Publicly-Funded Nursing Home Profits Protected in California Budget While Vital Services Cut for Seniors and People With Disabilities

I manage nursing homes;

first your title is a little misleading. to say that nursing home don't provide services to seniors and people with disabilities is ridiculous. If you spent a day in one that fact would be obvious. Secondly your assumption that the guaranteed profit is not tied to care is wrong. Nursing homes have the second most regulation of any industy besides nuclear power. They must satisfy regulations set by the dept of health. hence, bad care = no funding= closure. One example is the 3.2 nursing hour ratio that must be met on a daily basis. Which i believe does not exist in the majority of states. Also we have some of the lowest reimbursment rates in any state as well as one of the highest cost of living. theres a massive nursing shortage and if you actually read AB1629 you would realize that the guaranteed profits are based on cost centers such as nursing as well.

Dear Anonymous,

My mom died in a nursing home August 15, 2005 (Los Angeles, California). She was only in the nursing home for approximately 3 hours and she was suffering from terminal colon cancer. This facility, along with many others in the country have been cited for numerous violations(i.e., safety, too many patients in restraits, etc.). My issue with the home is that they allowed my mother to suffer for 3 hours, gave her only 1 Vicodin and a pillow so flat that they had to fold it in half. I told them she needed her feet elevated because of her edema among other issues which were ignored (the edema should have been in her chart from the hospice). Also, I was told that they did not have additional pillows and therefore left the facility for approximately 25 minutes to get pillows for her feet and head, bottled water and Ensure. They made no attempts to feed her, it was obvious even to me that she dehydrated because she had been throwing up water earlier and she was not sweating. I told them that it was suggested that we move her here so that she could get "around the clock care." I said I could not believe that she had been seen by a doctor, otherwise she would have been given some type of treatment (I.V., oxygen, etc.) I was told that I must have misunderstood about the care and that they were not a hospital. In hind site, I believe that the hospice nurse should have recommended emergency care to a hospital instead of this nursing home. Instead of a place where nurses where sitting around doing nothing. The head nurse said that they could not relieve her suffering until they received her new meds which could take up to 4 hours. Anyway, I returned to the facility discovered my mother was not breathing and could not get these nurses to respond until I made several attempts. There was a nurse or nurse assistant in the room when I returned and she was trying to look inconspicuous, to no avail, it was obvious by her demeanor that something was wrong. I looked at my mother and she was no longer moving and fliching from pain her eyes remained open as well as her mouth. I said to the woman why does she look like that, when was they last time someone checked her vitals. Her response was "a little while ago". She made no movement toward my mother. I went over and put my hand on her chest and said oh my god, she's not breathing. Again, no movement. I went to the door (located 10 feet from her room) and said to the head nurse, my mother is not breathing. Again, nothing. When I said it a a second time, the head nurse stood up and said to me "did you check her pulse". I said firmly, she's not breathing. She then,with attitued, very slowly made her way to my mother and walk over the check her pulse and then said nothing. I had to say several times. What? What? What? Is she dead? Is she dead? Finally, she said. "Yes".

After the funeral, I called to register my complaint, and spoke with the Director of Nursing who was very pleasant and understanding. She was also appalled. She told me that a doctor had never examined my mother and that they were not equipped to handle critically illed patients. I was also told by the Director that sometimes a doctor does not show up to check a new patient for 72 hours. Before all of this I knew absolutely nothing about nursing homes. However, after extensive research what I do know makes my skin crawl and the more I read the more I believe that they don't have to improve the quality of care because they know they will get paid inspite of poor quality. Also, the fines are very minimal, basically a slap on the wrist (this is per an extensive investigation by the New York Times). Oh! Also, I forgot to mention that the Director also told me that this nurse (i.e., charge nurse) lied about only being able to give her 1 Vicodin while she waited for a new meds. They also lied about not having the items I went home for (water, Ensure, pillows). I was told they had filtered water, something similar to Ensure and a closet full of pillows. When I left for the last 25 minutes of my mother life, I also told them that she had not had much to eat and that her feet needed to be elevated per the hospice nurse or she could suffer a stroke or heart attack. Again, none of my simple request were honored. Everyone I speak with has a horror story about a nursing home and the sad news is they don't feel they can do anything about because they government sits on their hands and keep paying this poor excuses for caregivers. Anyway, I found your post while I was doing research in order to get my fact straight before sending in a complete account of this incident to my public officials(whether it does any good or not). Maybe the nursing homes you have managed were the exception to the rule, but please check the statistics on the government website, before you decide to make another post anonymous or otherwise.
Please check out the below listed website do that you can at best see that your comment about the 3.2 hour requirement is a farce. The average hours given nationally is more like 1 and 1/2 hours. Don't take my word or it do you own research. In closing, you could have managed over 20 nursing home in your career and this still would not make you an expert on the care as a whole. It just makes you an expert on the facilities that you have managed.
www.medicare.gov.NHCompare/include/DataSection/
ResultsSummary/OneHome_AlResults.asp?..).

I took the time to write a thoughtful comment. Will you post it? David.

First let me say to all of the people who have lost a loved one, I am so sorry for your loss. I know that the void made from the loss of your loved one can never be filled.

But I must defend my profession and my "place of employment" I didn't work at the facility that your mom was at, but I work the graveyard shift at one like it. I have 45 patients. Yes, you read that right, 45. I have patients that require little to no assistance and I have patients that require total care, and everything in between. I have to do some type of documentation on most of those people. I have various other minor shift responsibilities to do. I have a round of medications to pass towards the end of my shift. I have to do all of this in only 8 hours. Just to give you an idea:

change of shift reporting (so I know whats going on and whats happened since I last worked): 1 hr
charting and other patient documentation: 3 hrs
various shift work that is vital to the
whole facility: 1 hr
medication pass: 2 hrs

That leaves me with 1 hour in which to deal with unplanned incidences such as skin tears, pharmacy deliveries, a patient that deteriorates, staffing issues, the "new guy in 12a that wants a sandwich and a pain pill", and my bathroom break. This is also the time that we are supposed to give your loved one (and the other 44 patients) attention specific to their needs. How do I fit it all in? I am not allowed over time nor can I expect the next shift to do it, because they have to do all of these same things, too.

If we are grumpy, busy, don't smile, or "dont move fast enough", let me say that I am sorry for all of us. We are tired, our bodies hurt and we are sad (we loved your family member/friend also) but we are trying our best.

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