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Investigate Nursing Home Neglect

April 11, 2016 Comments off

nursing_homesI’ve written this blog intermittently for some years now about communications, public relations, social media and communication trends.

But of late, I’ve felt the real need to use this space to communicate about some obvious needs about poor senior care, which needs further investigation. Therefore, this post is a personal communique about elder care issues.

I fear I may be shunned for speaking out, in shedding light for those who need a voice. Recently, I was contacted by an anonymous source about elder neglect taking place in a nursing home. The information worries me enough personally, that I feel compelled to share some shocking behind the scene “stuff” taking place.

I implore any reader of this blog to share it, do something and demand national, state and localized investigations without warning. Perform investigations after 5 p.m. If it is happening in one town within one state, it is likely occurring in many states and towns all across the country.

We must ask ourselves to dig deeper, to see what is really happening behind closed doors, after the health inspectors leave or just before they arrive to make everything seem “OK” and smooth sailing.

Clearly things are not well, based on an eyewitness account shared with me personally. It’s sad that people have to fear for their jobs by communicating about internal abuses. But, that is another story in and of itself.  We must look beyond Elderly woman sits in her room at a nursing homethe superficial “front end” of elder care health inspections.

I am just one person sharing information provided with no other agenda but for better care for our beloved seniors, especially our low-income seniors.

I’ve done my best to perform some limited research with numbers. But I preface, that I am by no means an expert in this industry. Therefore, take the bigger numbers with an ounce of patience and understanding. Please see the bigger picture here, the need for better accountable care.

There should be enough information here to cause readers, leaders, and families to give great pause, and to think twice about what is really is happening behind the closed doors of nursing homes.

How do we do more as advocates for our mothers, fathers and sisters, great aunts, grandparents and great grandparents? Here is just

Here is just one video had their 96-year-old mother in a nursing home.

Be proactive. Please investigate deeper. My dear readers, please, please, please be more informed about your parents or grandparents and their long-term care needs before sending them off into nursing homes. And, know that they may not be as well cared, as you might think.

Think ahead, when choosing a senior nursing home. Install a camera, secretly. And, for those who don’t have any family to help seniors make the best choices for themselves, the due diligence is all of our responsibility because many are all alone.

This article will first touch upon some national numbers, and drill down to one state for some observations and real serious senior care risks and concerns.

Nationally, there are currently more than 25 million Americans aged 60 plus who are economically insecure, and living at or 250% below the federal poverty level ($29,425 per year) for a single person.

The numbers will undoubtedly skyrocket in the next ten to fifteen years as the aging boomer demographic explodes. More than 47% of all our single elderly population depend entirely on their social security benefits.

In other words, 90% of their entire net income comes from Social Security. These older adults struggle with rising housing costs, nursing facility costs, lack of transportation and rising health care bills, not to mention medications and the need to eat. One major adverse life event can change their entire world in an eye blink.

The myriad scope of concerns and risks are national in scope. The changes needed must happen at the state and local level. The question begs, whose eyes are really watching out for the essential “care” being given to our very deserving elders when backs are turned the other direction? The following are some broader risk-related concerns. But, at the end of the day, the absolute best in class care is the responsibility of all nursing home and assisted living staff as a priority for each and every one of our elders.

We all must look very closely, and more deeply not at the numbers, or budgets but at our patients, as individuals.

We must be their voice when they no longer have a voice when curled up in a bed and left alone. They have paid their dues, lived long and productive lives, and we utterly owe it to them to look hard at the “care” they are or are not receiving and provide the oversight needed for the things risking their potential quality of life, at this late stage in their lives

Lack of Enough Skilled Workers.
Low Paying Senior Nursing Care Wages.

There are not enough qualified people to care for all our seniors in nursing homes. The pay is low. Low pay equals less adequate care or less than optimal care. Workers are leaving low-paying jobs to work at fast food restaurants and retail chains, for higher pay. See my news article further below about this issue in just one state.

Gender Risks.
Most people who are older than 65 have worked long and hard most of their adult lives. They paid into the system all of their lives, with their taxes. But, women of this age group were mothers who did not work outside of the home, but rather raised their families, while their husbands were the breadwinners. Since women statistically live longer than men on average, it is only likely that the largest number of patients in nursing homes will be and are elderly women. There have been large demographic discrepancies in the retirement community reporting.

As reported from 2006, retirement communities were comprised of 69% women and 31% men. The raw data supports the notion that women are most at risk of receiving the optimal elder care they need.

Full-time elder nursing home costs average more than $4,000 a month, and much more for more those suffering from dementia and/or Alzheimer’s. Most elderly people living on very limited social security benefits will not be able to afford the cost of a nursing home.

Most private insurance health insurance policies do not cover long-term care, and very few people have likely not purchased private long-term care.

Older women typically receive about $4,000 or less a year in social security than men due to lower lifetime earnings, time off to care for children, parents, and spouses, occupational segregation, and a lower wage work history. The same applies to those who’ve lost most of their retirement assets due to the recession, veteran widows and or farming widows.

There’s only about 15,700 nursing home facilities across the entire United States to serve one million seniors. That number is expected to double in 10-15 years. Remember there are currently 25 million living at poverty level or below. Every single state will have increasingly larger numbers of older residents who will need care.

For example, let’s take a look at Texas.

  1. For most low-income Texans (or anyone else for that matter) needing long-term care, Medicaid is the only source of funding. Medicaid is funded by both federal and state funds.
  2. To qualify for Medicaid, a single person’s monthly income must be less than $2,199 a month. And for couples, it can not exceed $4,398. In other words, you must be really poor, with very few resources.
  3. Nursing homes are supposed to be credentialed residential facilities that offer  24-hour skilled nursing care. This is often services provided through a managed care system.

The state of Texas for example, can pay a nursing home facility funds for three months before any Medicaid approval kicks in. The nursing home then refunds any personal payments according to specific time limits.

Therefore, nursing homes depend heavily on getting paid for each patient, either by the state and or by the federal government or both. But, they get paid. It would seem that there would be no shortage of funds coming from both government sources, and funds to pay staff.

A key issue is that there not enough facilities, nor enough licensed professional staff to provide around the clock care, the way they should.

More specifically, in more rural areas like Texas, there are extreme staffing shortages for licensed professional nurses and licensed support nursing staff. Essentially there is not enough help.

Not Enough Facilities.

  • Texas is currently home to about 5.2 million baby boomers
  • By 2030 it is estimated more than 20% of Texas’s will be over 65
  • There are now three million Texans older than 65, and the number rise to 10 million by 2050
  • According to Kaiser Foundation, there are only about 1,211 Texas senior nursing care facilities in Texas
  • Texas has a substantial rural, low-income and minority populations
  • The average older single adult in Texas receives only $433 from social security
  • Texas is traditionally a “conservative low-service state with a general philosophy that residents take care of their own.” Do they?

Why the above-stated numbers? Well, the summary substantively implies:

  1. There are NOT enough nursing home facilities to care for the growing number of seniors with complex medical needs
  2. There are NOT enough qualified licensed staff to provide the level of care needed at facilities, especially in more rural facilities
  3. Assisted living is highly under-regulated and a term with many differing definitions and jargon
  4. The industry as a whole is full of problems due to inadequate standards, under-staffing and inappropriate or inadequate “care” provided for our elders.

The following information comes from an anonymous care provider who experienced first hand some serious concerns about the inadequate, unsafe and poorly managed care being provided to seniors at one facility. There is neglect. It needs further investigation.

Supposedly the facility is seriously understaffed. The certified care provider indicated there are many other facilities locally with similar situations.

Background.

For the purpose of this article, we shall call her “Betty.” Betty was left unattended for hours and hours in a wheelchair, just slouched over.Nobody notices nor has enough time for her. She is forgotten about. Betty fell out of her wheelchair and was unable to get up nor was she heard when asking for help. Most of the Betty’s are left alone for very long periods of time. No one saw her on the cold floor in her room.

Betty hasn’t had a shower nor been bathed for more than a week. Sometimes Betty will go 10 days without a bath or simply having her hair brushed. There are not enough certified staff to bathe everyone regularly. 

When Betty is bathed it is performed by a male who is not a registered licensed care provider.

Betty doesn’t want “Billy Bob” to be bathing and touching all of her private parts. She is easily startled, afraid, very frail and soft-spoken. She has “no voice”. Betty doesn’t want her hair only combed on “salon days, every two weeks or more”

Betty lays awake at night for hours and hours all alone and has no one to talk to, at all. Betty is very lonely and she can’t speak Spanish, nor does she understand Spanish.

There are many Betty’s in nursing homes who are not getting the level of care, healthy human interaction and help that they need.

Who is “Betty’s” voice?

There Are Multiple Risks Due to Inadequate Care.
Let’s Look at The Risks at Just One Texas Facility.

Sixty residents are currently living at the Hill Country Care Facility at 1505 W. Highway 290 in Dripping Springs, Texas.

The layout of the internal facility provides four hallways radiating out from a central nursing station. Below are the basic operations staffing facts:

  • Administrative staff work five days a week, 8 a.m. – 5 p.m., they perform administration tasks in a separate office, off the main floor.
  • Each group of staff wears specific colored coded “uniforms”, for identification and visible professional skill classification and for easier identification by the patients. “This is a uniform and the uniform code should be followed and enforced.” Each staff member also must wear a name tag.
  • There are Registered Nurses (RNs), who wear dark blue tops
  • Licensed Vocational Nurses (LVNs) wear dark blue tops
  • Certified Nursing Assistants (CNAs), wear maroon tops
  • Nursing Assistants [(NAs] finished academics, but are NOT state licensed, nor certified).
  • Hospitality Aides (enrolled in CNA courses, not certified, not licensed and can not put hands on any patients)
  • House Keeping, (cleaning crews, they can not legally put hands on ANY patient. They wear Blue Tops /Blue Scrubs. Housekeeping staff wear the same color scrubs as the RNs. Low vision seniors can’t tell the difference on who is a professional care provider or not. Housekeeping crew are handling patients.

 

  • The facility’s Nursing staff work rotating shifts which run from;
    • 6 a.m.- 2p.m.,
    • 2 p.m.- 10 p.m.,
    • 10 p.m.– 6 a.m.

Situation Risks Observed.

  1. During normal business hours, an administrative staffer who is not in a meeting will usually investigate a patient call light for help. Often times a patient can’t reach something or dropped the remote control for their TV. But, if a patient needs “hands on” assistance the Administrative staff member will seek out a certified CNA to meet the patient’s need.
  2. From 9 a.m. to 5 p.m. there is usually only one RN and one LVN per shift, for 60 residents
  3. Frequently there are only two CNA’s covering four hallways of 60 residents from 2 p.m. To 10 p.m.
  4. Some patients require two-person transfers
  • If two only two CNA’s are on duty and working with one patient, the remaining 59 residents do not get the care they need and are not being safely monitored
  • Why are there not more CNA’s or Nurses to help for just safety reasons
  1. There is a substantive licensed nursing care staff shortage. Being short-staffed and lacking certified “hands on” nursing care means:
  • Inadequate or no showers for long periods of time
  • Inadequate or very little oral care
  • Inadequate or to no hair care
  • No skin care
  • At risk for increased pressure bed sores from not being rotated or moved every two hours
  • At risk increased urinary tract infections (December 2015 was really bad supposedly)
  • At risk for increased wounds from not being monitored and cared for  adequately
  • risk of urinary burns or feces due prolonged periods of unchanged briefs
  • Risk of humiliation, embarrassment and lack of dignity due to over saturated briefs
  • There are employees handling patients who are not in uniform. Uniforms are confusing. Housekeeping staff are wearing the same color as RNs. The outward appearance shows that literally anyone in street clothes in blue scrubs can enter the facility and handle a patient, without proper ID or in a “blue” uniform to show they are professional nursing staff.
  • Risk of inadequate or no conversation at all with patients. No ability to express care and compassion due to substantive low-paid non-English speaking night workers. The 10 p.m to 6 a.m shift is largely a Hispanic workforce who speak very little English. They often only speak only Spanish while working in proximity of an English-speaking patient in their room at the facility.

How do patients communicate their needs if there is a language barrier?
English speaking patients can not adequately convey what their needs are and do not understand the Hispanic speaking staff.

  • “The Hispanic staff carry on about their business speaking between themselves in front of awake silent patients, with no consideration for if they’d like a conversation”
  • I am told, the night staff “just assume residents are sleeping, so who needs conversational English spoken to the patients to help them pass the long, long nights while they are still awake”

elderabusenursinghome.jpg On a national level, is this representative of most facilities providing care to the exploding senior population where there are undoubtedly many, many low-income seniors? Especially, all the low-income women seniors. They deserve better.

Who is really looking out for the true well-being of all of our ladies, veterans, and men from the Greatest Generation? They, who should be our honored seniors.

Where is the oversight after the infrequent inspectors leave, or when it’s after 5 p.m., or when the lights go out when nobody really sees what is really going on?

Someone, please help our elders who are no longer seen nor have voices to change what is happening all around them. Will you help me take up the gauntlet and not only share this story but share it with those who can help make changes.

Our Greatest Generation should not have to be the Silent Generation.

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