wide enough to easily maneuver walkers and wheelchairs through. They don’t see the overly filled rooms that are almost impossible to navigate.

         These people, whose sole responsibility is to protect those who live in these facilities, are blind to everything that is not on a list to check off or in a chart. They may check to be certain that there is enough staff to cover the states mandated hours of care per resident but they will never ask themselves if that mandated number is ENOUGH for the reality of each individual facility.

       But they TALK to the RESIDENTS, you might be thinking. Well, let’s think about that for a second. Let’s take a walk in their shoes. Say I live in a facility. Maybe it’s not so great, but I’ve been there a number of years. It’s what I know. While the majority of people who care for me come and go, there are a few who have been around as long as I have. They KNOW me. They know I get cold easily, or how I like my coffee or my fears. And what about my friends? Mr. __ two doors down and Ms.__ who will only eat if I sit with her? What will happen to THEM if I speak up? What if this place closes? Where would I go? Why complain? It’s not going to change anything anyway. Every year, these people come in and the only thing that ever changes are the people in the office and maybe some paint on the walls. It’s always business as usual. And then a stranger comes in and interrupts my daily routine with a list of questions and I’m supposed to give honest and well thought out opinions as to the quality of my care to someone I don’t even know let alone trust? Not bloody likely. It might be terrible, but at least it’s familiar. That’s how I would think if I were a resident in a facility.

       And really, what comes of it? A type “A” violation results in a fine that can be reduced either by following a plan of correction or on appeal. Then it’s back to business as usual until the next annual survey. It’s all about money.

         In my perfect world, for every serious violation, the owner and administrators would be required to live for a week in the facility for which they are responsible. Now THAT would have a serious impact. Short of that, I do have another suggestion: require each survey team to employ several seasoned CNAs who have considerable experience on the floor. In my opinion, any inspection without the eyes of those who know the reality of the Long Term Care system from working directly within it is incomplete. Social workers, RN’s, and all of the other professionals on a survey team have the education and experience to offer valuable input, but without the knowledge of objective direct care workers the picture will always be incomplete.

3 thoughts on “A State of Affairs

  1. minstrel

    Excellent suggestions, especially re having LTC owners and operators live in the places they oversee, and having CNAs on the teams that inspect. I was a volunteer Ombudsman for a while but saw how lacking in meaning their investigations were, unless there was prior public exposure of serious violations.

  2. L Wright

    I have over twenty years in the healthcare field.
    1. Why don’t facilities hire enough careprividers and pay them an adequate salary.
    2. Turnover in care staff is hard on patients and residents, especially
    when they become accustomed to seeing familiar faces.
    3. Burnout is usually caused by care providers who are overwhelmed by
    an inadequate staff which means one staff has to care for more pts and residents.than original posted.
    4. Reviewers do care about understaffing. They do however find useful interrogating pts. and residents. They are not going to get damaging information there they are trying to protect their “home”.
    5. Administrators care only about
    the money the facility makes annually. Ask administrators the name of ten pts.

    1. minstrel

      How right you are, L. Wright. People are not addressing the issues of staff-to-resident ratios, and how irrelevant good training is if the staff don’t have the time to work as they are trained to work. Training seems all about CingYA. Most aides I know work two jobs–then go home to care for families. No wonder all they want to do is get the ADLs done as quickly as possible so they can rest.


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