A SPECIAL MESSAGE
We receive a lot of calls and emails from people disturbed about the care they see in nursing homes. But no message has touched us more than this one from a Certified Nursing Assistant. It says more than anything we can say about how poorly our loved ones are being treated in many nursing facilities.
We have shared this message with our newsletter readers, but what we didn’t have space in it to share some of the comments we have received. The comments are interesting and the writers don’t all agree with us completely. We urge you to read all of them after you read the CNA’s message. It will take a little time, but it is an interesting exercise to see the reaction this simple and sincere message received.
The comments from our readers are at the end of the CNA’s message. We have kept the writers of them anonymous, too.
“...they’re my babies.”
(Anonymous)
I'm a new CNA. I don't feel I received adequate training in school or upon hiring. I'm shattered and overwhelmed. I've just landed my first-ever CNA gig. I found out during clinical that I love the residents and nature of the work. My teacher predicted I would fall in love. And I did. I love my babies (I'm not being disrespectful. I understand they are ADULTS and probably ran circles around me when they were my age. Unlike them, I don't know how to make apple pie from scratch, stay married to the same person for 50 years, raise 8 cloth-diapered children, harvest 10 acres each of corn and wheat, or milk 6 cows and collect the eggs from 2 dozen hens before sunrise and then butcher, pluck, and fry one of these aforementioned hens for Sunday dinner. But I'm fond of them, I care about them, I respect them, and they're my babies).
My facility pays exceptionally well (to make up for being chronically understaffed, perhaps?). I'm inexperienced and slow and flying by the seat of my pants. I'm honestly doing the best I can and still I don't feel I'm doing right by any of them and I don't know what to do about it. My assignment for the past 2 shifts has been 29 residents, the majority of whom I haven't had time to become familiar with. This boils down to roughly 15 minutes of individual care per resident spread out over 8 hours. Two minutes per resident is shaved off due to reasons that could have been avoided by a little forethought on the part of those in authority. Stupid reasons, such as having to chase down gloves, wipes, clean linens and briefs, or read 20 charts because I'm in charge of the health and safety of people I know nothing about and any uninformed decision or action on my part has the potential to kill someone.
A few of them are pretty self-sufficient, and the rest of them require and DESERVE waaaaay more than the remaining 13 minutes of hands-on care. These are people's mothers and fathers. They could be my parents. The quality of care I have time to give each resident is inadequate, and certainly far below that which I would expect if they were my own parents. I feel like they're being neglected. Neglected by me, despite that I don't have an idle moment and usually end up working off the clock. It's breaking my mind a little. When I finally fall asleep after I get home, I have nightmares. I don't believe that even the most experienced and proficient of aides can provide *adequate* care to that many residents singlehandedly. I'm probably going to get fired for not charting. Because I can't bring myself to ignore a call light and humiliate one of my babies into soiling herself so that I can go make a note that someone else eliminated and how much and whether or not it was in a brief or in the toilet, while someone is begging *right now* to be taken to the toilet to eliminate like the adult that she is.
So there's this nurse who is counted among THE PEOPLE WHO ARE OFFICIALLY CARING FOR YOUR MOM OR DAD. Because she's there at the same time as I am, the facility gets to count her as someone who is providing hands-on care and include her in the minimum staff-to-resident ratio. Except all she does is administer meds. She's "above" doing what she can to make sure your mother isn't having her skin digested by the enzymes in her diarrhea. She can see that I'm already up to my elbows in 7 different cases of diarrhea, yet she'll sit and chitchat with the other nurse about what's on sale at K-mart and still see fit to remind me about all these other call lights that are on, rather than step up herself and free someone from the caustic soup that's eating the skin off his nether regions.
I just wanted to propose the possibility that for every aide you encounter who seems jaded and apathetic, there's another one who wishes she had a button to stop time and make sure absolutely everyone's every need is met, so that she could go home and rest easy feeling that her best was good enough by her own standards. I don't know who to hate more, myself for not knowing how not to fail my babies, or the powers that be at the facility for failing all of us. There's a very high turnover rate for CNAs. I had to become one to understand why.
Please know that it breaks my heart to see you or your mom or your dad suffer and I will do everything in my power to prevent that, but that my power is very, very limited. Please understand that I have to feed my kids and this is the only way I know how to do it. Please keep in mind that the people with the least authority and power are most likely the ones who are the most emotionally invested in your mom's or dad's happiness and wellbeing.
Anyway, I just wanted you to know how much a lot of us care and how much some of us are up against.
—J.
Here are Some of the Comments We Received from People Who Read this Message:
From a Nursing Home Reform supporter….
“I am sure this has come straight from this person's heart. I have witnessed these same things. I certainly hope that more people understand this, then maybe there eventually will be changes made.”
From A Retired RN….
“I am a retired RN who agrees completely with the young CNA who wrote the letter. I have seen this happen many, many, many times. The CNAs are the ones who do the work in nursing homes. The RNs, who do nothing but pass meds and chart, should not be counted in the hands-on staff number.”
From a Hoosier Friend….
“Bernie, thanks for passing that on to your many, but especially to me. She may not have planned to be a writer, but she greatly is a writer. Her purpose may not last long inside that nursing home. Her message will, with your help. I live in Indianapolis among old folk who frequently utter, "I am not going to a nursing home." You know the many reasons why that is an old adage. We cannot continue to use that phrase in a nation of more and more older demographics. And we cannot abide such behavior within the homes.
From a Dentist….
“WOW!!! Bernie, this is powerful stuff.”
From a Nursing Home Reform Advocate in Arkansas….
“This article is priceless! Thank you for sending it.”
From a Nursing Home Nurse….
“I agree with the young lady. I am a nurse in a nursing home. I have been there for 12 years ,and I have indeed found that the personal care each resident gets isn't enough. The government guidelines take away from so much of the time we have with each resident. I have 25-30 residents each shift and I work 12-hour shifts. I cannot perform all the nursing care I need to give each resident and cover all the paper work to prove I have done it. I also fear the threat of losing my job for not keeping the paper work done, If I use the paperwork time to care for the resident it still leaves them short. They need more personal care and attention than putting a pill in their mouth and head to the next resident. I work two days and then off three days and there is so much communication that does get passed on to all shifts, and again this is a time waster. We miss so many lessons that we can learn from these people, a lifestyle that we all came from.”
From a Special Friend….
“I have witnessed the very same thing at my parents' assisted living facility. I wish J's letter could be in the Herald-Leader and The Courier Journal -- whatever it takes to get our legislators to step-up and do what's right. The staffing ratio must be improved.”
From an Investment Firm Executive….
“Very powerful!”
From an LPN….
“I appreciate you sending out this very heartfelt letter from a CNA who is obviously outstanding; however, I must take exception to some of her comments about nurses.
I have been an LPN for over 13 years, and I currently work in a LTC facility. Although I work in one of the best facilities I've ever seen, and alongside some of the best caregivers one could hope for, we are all still overworked and overwhelmed by our assignments. While CNAs try desperately to keep up with the cleaning and feeding of residents (that's really all anyone has time for), the nurses frantically try to pass medications, check vital signs, perform treatments and assessments and then document all of the above. Documentation seems like a waste of time to everyone, but it is vital, not only for continuity of care but so that Medicare and Medicaid will continue to pay for the residents to live in the facility. I do not have time to chitchat with other nurses, any more than I have time to change soiled briefs. I do not see my coworkers wasting time, either; instead, I see them working non-stop, foregoing breaks to keep up with the workload and even working "off the clock" to complete their assignments.
There will always be "bad apples," but they are the exception. Consider the analogy of air travel. Statistically, the percentage of airplanes that crash is very low, yet when a plane does crash, the publicity is so great that it overshadows the inherent safety of this means of travel. Similarly, there are hundreds of dedicated, compassionate nurses for every one uncaring or incompetent nurse. This is incredibly difficult work, and a paycheck is small reward for the commitment required. Nurses take their jobs very seriously.
I would not try to convince anyone that all nurses (or all CNAs) are perfect. I would, however, submit that the vast majority of us are working harder than one might imagine to provide the safety, care and comfort that our residents deserve and require. It is imperative that your readers and all family members of LTC residents keep confidence in the nurses that work so hard to provide the best possible care. When a bad apple turns up, they should be removed promptly, but one bad one does NOT spoil the bunch!
Thank you for all the hard work KFNHR puts in to advocate and oversee the LTC industry of Kentucky.”
From a Daughter Who Cared….
“To say thank you for sending the letter "they're my babies". No one really knows how true this is until they have experienced it. My mother was in a nursing home for 12 years only because I was the only caretaker with a family to take care of and she needed care I couldn't give her. But I spent a very lot of time with her and know first hand how they operate. And this lady told it just like it is. How I pray something is done soon. I really worked hard while she was there with families to educate on this. But most of them said if they complain their loved one would be retaliated against. How sad. And yes, somewhere only we can make a difference. Thank you for getting the word out.”
From a Social Service Aide….
“Oh my goodness, that is sooo true. I am a CNA of 13 years, also a recent BSW grad. I am currently a social service aide at a nursing facility. There are times I really want to help more. The fact is social service aides/social workers can have a case load as high as 120 residents. There are many frequent interruptions. Budgets are big concerns for the for-profit facilities and during the meetings they say the budget isn't pretty. They never really break it down and explain but I am sure it affects their bonuses for census. I do not understand why social workers are employed by the facility. Social workers should be employed by the state. When allegations of abuse, neglect, fraud are brought up it puts even more work on the understaffed staff. I love what I do but there is no one on our side. Or at least it feels like it.
Part of the problem with legislation is they are vested in health care. It all boils down to the money and how they can make more of it. Yes, they are the forgotten Americans. Yes, nursing homes will take everything the elderly own and worked so hard for and will die as a pauper in most cases.”
From a Former Nursing Home LPN….
“Amen, Amen, Amen. I know exactly how she feels. I was a new LPN grad when I got my first job in a nursing home. I was the "Day Supervisor." I watched the nursing assistants work hard to give the residents dignity. The D.O.A. and her assistant sat on their rears all day and did nothing! One day I got fed up and wrote a letter telling how I felt, She was livid ...how dare this new LPN tell her she had no idea what the nursing assistant load was ,how she didn't have a clue to how hard they worked because they loved their jobs. She was dumbfounded and wanted to fire me....I quit before she could. Throughout my career I prided myself on taking care of the residents like they were a member of my family. To the person who wrote this, your heart is good and believe me when I say your residents know by your tone of your voice, your touch ,your smile that you care. God Bless you.”
From a Nursing Home Family Member…..
“I am making copies of this letter and taking it to the director of nursing where my sister is a resident. How I wish we had more CNAs who felt like this. They are worth their weight in gold!! I also see exactly what this person sees. Thank you also Bernie for all the work you put into this cause.”
From an Associate Professor …
“I teach a course to upper division undergraduates and graduate students at EKU -- Nutrition in Aging -- during Fall Semester. We talk about all aspects of aging including nutrition because nutrition is impacted by so many contextual issues. We have discussed many times the understaffing situation in nursing homes. Even though the course is over now, I am going to forward this email to the students whom I still have in classes. Thank you for sharing this.
On a personal note my mother was in a nursing home facility here in Central Kentucky for a few years until she passed away in 1996. The facility was Taylor Manor in Versailles, and I have to say that in that nursing home staff does take time and they are very concerned about the residents. It is a wonderful place. Thanks to all of the facilities like Taylor Manor.”
From a Nursing Home Social Worker….
“I don't know what state this CNA works in, but 29 residents is unconscionable. It should be half that. If you can let her know how to check with state licensing about the ratio expected. I bet it's a for-profit facility. I also don't know whether CNAs are expected or even allowed to read charts; they get assignment sheets. I would want to tell her she does not have anything to feel guilty about because her heart is in the right place and the patients and families can tell that. And they will end up being most grateful for her hard work and intent to do her best, no matter the time constraints. If she's in Kentucky or Indiana, she shouldn't have to be doing more than jotting down the information she describes rather than "documentation." Maybe she could ask for some time with the Director of Nursing (since CNAs are at the mercy of nurse managers) about where her duties start and end. Those nurses may be expected to pick up the slack. They do in facilities I've worked in. She can also check with other CNAs where she works and find out which units are the best and put in for a transfer. CMS rates all US nursing homes and it's on the Internet; she can find out the best in her town and apply there.It doesn't have to be as bad as she's describing.”
From a Nursing Home Administrator….
“In response to this nursing assistant's experience, I could see why her story would be disheartening. However, every nursing home should not be seen in this light. Sounds like she had a very bad experience from the start. Just a word of encouragement; you're not alone in having a heart when caring for our elderly residents. I have been in the long-term care profession since I was 16 years old and began as a nursing assistant. Since that time, I managed to become a nurse and eventually a facility administrator. I also teach nursing students at the college level and it is my primary goal to change the negative perceptions of today's nursing homes. Unfortunately, we are a service industry. We do not have a product for sale. Our service is, and should be, the best quality of care that we can provide our residents. Unfortunately in the service industry, just as any other industry, you have good performers and bad. This poor soul hit the nail on the head when she spoke about the importance of training. A good thorough training and orientation, followed by continuous monitoring and education is what creates the very best staff and quality outcomes for residents. Having been a front-line caregiver, teacher, and upper management, I have seen the entire spectrum of health care dilemmas. I use this knowledge in my day-to-day work striving to provide excellent care for our residents. You see, my father resided in a nursing home for four years prior to his death in the 1970s. This has been my motivating force and career objectives to concentrate on improving resident outcomes. I am very disappointed to hear that this nursing assistant feels that no one cares about the residents like the front-line caregivers do, but I admire her caring heart which is very apparent. I would love to have more staff like her. However, the challenge that we face is first, obtaining staff who really care. As a teacher I understand that it is possible to train anyone to perform the required duties of a nursing assistant. The problem is that it is virtually impossible to teach someone to care. A program that we require at our facility is that each nursing assistant student spend a day living life as a resident. They get to experience what it is like to have poor vision, hearing loss, the loss of dignity when having to be fed by someone else, and various other learning experiences throughout the day. This is what we call CNA Boot Camp and it is the best method we have found to help new CNAs see life from the viewpoint of a resident. Our hope is that this exercise will help instill a caring attitude. If you look at the majority of the nursing assistants in practice, you will find that they have not yet experienced the aging process. Until they can better understand this process and what it is like for the residents of a nursing facility, the "caring" component will sometimes be missing. I am guessing from the grammar (in her email) that this nursing assistant fits in this category of the younger population to whom I am referring based on her slang of calling her job a "gig". Those of us who have been striving for excellence over the decades understand that this is a profession and much more than a "gig". Although I sympathize with her for a poor learning experience, she probably had opportunities to remain employed and work with administration to address any concerns. Rather quitting is a much easier solution for some. However, those of us who remain dedicated receive great satisfaction from the work we do. Again, caring for our elderly population is a team approach and you will obviously have some providers who are not up to par and maybe even a few who do not really care. However, from working with long-term care professionals across the state I can tell you that the vast majority of us put our hearts into our jobs each and every day and will continue to do so.”
If you have any questions, please contact:
KENTUCKIANS FOR NURSING HOME REFORM
E-mail: KyNursingHomeReform@yahoo.com
Telephone: (859) 312-5617