A Different View of National Nursing Home Week

"As you get older it is harder to have heroes, but it is sort of necessary"- Ernest Hemingway

National Nursing Home Week will be celebrated the week of May 10th thru May 17th. This week is set aside across the nation to remember the industry and the people that takes care of our elderly and disabled.

While the degree of quality of care varies from facility to facility, there is one thing that never varies; the motive of the nursing home owner to have the facility in operation. As is true in most businesses nursing homes are operated and owned by individuals or corporations motivated to make profit. While some may feel there nothing wrong with this motivation, the problem lies when making a profit takes priority over the quality of care received by the nursing home resident.

Nursing homes are regulated by federal and state mandates intended to assure a minimum standard of care for the infirmed. Unfortunatley these regulations while numerous but needed DO NOT guarantee that quality care is either delivered or received!

In Texas, nursing home regulations require that licensed nurses be on duty and that trained, certified nursing assistants provide the unskilled care required by those no longer able to care for themselves. On the surface this appears to be a good thing, but that's where it ends. The state of Texas has NO real resident to staff ratios that are truly effective. In the past six and a half years I have worked in several nursing facilities and I have seen the ratio of certified nursing assistants (CNAs) to residents as high as 15-16 to one! While on the subject of staff to resident ratios, most of the facilities where I have worked the ratio of social worker to residents has been anywhere from 100 to 125 to one! Yet nursing home bosses insist that social workers perform other unrelated duties such as admissions, marketing, answering the phone and at one facility the bosses have social workers picking up meal trays because they do not want to hire sufficietn number of CNAs to perform this duty!

Nursing home management likes to count the licensed nurses in their interpretation of "safe" ratios, but in reality this is not accurate as nurses are usually bogged down in paperwork that is required in order for the facility to adhere to state regulations and receive maximum revenue!

At mealtimes residents that are bed bound or who prefer to take their meals in their rooms must often sit in their own urine and waste as the limited number of CNAs are busy passing out trays or feeding residents unable to feed themselves. This waiting time can range from 45 minutes to an hour and a half before CNAs are finally able to attend to those residents needing cleaning and changing.

While the Texas Dept. of Aging and Disability Services (DADS) and nursing home bosses harp a lot about protecting nursing home resident dignity, this usually amounts to talk only considering the fact that the state will not develop and enforce true staff to resident ratios and nursing home management is not going to do anything thata adversely affects the bottom line!

Other factors thata contribute to less than quality care for nursing home residents would include: 1) Poor morale among nursing home workers. This poor morale is caused by low pay amongst other reasons. Wages for CNAs ranges from $8 to $13 per hour, but the amount of pay depends solely on the whims of the nursing home management that hires. CNAs seldom get a full 40 hour week. Another factor for low morale is a lack of good fringe benefits including upward mobility, pensions and quality, affordable healthcare. Favoritism, disrespect, by management as well as unbearable work loads all contribute to poor employee morale! 2) State and federal regulations that are excessively documentation oriented as opposed to actual practice oriented. With so much paperwork there is little time to do the actual work by the healthcare professional! 3) Texas is one of the lowest paying states for nursing home Medicaid reimbursement. Both nursing home management and nursing home resident advocates agree on this reality, 4) Nursing home workers in Texas are for the most part unorganized and defenseless to management abuse, 5) Management mindset views individuals confined to nursing homes as monetary figures rather than as human being in need of care. While most nursing home residents receive it is usually done in the least expensive manner which has both negative and positive results.

Given the aforementioned information, the reader is probably asking; What can be done to correct this injustice? The following are some, but not all conclusive solutions: ! The Texas legislature must become more realistic in it's funding of nursing Medicaid as current Medicaid reimbursements are grossly insufficient, 2) The Texas Dept. of Aging & Disabled Services must enact and enforce strict, safe resident to staff ratios! While consistent documentation of care is good, documentation in of itself does not guarantee actual delivery of care! This is especially true when staff are overworked, exhausted, underpaid, demoralized and not given their due respect! 3) The United States Congress must pass the Employee Free Choice Act giving nursisng home and other workers much needed and stronger protection of their right to organize unions on the job! Present labor laws are NOT sufficient or even enforced! Workers are subjected to harrassment, being spied on and unfairly fired for exercising thier right to organize! EFCA does not eliminate secret ballots as the bosses claim, it will eliminatae employer injustice towards seeking to organize! Along with passage of EFCA nuring home workers must overcome their present feelings of being powerless, fearful and discouraged. They must come to realize that only by uniting with each other, JUSTICE can indeed be achieved! Where worker justice is violated one can be assured patient care is not what it should be! 4) Family Councils must also be organized to assure adequate care is given to residents and they must also be supportive of nursing home worker's struggle for on the job justice!

We owe this much to our elderly confined to nursing homes. We must also show respect to those who perform the hardest and dirtiest work in caring for our elderly loved ones! It can be done! IT MUST BE DONE! SI SE PUEDE!
- Frank Valdez has worked the past six and a half years as a nursing home social worker. He has 44 years of civil rights, labor and peace movement experience. Contact info:: fv.agitator@gmail.com

Views expressed on this page are those of the authors and not necessarily those of Campaign for America's Future or Institute for America's Future