Category Archives: caregiver shortage

A Numbers Game: Resident Acuity and Staffing – Part Three

 

 

Minstrel

We cannot provide person-centered care without the personnel.  My previous comment, Part Two, presented a list of symptoms that arise from dementia.  These symptoms are the constant companions of those living with more advanced dementia, and their care partners.  The symptoms create behavioral challenges we CNAs must and want to respond effectively, so our residents can feel secure, content, at home.  

We have our list of dementia symptoms.  But wait—there’s more.  Let’s look concretely at the workday of a LTC direct-care worker.  Aides work an 8-hour shift, with one-half hour mandatory meal break.  (In some places they are also entitled to or permitted to have a second 15-minute break.)  The first and last ten or so minutes of a shift are spent getting and giving shift updates to the previous or next shift of aides.  Aides will also need one or two bathroom breaks during a shift.  Thus an aide has about 7 hours (420 minutes) left for care tasks.  This scenario doesn’t take into account the moments an aide might need for a calming ‘time-out,’ for a few minutes of helpful conversation with another aide or a supervisor, for an important phone call from home, for time spent walking from one task to another or one resident to another.   And it doesn’t allow for other encounters we expect aides to have with residents, creating ‘moments of joy.’ 

Aides will customarily be responsible for the care of six to ten residents on a shift that has plus or minus 420 minutes of usable work time.  (And would you believe the number of residents might be higher?)  If you do the math, you see that aides may have 42 to 70 minutes for each resident.  Seventy minutes to help a person exhibiting symptoms of dementia with toileting, washing (on certain days showering), grooming, dressing or undressing, moving to the dining room, eating, returning to the day room, using the toilet during the day.  And these are just the essential ADLs.   

Other tasks aides are responsible for during a shift: 

  • for safety purposes, keep alert to where each resident is;
  • distribute drinks to prevent hydration;
  • serve snacks;
  • check toileting needs and assist residents with this as needed;
  • help with transfers (from bed to wheelchair, wheelchair to lounge chair, lounge chair to wheelchair, wheelchair to toilet and back several times in a day, wheelchair to bed) for those residents who cannot transfer themselves;
  • help other aides with two-person-assist transfers;
  • answer resident questions throughout the shift (“When can I eat?” “Where is my mother?” “When will my son be here?”  “I’m cold, where is my jacket?” “Don’t I have a doctor’s appointment today?”) ; 
  • in between ADLs engage with residents through conversation, music, activities;
  • accompany residents to other areas of the building as needed for medical care, hairdressing appointments, other events.

In some LTC communities aides are also responsible for making beds, doing laundry and putting it away, or other housekeeping duties.  Throughout the day there are spills to clean up, phones to answer, paperwork to be done, questions from visitors.  If an aide is tired from working a second job, or a double shift, this will slow the aide down.  If an aide has a bad back that day, or sore knees, or is pregnant, these things will also mean the aide has a lower energy level or slower response time.  All these factors take a toll.  If some aide should call out at the last minute and the shift is short-staffed, this further impacts care.   Even if forty or fifty or seventy minutes of care per resident were sufficient—and really, it’s not—at the current staffing levels in most LTC homes, residents don’t get even this.  I challenge administrators to refute this with data.  

Is it really acceptable to pare staff levels so thin that we impair not only the quality of care but the safety of residents and aides alike?  Is it acceptable that the owners of long-term care homes are sustaining their organizations by controlling their costs with sub-par staffing levels?  Those responsible for setting care and staffing standards should feel responsible for doing something about the unacceptably low staffing requirements they’ve established and tolerated, thanks to lobbying efforts of the long-term care industry.  (Shame on you, CMS.)  The rest of us should hold them accountable.  Families and direct-care workers and anyone who is an advocate for those living in long-term care communities:  Unite!  Lobby!  Write, email, text, twitter.  Demand that your care home managers and your state legislators see what is before their eyes.  For added clout, partner with organizations that advocate for better long-term care.  To any CNAs up for a little non-violent guerrilla warfare: sneak a copy of these comments to a few trusted family members of residents.  Ask them to bring the staffing issue up at a Family Council meeting.  Send a copy anonymously to your Administrator.  

Owners, operators, executives and regulators of LTC homes will say that we don’t need more staff, we need more or better training.  Our CNAs need to work ‘smarter.’  And there is something to this, we do need to look at work assignments and patterns and at aides’ understanding of how to interact with persons with symptoms of dementia, etc.  But tell me how all this will change the fact that an aide may, on a good day under ideal conditions, have 70 minutes to give a resident.  (A resident who may be paying $5000 to $8000 a month for memory care.)  

This isn’t a game.  Would we let a dog lie in a kennel and give that animal only seventy minutes of direct attention a day?  Long-term care homes don’t care for dogs, they care for human beings.  Tell me please, how can we sit still and stay quiet about this appalling reality, one minute longer? 

The Facts About CNA Wages

 

Bob Goddard

There is a great deal of confusion within the CNA community regarding the issue of wages and how it fits into the larger long term care picture. While there is general agreement that caregivers are underpaid, that perception is primarily based on personal experience, that of our own and of others. This anecdotal evidence is useful in its own right, if for no other reason than it is overwhelming. However, discussions regarding the wage issue are characterized by emotional responses and typically lack references to data that back up the arguments.  Solid facts are sometimes offered within the CNA online forums, but usually not in any kind of comprehensive or purposeful way.

In order to help us get a more accurate picture of the state of direct care work in this country, below is a list of just a few of the more significant statistics. The primary source for these is a PHI fact sheet published in August of 2017.

I think this kind of short list might be useful for those who argue for better wages for caregivers. In future posts, I’ll give my take on what I think these statistics mean.

First, just to get a sense of the scope:

15,400 long term care facilities in the United States

1.4 million residents live in these facilities

600,000 CNAs work in them

But those 600,000 are only 13 percent of the total of direct care workers employed in the United States, because…

4.5 million direct care workers are employed in all types of situations, including home care, Continuing Care Retirement Communities, Assisted Living Facilities, Hospitals, Centers for Developmentally Disabled, Mental Health, Substance Abuse, Employment & Rehab.

Second, the demographics of caregivers:

91 percent are female

Half are under age 35

Half are people of color

Half have some college, (about 1 in 7 have associates degree or higher)

20 percent were born outside of the United States

Third, the money issue:

$12.34/hr is the median wage of CNAs (half make more, half make less)

$20,000 is the average annual income

Half work part time at least part of the year

17 percent live below the poverty line (compared to 7 percent of all American workers)

40 percent receive some form of public assistance

72 percent of long term care is finance through public programs (mostly Medicaid and Medicare)

Finally, the demand for caregivers is growing:

60,000 more caregivers will be needed by 2024. It is one of the fastest growing occupations in the United States workforce.

1 in 2 caregivers leave the job within 12 months. And more LTC workers are leaving this sector than entering it.

I would encourage anyone who is interested to visit the PHI site where more information like this can be found. Of current interest is the ongoing 60 Caregivers Issues series where they tackle a whole range of issues regarding our work, such as caregiver wages, training, recruitment and retention, and advocacy.

Next week, I’ll share what I think some of these numbers mean for the larger long term care picture.

A Number’s Game: Resident Acuity and Staffing – Part Two

 

 

 

Minstrel 

This is about person-centered care. To repeat: We cannot provide person-centered care without the personnel! CNAs, do the administrators of the LTC homes you work get this? Do they really comprehend what your work day is like? Do they appreciate how much time it takes for you just to assist with ADLs, when a person is showing symptoms of dementia? Do the state regulators? Or are they ‘cognitively impaired’ when it comes to understanding life on a memory care unit. As my uncle used to say when his dementia advanced: “Donna, I hear you but I don’t understand what you’re saying.” Administrators may see things, but do they really understand? A Resident Acuity Assessment tool might help them understand.

A Resident Acuity Assessment tool is a descriptive list of the symptoms of dementia. This list isn’t comprehensive; it can’t be. We’ve all heard this: “If you’ve seen one case of dementia, you’ve seen…one case of dementia.” Everyone is different; each care partner may observe a new symptom. This list isn’t meant to be discouraging for those who, thanks to the support they have, may not show severe symptoms. The better care a person has, the more a person diagnosed with dementia can retain functionality, with fewer and less severe behavioral symptoms. But insofar as residents of LTC homes do experience serious consequences of dementia, those who regulate care homes need to appreciate their needs and regulate accordingly with regard to staffing.

Here is what I think a Resident Acuity Assessment tool might look like.* If you are a CNA working in a memory-care community, or a home care aide, or someone caring for a family member at home, these symptoms of dementia are familiar to you. I’m not sure they’re as familiar as they need to be to those who set long-term care standards. If they were, we would have better staffing.

Part Three, the next chapter in my mission to lobby for better aide-to-resident staffing ratios, will mention other factors that need to be taken into account by administrators and regulators.

RESIDENT ACUITY ASSESSMENT

Key: N = Never = 0      S = Sometimes = 1        F = Frequently = 2        A = Always = 3

** under 60: low to moderate acuity;   61 to 100: moderate to high acuity; over 100: very high acuity.

RESIDENT _________________________ Date Assessed _______ by ________________

*There may already be such a tool, a better one, that I haven’t found. (The tests used to diagnose dementia serve a different purpose.)

 

 

 

 

 

 

 

 

Can I Afford to be a CNA?

 

 

Bob Goddard

A prospective caregiver asked this question in one of the CNA Facebook groups: “What do CNAs start at?”

The first person to reply said this: “If that’s the first thing you want to know about being a caregiver, you don’t belong in this field.”

That reply got several positive responses. After all, CNA work isn’t about making money, right?  It’s all about taking care of people, not your bank account. Right? So take your question elsewhere, you money grubbing sociopath.

Of course, they didn’t actually say those words, but the condescension was certainly there.

This attitude is shared by a small, but vocal minority within the direct care workforce. It’s an attitude that arises from a small-minded, but persistent misconception: expecting reasonable compensation for the work is incompatible with the compassion necessary to do the work. This notion is erroneous and harmful.

Really, take a moment and consider what the young lady was actually asking. I think it was this: “Can I afford to be a CNA?” “Will it pay my bills? Will I be able to support myself and my family? What sacrifices will I have to make? What sacrifices will the people who depend me have to make? Or do I have to go elsewhere in order to better meet my obligations?”

My guess is that she went elsewhere.

“Can I afford to be a CNA?”  This is grown-up talk. It’s about the hard realities and difficult choices people have to make. Asking it has nothing to do with a person’s capacity for caring and compassion. Anywhere else this would be regarded as reasonable and responsible question. But for some in the CNA community, it’s a red flag and those who ask it should be dismissed as morally unfit for caregiving.

I have a question for the caregiver who gave the “you don’t belong in the field” reply – or for anyone who thought that it was a good way to respond: Where is your compassion for that young lady?  Where is your compassion for people who might very well become great caregivers and love the work just as much as you, but are denied the opportunity because they simply wouldn’t be able to make ends meet?

Where is your compassion for caregivers who are single mothers and have to work two jobs or unreasonable amounts of overtime just to feed and clothe their kids? Do you have any compassion for the young children who don’t see enough of their mothers?

We know that wages have a direct impact on attracting and retaining workers. The high turnover rate of caregivers has an appalling effect on the continuity and quality of care in LTC, and makes it almost impossible to keep many of these homes adequately staffed. Where is your compassion for the workers who struggle day after day in these chaotic conditions and unmanageable work situations?

Also, let’s not forget the managers that are forced to hire people they might not necessarily want to hire, because poor wages artificially limits the pool of candidates. And then they – and everyone else in the place – has to tolerate inadequate work performance or absenteeism or tardiness or outright disrespect from these workers because the managers know how difficult it is to replace these caregivers.

Where is your compassion for the families of residents who live in poorly staffed homes?

Finally, where is your compassion for the residents who have to live in these homes? And really, isn’t that the bottom line here?

There are those in positions of authority who are influenced by and even exploit the notion that “good caregivers don’t care about money.”  Make no mistake, when that idea comes from our ranks, they will use it.

A Not so Obvious Picture at the Grand Rapids Home for Veterans

Bob Goddard

In early August, a disturbing news story broke about the Grand Rapids Home for Veterans, my old workplace.  After an investigation by the State of Michigan’s Attorney General’s office, eleven former employees – all direct care workers – were charged with falsifying medical records. The caregivers charted that they had checked on members (the Veterans Home refers to the residents living there as members) while surveillance video shows that these checks were not done. In Michigan, falsifying medical records by a health care provider is a felony, punishable by up to four years in prison and a fine of up to $5000.

The investigation followed a scathing February 2016 report by the Michigan Auditor General. According to that report, the home failed to properly investigate allegations of abuse and neglect, took too long to fill prescriptions and operated with inadequate staffing levels. Both the Attorney General’s investigation and the audit came almost three years after the State privatized the entire direct care workforce at the home, thus replacing a dedicated, stable direct care workforce with contract workers from a demonstrably unreliable agency, J2S.

The eleven workers charged by Attorney General’s office were employed by J2S. That company was replaced by two other contract agencies last year after J2S repeatedly fell short of adequately staffing the facility.

As we have come to expect in media coverage of anything related to long term care, the local media treatment of this story displayed a superficial understanding of how a long term care facility operates and relied on sensational wording to make the story more compelling. In the process, the reporting presented a misleading picture of how caregivers go about their work. While reporters expressed outrage over the quality of care at the home, they seemed clueless regarding what it takes to make good care happen. I think it would be useful to correct this and offer a different perspective.

In one report following the announcement of the felony charges against the caregivers, a local TV reporter assured viewers that the Attorney General’s investigation “paints a pretty obvious picture of the situation” and concluded that bringing the charges does two things: “it holds people accountable for what they did,” and second, “I can guarantee you tonight at the home for veterans they’re going to be doing their member checks.”

The assumption in that last statement is that fear is a necessary and effective motivator in providing good care. This is a common fallacy among observers unfamiliar with the nature and practice of caregiving. You cannot get genuine compassion and caring from fear.

Yes, as our visibly self-satisfied watchdog reporter suggested, I’m guessing “those member checks” were indeed “being done tonight,” but as I will explain below, that form of diligence has little do with the actual quality of care at the home.

The media reports and statements from the Attorney General gave the impression that these hourly checks were at the heart of what caregivers do. They are not. In fact, the hourly checks are superimposed over normal care routines. In a typical institutional setting, each caregiver is assigned a group, usually ten or more residents depending on the shift, unit and facility, and is charged with completing a whole series tasks including assisting with the residents’ personal hygiene, bathing, grooming, dressing, toileting, bowel care, skin care, turning positioning, transferring, ambulating, transport, serving meals and feeding patients, offering fresh water and snacks, take vital signs, make beds, keep the residents’ room clean, answer calls lights and respond to requests, record intake and output information, observe and report changes in residents’ physical and mental condition. And of course, document these activities via flowsheets and other similar forms. The location sheet is one of these forms.

It’s important to understand that given the direct care staffing levels in a typical long term care facility, and this certainly includes the Grand Rapids Home for Veterans, assigned caregiver workloads are rarely possible to complete – not to the standards set forth by regulators, facility policy, and customary nursing practices, let alone family and public expectations.  This means caregivers are constantly engaged in a form of care triage, made necessary because no one above them in the Long Term Care hierarchy, including policy makers and legislators, seem able to provide the resources necessary to do the job according to standards. Either they lack adequate awareness of the problem or are simply not willing to make the hard choices. By default, this is left to the direct care worker.

Given the inadequacies of the system, the best a caregiver can do is to arrange these various tasks in some order that makes the most sense for everyone in the group, taking into account the unit’s mealtimes and other facility routines. While a good caregiver tries to plan ahead, working with human beings means that unexpected needs routinely arise and no can anticipate everything.  Each shift becomes a unique time puzzle that the caregiver must solve if the residents are going to receive the best care he or she can provide. But the puzzle is dynamic, the “pieces” change according to the immediate needs and expectations of residents, coworkers and management. The caregiver must continually adapt his or her time organization to ever changing circumstances and priorities. In essence, the caregiver spends the shift involved in perpetual problem solving with ethical implications.

At the Veteran’s Home, the check sheets are kept behind the nurses station while the majority of care is conducted in the members’ bedrooms and bathing areas. So, to properly document the checks consistently in a timely manner requires this absurdity: the already overwhelmed direct care worker must pause care and walk away from the members for whom she is providing care for the purpose of putting her initials on a sheet of paper that indicates she knows the location of the members she was just with. This may provide the facility with documentary evidence and meet an institutional need, but it does not necessarily address the needs of the members.

If we are truly concerned about the quality of care for our veterans, the real question is not whether or not the checks were properly documented, but what the caregivers were actually doing when they indicated they made the checks. Were they in the shower room with a member or making sure an unsteady member wasn’t tumbling off a commode or perhaps transporting a member to a therapy appointment? Were they in the middle of assisting a member with his meal or helping a coworker transfer a 350 pound man from his bed to his wheelchair? Were they responding to a member’s urgent request for help? Were they redirecting a confused member for the tenth time in the last five minutes? Were they assisting another caregiver who was trying to manage a combative member? Were they comforting a member who was experiencing some kind emotional turmoil? Were they on their way to nurses’ station to get the location checks clipboard when they noticed a call light? Were they with a sick member, maybe dealing with copious amounts of diarrhea or vomit? Were they cleaning up a spill that presented a fall hazard? Were they speaking with the family of a member regarding their loved ones’ care and status? Were they holding a dying member in their arms? Or perhaps they were engaged in a member’s post-mortem care.

I will leave it to the Attorney General and media reporters to decide to which of these activities caregivers ought to interrupt so that they might properly document the checks – and presumably stay out of prison.

Let’s be clear, if the workers were sitting behind the desk or off the unit or otherwise not engaged with the members when these checks were supposed to be made, then our sympathy and support for them evaporates. Not because they didn’t make the checks properly, but because they weren’t with the members and on task. Even in bad work environments, caregivers are ethically and morally obligated to the use the time and resources that they do have to do the best they can for the residents.

Of course, it could be argued that the hourly checks provide a more systematic way of accounting for the members’ location and condition. Regular checks ensure that no one gets forgotten.  It seems obvious, right?

However, when you start to look at how caregivers actually gather information and keep tabs on the members in their group, the hourly checks take secondary importance. Caregivers are routinely provided with a “cheat sheet,” a one or two page list of all the members in their assigned group. The cheat sheet includes basic care information for each member. The caregivers carry these sheets with them and will refer to them throughout the shift. Even caregivers who are familiar with the members in their group will often use the cheat sheet as an aid to help organize their time and, of course, to help make sure no one is forgotten.

Given the real needs of the members, the fact that the checks are hourly is completely arbitrary. The reality is that some members don’t need to be checked that often and some leave the grounds for long periods – as is their right, it’s a home not a prison. Other members may need to be checked even more frequently depending on their particular physical and mental status.  A lot can happen in 59 minutes and the hourly checks can no way guarantee the safety and well-being of all members. The best way to keep members safe and their immediate needs met is to have well informed, well supported, on-task caregivers. And by well-informed, we mean caregivers who are thoroughly familiar with the members – not just with their current medical status, but who they are as individuals, their daily needs, preferences, and habits.

By threatening caregivers with prison sentences and the like, we can make them jump through hoops and give the appearance that good care is being done, but we should wonder what is actually being missed while they’re putting on this show for us. As our watchdog reporter implied, fear will elicit a sure response. But with fear, the issue becomes not about the real quality of your work and how those in your care are experiencing it, it’s about how you think it’s being perceived by those who can punish you. Under siege, our actions are informed not by our sense of right and wrong nor even by common sense, but by the assessments and attitudes of those who are judging us. When those assessments and attitudes are based on faulty perceptions – which is often the case in long term care and certainly the case here – our priorities become skewed and we add yet another obstacle to good care.

Fear won’t take caregivers into the places where genuine compassion and caring will go. As a motivator, it’s a weak and insufficient substitute for the truly powerful motivations that result in the best care possible. On the other side of those closed doors and privacy curtains where caregivers engage members and actual care takes place, you really want people who are inspired by the better angels of their nature.

The quality of care in any long term care facility is directly tied to the facility’s investment in the caregivers who provide it. Paying direct care workers good wages with decent benefits not only helps attract and retain workers, but it also gives them the means to adequately provide for themselves and their families. Many caregivers have no choice but to work a lot of overtime or find second jobs just to make ends meet. The work itself is physically and emotionally demanding, and when you add the stress of double shifts and long hours, the result is a caregiver workforce perpetually on the edge burnout. You can’t get the best possible care on a consistent basis from workers who are physically exhausted and emotionally drained.

It should be no mystery why J2S had such difficulty staffing the place and why even now one of the current contract agencies continues to have problems. The shortage of caregivers has become a nation-wide crisis and annual turnover rates for direct care workers typically run between fifty and sixty percent. Prior to the State’s privatization of the direct care workers, the Grand Rapids Home for Veterans was immune to this crisis.

The cost of losing that stable direct care workforce cannot be overestimated. Caregivers who are unfamiliar with the members in their care groups cannot possibly provide the same level of care as those who have had long standing relationships. But we continue to routinely throw these workers into chaotic situations and expect them to perform a high level. Usually they feel fortunate just to get through the shift with no major disasters. Or investigations.

While a sense of duty and a good work ethic are necessary in providing adequate care, there is no substitute for the personal relationship that develops between the caregiver and resident. This bond is the single most powerful motivator in providing excellent care. In environments where these relationships are encouraged to develop and flourish, workers become more caregivers, they become advocates.

If the caregiver has a moral obligation to do the best for his or her residents despite difficult circumstances, then those above us in the hierarchy and those on the outside who seek to influence the activity of caregivers have an equally compelling moral obligation to understand the consequences of that influence. This requires a basic awareness of the real challenges faced by caregivers and insight into what really motivates them. From what I’ve seen, both the Attorney General and the local watchdog reporters have failed to demonstrate that awareness and insight.

  

A Step Backward for Long Term Care

 

 

Yang

Last week, PHI posted the third installment of their 60 Caregiver Issues Campaign. This issue brief highlighted how the Affordable Care Act brought coverage to many caregivers who previously had no healthcare insurance and discussed how proposed changes now before congress could impact the nation’s direct care workforce.  The link to PHI’s report is at the bottom of this post.

It boils down to this: among its many provisions, the ACA included an expansion of Medicaid that benefited the working poor and thus provided healthcare coverage to caregivers who did not previously qualify because they “earned too much.” 

Here are the numbers directly from the PHI brief:

  1. From 2010 to 2014, approximately 500,000 direct care workers nationwide gained health insurance following implementation of the Affordable Care Act.
  2. The uninsured rate decreased 26 percent during the same time frame, from 28 percent to 21 percent.
  3. These coverage gains are primarily attributable to a 30 percent increase in the number of workers insured through Medicaid programs.

The repeal of the ACA threatens this coverage and many caregivers may again find themselves without the means for adequate health care. In a field where workers are at high risk for injuries resulting in musculoskeletal disorders and face the risk of serious infection every day, this lack of healthcare coverage is devastating. It not only leads to higher turnover rates that negatively impact the care of our elderly and disabled, it also reinforces the tendency to view caregivers as short-term workers, an expendable resource that can be used up, disposed of, and replaced.

We cannot properly care for the most vulnerable of our citizenry if we overlook the health and well-being of those who care for them. The two cannot be separated. In a time when the demand for caregivers has reached a crisis, reducing direct workers’ access to adequate health care is an unwise – and unhealthy – step backward.

The PHI report can be found here.

 

 

 

60 Caregiver Issues: Whose Issues Will We Hear?

 

 

Minstrel

In his recent post Yang brought our attention to PHI’s campaign to educate the public about caregiver issues, and gave us a link to their introductory video.  In that video PHI posed these questions:   

1. How can we ensure caregivers get the training they need?

2. How can we keep care affordable to families? 

3. What data is needed to help policyholders take action? 

While these are important questions, if you ask caregivers themselves why some are leaving the field and others wouldn’t think of entering it, they’ll no doubt raise a different set of issues.  At nearly every conference or webinar I attend I ask about staff-to-resident ratios and caregiver wages.  Usually there is no reply, as if I were speaking from some parallel universe and couldn’t be heard.  If there is a reply it’s on the lines of “Yes, we know.  But it’s complicated.  These things take time. You can’t expect things to change overnight.” 

Yes, there is a shortage of caregivers.  And yes, good care isn’t affordable.  In fact good care can’t be bought.  By that I mean whatever you might be paying, either for in-home care ($20/ hour? $40?) or for care in a long-term care home of some sort ($6,000-10,000/ month), the more care the person needs as health declines, the wider the gap between the person’s needs and the quality of care the person actually receives.   

Everyone is selling solutions like workshops and videos and toolkits and new business models to long-term care administrators or home healthcare systems’ owners.  Some groups are advocating on a state or even national level and some gains have been won.  But from the outcomes I’d say that a lot of the effort is wheel-spinning.  (An increase in the NYC minimum wage for home care workers to $15/hour by 2021??)   Today’s aides have rare luck if they earn $15 an hour and have a regular 40-hour work week.  An aide may have six to ten residents/patients to care for, and many of those will suffer from dementia and/or be unable to walk alone safely or even support themselves standing.  (Yes, I know I’m a broken record…)  Do you know what it’s like to try to wash, toilet, transfer these residents several times a shift, and keep them from falling the rest of the time?  (If not, go back and read CNA Edge.)  This is before we even begin to provide enrichment a la ‘person-centered care.’   

I want the whole healthcare industry – including those championing reform — to acknowledge what the biggest issues are for caregivers: our obscenely low wages and our outrageously onerous, even unsafe, working conditions.  These organizations don’t yet tackle caregivers’ most urgent needs: a living wage, safe work conditions, and a work environment that supports person entered care.  We need to ask them, What are you doing about these issues and what can we CNAs do to support you in this?  

When Malcolm X called for a change in Americans’ attitudes on race and was told that such changes (culture change, if you will) take generations, he reminded us of this: At the beginning of World War II Germany became our enemy and Russia became our ally.  But when the war ended we, America, saw Germany as our ally and Russia as our enemy.  That attitude-change didn’t take even one generation.  The healthcare industry needs an attitude adjustment.  It is not okay for long-term care operators or owners of home healthcare agencies to charge exorbitant fees to clients and return a too-small fraction of these fees as wages to their direct-care workers, while management and professional staff and consultants are handsomely compensated.  It is not okay to hire employees unless you train them in the skills they need to work with the elderly frail, starting with English language skills.  It’s not okay for the industry to tolerate poor work ethics: last-minute callouts; texting while on duty; and most of all, failure to interact with residents in a way that says to them “I love being with you.  Thank you for letting me be part of your life.” 

There are thousands of followers of CNA Edge.  As Yang exhorted us, we need to support PHI in their effort to educate the public about caregiver issues.  Let’s ensure that when they frames their 60 Issues, they don’t airbrush our issues out of the picture they’re drawing.

60 Caregiver Issues: PHI and the Caregiver Shortage

 

Yang

Last week, the Paraprofessional Healthcare Institute (PHI), the leading expert on the nation’s direct care force, launched a two-year online public education effort called “60 Caregiver Issues.” Over the next two years, the campaign will identify 60 policy and practice ideas that can begin to address a problem that we, as CNAs, are all too familiar with: the growing shortage in direct care workers.

The first installment, “8 Signs the Shortage in Paid Caregivers is Getting Worse” can be found here.

The purpose of the campaign is to focus public attention on the problem and offer some real solutions. CNAs have a vital role to play in this effort. No one has greater awareness than we do of how chronic understaffing and turnover rates actually impact the care and well-being of individual residents on a day to day basis. We know what it looks like and we know what it feels like to our residents in a very real way. By sharing our real-life work experiences we can offer a perspective that gives these problems texture and a real sense of the human cost.

As advocates for our residents – and for ourselves – CNAs can become part of the solution by joining and supporting PHI in this effort. In the coming months, CNA Edge will share posts from the PHI campaign and, of course, we will offer our own take on the issues surrounding the nation’s caregiver shortage.

To kick off the campaign, PHI offers this 60 second video which highlights the problem:  Caregiving Crisis: 5 Million Workers Needed