94% of Nursing Homes Suck
Posted by WhiteCoat on September 30, 2008
… if you believe an article in the New York Times citing a Department of Health and Human Services report.
That is the percentage of nursing homes that were cited for violations of federal health and safety regulations in 2007. In addition, one out of 6 nursing homes reportedly had deficiencies that caused “actual harm or immediate jeopardy” to patients, including infected bedsores, medication mix-ups, poor nutrition, and abuse/neglect of patients. They even gave statistics on government-run nursing homes – 91% of government-run facilities had violations.
I volunteered in a nursing home for a while. Even back then, it was a difficult environment for the staff. There was a high staff turnover rate and I don’t ever remember the place having a full staff. Where I volunteered there was a lot of theft from the residents – both by staff members and by other residents. I used to find it ironic that many times families would hardly ever visit their elderly relatives. Sometimes the family might show up to visit for a half hour on Sunday before the football game and yell up and down the halls and curse at the staff because grandma’s blouse had a food stain on it.
It was a blast for me, though. You could see the residents’ eyes light up when you got there. The stories these people told were captivating – war stories, tales of a merchant marine, how one lady’s family built an empire from selling fabrics and then lost it all in the Great Depression. I was the only person who used to take one wheelchair-bound lady for a walk around the block in her wheelchair. She always used to kiss my hand and thank me when we were done. Another lady used to slobber kisses all over me because I would bring her a pack of Bubble Yum bubble gum every time I showed up. One guy would walk around patting me on the back and telling everyone that he wished I was his son because I would sneak him in a half-pint of whiskey every once in a while. Then there was the lady whose claim to fame was that she could always beat the “smart guy who was going to be a doctor” at checkers.
Times have changed, though.
More and more red tape. More hoops. Less funding.
According to the article, 1.5 million people live in the nation’s 15,000 nursing homes and Medicare/Medicaid “pays” the costs for two thirds of them – to a tune of $75 billion/year.
It should be a “eureka moment” when the article says that “Researchers have found that people receive better care at homes with a higher ratio of nursing staff members to patients.”
Rational minds would think that the government would therefore encourage a system in which more nurses are available to care for patients.
We aren’t dealing with rational minds.
Instead, payments are cut, nursing homes cut corners to stay afloat, and then care suffers. The paucity of reimbursement makes it less attractive for physicians to care for nursing home patients. The whole system implodes.
Comments about the NY Times article generally vilify the nursing homes – many describing how their family members didn’t receive basic care. Many comments call for tougher legislation and more restrictions.
You want better care? Put more money into the system. What’s going to happen to all of our elderly when the unfunded “tougher legislation and more restrictions” force enough nursing homes out of existence that there aren’t enough beds for all of the baby boomers?
Then the American public is going to be faced with a position that it hasn’t seen in a while … take care of your own relatives. Keep them at home with you. Pay for your own babysitter and nurse. In fact, if you think the nursing homes are doing such a poor job, take grandma and grandpa home right now and do a better job. And hope they don’t have to come to the emergency department where we are mandated reporters of any type of elder abuse.
It’s easy to jump on the bandwagon and lash out at all these “substandard” nursing homes. I’m sure that some of them really are atrocious. Just think about a couple of things:
1. 91% of the time the government can’t even meet its own standards.
2. If you aren’t able to take care of one elderly relative, think twice about criticizing a nurse that is trying to take care of 6 or 7 elderly patients at the same time.
All goes back to that triangle – fast care, quality care, free care … pick any two.
Scalpel’s point rings true more than ever right now – sometimes you’re lucky if you get to pick one.
marcia (2) said
The six weeks I spent working in a nursing home as a pre-nursing student is exactly what made me decide change majors.
The facility was one of the nicer ones in our community, yet each unit (consisting of approximately 40 patients) had only one full-time RN and one LPN on day shift. Most of the direct care was provided by STNAs/CNAs, and there certainly weren’t enough to go around. Even with four students helping(granted we were slow and inexperienced), people waited a long time for routine care: ADLs, meals, help to the bathroom (for the ambulatory), baths, turning, wound care, vitals, etc.
There was no time to chat with residents, and recreational activities were limited to one hour/day. Most days, people sat in wheelchairs near the nursing station for hours, with no human interaction, and there were very few visitors. The whole experience was incredibly depressing.
When I get to the point of needing a SNF, I’m just going to shoot myself. This is a horrible way to live out your remaining years.
Aimee said
I was a housekeeper for several years at one of the best nursing homes in my state. Our last survey, we had two minor deficiencies–a woman in end-stage renal disease had been getting an extra 100 CCs of fluid a day, due to a communication mixup (she always wanted another drink, and as far as I’m concerned, [in my highly non-trained opinion,] if the dying woman wants something to drink, who cares?!? Give it to her!), and a resident had a bruise that hadn’t been documented properly. By “not documented properly,” they mean that the 11-7 CNA the third day after she’d gotten said bruise and it had been investigated by the DON hadn’t signed some bit of paper.
On paper, we were a fantastic facility.
Would I put a member of my family there?
Never in a million years.
These “standards” may show potentially life-threatening situations, and that’s nice. But I saw so many things there that give me nightmares.
The Scrivener said
Well put, as always. I spent some time volunteering at a nursing home (sorry, assisted living facility) as a teenager. The residents were “cared for” in the sense that they got 3 meals a day and such (which would likely put it in the top 6%), but the impressionist paintings and flowers didn’t hide the sense that the place was like a prison. Even when things look good on paper, the experience of the residents tells a very different story. I’d volunteer on Saturdays, which ought to be prime visit days, but in the two years I was there, I never saw a family member.
I come from a very anti-nursing home immigrant culture. The expectation is that children will care for their elderly parents. So I grew up with at least one grandparent at home at all times, and it added immensely to my childhood. Granted, they did not need significant medical care, which makes a difference (but then, neither did the majority of residents in the home where I volunteered).
The funny thing is, everyone is aware that nursing homes are substandard and insists they would never put a family member in one, but everyone seems to do it anyway.
CR said
I actually like talking to older people about history and such. But it is hard to talk if they are very hard of hearing and refuse to get a hearing aid (assuming insurance covers it). I am also a little hard of hearing, so that adds to the problem.
Nurse K said
I was a CNA at a nursing home on the dementia unit, which, I think it was probably a good one (it’s not “known” in our community as one of the problem NHs). Getting 12-14 cleaned up, dressed, toileted, teeth brushed, and to the dining room in under two hours in their wheelchairs or with their walkers where I was responsible for throwing together an a la carte-type breakfast based on their diet…yeah, it sucked. Then two hours later, toilet and change all the people again. I pretty much got no break and my time consisted of lining people up outside the toilet and just taking them off and on the toilet. Sometime in there, I was supposed to eat (most of us just ate with the residents in between feeding them). Lucky for us, there was someone called a “therapy aide” whose job was to ambulate all the patients who were supposed to walk; otherwise, no one would have ever gotten walked ever (or, if they did, they wouldn’t have had their diapers changed quickly).
For all this, I started at pretty much the highest starting salary in the nursing home (because I was per-diem house float–$1 extra/hr for per diem, $1 extra for float) and I made $9.75 an hour in around 2003. I made about a million dollars more per hour waiting tables.
Anony said
I agree, there are residents at the nursing who are so kind and have wonderful stories to tell. I used to volunteer at this one nursing home and the residents would have a bright smile on their faces everytime they saw volunteers, since they know they would have someone to talk to or play games with.
I think what makes some residents so grouchy is just the the bad enviroment they are in. I mean, who wouldn’t be. So I really don’t blame them.
EEJ said
My grandmother lives in a “retirement village” here in town. Seems to be a pretty nice place, but my younger sister recently asked her “Why does it seem there are so few minorities here?”, and I expected my grandmother to say “they can’t afford it”.
Her answer? “Most minorities take care of their elders themselves. They’re part of the family, aren’t they?”
Unfortunately, we could not take her out of there if we wanted to, because she essentially “bought” the apartment she lives in, and it certainly wasn’t cheap! She is lucky in that she and my grandfather had several pensions, investments and great insurance, but it certainly wasn’t luck that got her those things. They worked hard, planned well, and lived within their means…..something I see very few people these days doing.
NurseExec said
As a DON in a skilled nursing facility that does about 50% long term care, I really appreciated your post. Most people in health care have absolutely NO idea how regulated we are (over 540 possible Federal citations at last count). We can be given a Federal citation for a single stain on a single cubicle curtain in a 120-bed facility. That’s one curtain out of 120. Insane. I am blessed to work in a great building, with a committed and talented staff who love working here. Great facilities are out there, just like crap facilities. Thanks again for the post.
hannah said
Man, all I can say is a big fuck you to everyone who hasn’t had to deal with a demented/ill/totally handicapped parent. It’s great that you haven’t had the “do I pay for my food and rent or quit my job to care for mom 24/7?” dilemma. Even better if you can afford a decent “community” for your parent/s to live. The rest of us actually have to deal with life. And the fucking scariness that comes with knowing that your parent/s need around-the-clock care but you’re barely getting by with that slightly-above-minimum-wage-paycheck so how do you afford that nurse or that community or to quit your job to provide total care?!
jehingr said
This is why I promised my father that he would NEVER have to live in one of these “warehouses for people.” I gave up a bit to drop everything and move in with Dad so that he could live the rest of his life in the comfort and familiar surroundings of home. And the joy of spending so much time with Dad makes all of the sacrifice meaningless. I wouldn’t trade this time for anything.
SeaSpray said
This is so depressing.
SeaSpray said
But your story about interacting with the nursing home pts was sweet. I am sure you were an angel on earth to them.
My heart is breaking over all this though… in view of my recent and ongoing experiences.
I do agree about not being given more than you can handle…but sometimes….
ninjamedic said
Working in a nursing home (long term care facility for the PC crowd) whilst in nursing school was a HUGE factor in my decision to abandon a career in nursing and go into EMS instead.
There was never enough time to provide what I considered to be adequate care, there were never enough RN’s, LPN’s and CNA’s, and the patients were the ones who suffered. The final straw for me was when we ran out of incontinent pads for patient beds and had to use bath blankets and towels instead.
It wasn’t just that one nursing home, either. I’ve worked at a few places and as part of my hospice duties have reason to visit many more, and no matter how high-end (or low-end) they are, it’s the same story over and over again. Not enough time, staff or equipment.
It’s pitiful, and we should be ashamed of ourselves for treating our elderly that way.
marcia (2) said
Back in the day, when we took care of our own elderly, families were intact and usually able to survive on a single paycheck, so there was someone home to do the babysitting and care. Now, thanks to economic circumstances, most people are either in dual-income or single-person (often with kid(s)) families who can’t stay home to watch Granny. Granny’s social security check doesn’t even cover half-time nursing, let alone round-the-clock care. A lot of people make the nursing home decision because they can’t afford to do anything else. That doesn’t change the fact that nursing homes (generally) suck.
Patient's daughter said
My mother died of a massive sepsis (gangrene) infection in a stage four coccyx bedsore which she got in a nursing home. The odor from gangrene was sickening, and at the time, I didn’t know what it was, but I’ll never forget it. She was in the nursing home for only 4 weeks after breaking her hip, and the care was obviously negligent, even though we spent almost every waking hour with her making sure she did her exercises and ate her meals. My father, one of my sisters, or my brother, spent hours every day watching over her. My father tipped her aides every day with small amounts of cash, so they would take better care of her, but in the end, the bedsore grew larger and larger.
Every day we asked her nurses to help her – we could tell she was getting sicker, but they wouldn’t listen to us – we even called her personal doctor, but he said that the nursing home doctor was in charge of my mother’s care and he couldn’t help us. We called all our friends who were nurses and they all said “get a wound care specialist” so we asked the nursing home for a consultation with a wound care nurse. They said “no” because they knew how to treat it. They were using A&D ointment and some other topical medications, but now we know that my mother needed antibiotics. By the third week, the odor was getting stronger and we kept asking why.She closed her eyes and wouldn’t talk to us and was shutting down. The nursing home doctor ignored our requests to get a consultation for the wound at the hospital. In the end, they neglected her care, and my mother died a painful, horrendous death. When they finally rushed her to the emergency room, the doctors there were horrified. They couldn’t understand how my mother’s bedsore had gotten to this stage. She was so infectious that we had to wear gowns and gloves to be near her. We couldn’t touch our beautiful mother in her last hours. She died 3 days later.
We were all in shock – we thought they could treat her at the hospital and make her all better, but they couldn’t help her. At her funeral, a friend told us to file a lawsuit, since what happened to our mother was wrong and should not happen to anyone.
Well, we worked with a law firm for 4 years. We felt that we had an excellent case against the nursing home, but today the jury decided against us. It is very hard to believe that the jury approved of this kind of neglectful care for a beautiful, sweet 86 year old woman who never hurt a fly! Their verdict says it’s OK for a nursing home to let our parents die horrendous deaths without taking responsibility.
Please, don’t put your loved ones in these horrible places. They’re in it for the money. They don’t care for the patients. Don’t let this happen to your family member.
jana kaye said
I have been working for a very very short time in a locked down dementia unit with a great rep. My problem is staff wellness. I developed an acute sinus infection and on the first day, feeling horrible, was not allowed to leave because I could not produce a fever. That night I presented with a high temp, other symptoms and have been home for four days.
I must return tomorrow to a patriarchal female management structure, the usual sadness of a dementia unit, screaming activity staff and mutlifaceted toxicity.
I cannot afford to quit, although I am being paid little more than minimum wage–need the bnefits.
NateRN said
1 nurse/7 patients is not reasonable. Not in the pacific northwest, which I’ve been led to believe has pretty good ratios.
1/40 is more like it.
Seriously.