Each morning, Lois Vernon, who is 96 years old, starts her day at the lodge of Ashworth with a little assistance from her home care companion, Kathy Anderson.
For Vernon, who has difficulty seeing, having Anderson come to her apartment for two hours to fix her breakfast and assist her with getting dressed and getting down: to the exercise room is "a big help," she said. "She's wonderful," Vernon said of Anderson, who is employed by Comfort Keepers, one of three national home-care franchises that operate in Greater Des Moines. As the number of seniors continues to grow across the United States, the demand for non-medical services that can help people stay in their homes longer will multiply, experts say. More than 33 million U.S. residents, or 13 percent of the population, are already over age 65, and their ranks are expected to double by 2030, when an estimated one in five Americans will be over 65. The need for these services, which range from light housekeeping, cooking and running errands to persona! Services such as baths are particularly great in Iowa, which in 2000 had the fourth-highest percentage of over-65 residents in the country.
Nursing homes routinely are unable to staff enough nursing assistants and this shortage leads to a high turnover and burnout, and this leads to poor care.
Nursing assistant staffing sometimes inexplicably decreases. What used to be a required five nursing assistants on the floor suddenly becomes four and temporary or agency nursing assistants, although usually competent, are often hired to save money. But it is difficult to provide quality care when someone is not familiar with the residents. Even if inadequate staffing is cited, fines and citations are often reduced and even eliminated through loopholes in the laws and extended, multiple appeal procedures.
Visit your loved one in the evening and occasionally on different nights when the staff does not expect you. This time period after the 9-5 staff has left and before residents are assisted to bed is usually the time of day when the quality of care is at its worse. (Melcher 1988)
Malnutrition is more prevalent in nursing homes. Providing enough time and the proper technique and attitude to getting a resident fed is extremely important. If your loved ones cannot communicate, then it's better for you to post a clearly written sign in her room describing the best way to get her to eat.
Making an official complaint with the nursing home division of your state's department of public health may be a necessary option.
The nurse gives an example of complaint, which will be followed by lawsuit:
"I have personally been involved in a negligence case. A couple of years ago eight nurses, including myself, received certified letters from the MA Board of Nursing, "You neglected Mrs. _____ at the So & So Nursing Home and she got a bedsore. How do you respond?" That was the gist of it. This event happened 6 months prior to receiving this letter (I had worked 2 shifts that week). All eight nurses had also been questioned by DPH investigators a couple of months prior to this formal complaint - this resident, a mostly bed bound woman in her late 80's with a variety of serious medical conditions, died several months after this bedsore was discovered, of other causes (treatment did heal this wound). Her daughter, who I believed, and others believed also, had unrealistic expectations of day-to-day care, filed a complaint and eventually there was a lawsuit. Every nurse who had worked a shift during the week prior to the discovery of the bedsore was accused and had to submit substantial documentation about their entire nursing career
Agency or temporary nurses (and nursing assistants) are used by many long-term care facilities and hospitals. Despite paying a higher hourly rate, the facility actually saves money by offering no benefits. The agency, hospital, or nursing home administrator will tell you all temporary staff is thoroughly trained, competent, and provided orientation to the facility, but sometimes the reality is quite different, because temporary placement services is a very competitive and cutthroat business (a nursing home or hospital often calls several agencies, whoever calls back first with a nurse who can work the shift needed, gets the contract), the agency's goal is to get a "body" to the facility. As long as they don't receive a serious complaint, they're satisfied. (Melcher 1988)
Racism continues to be a part of the fabric and tradition of American society and has adversely affected the health care system in general, and the profession of nursing in particular. 90% of Director's of Nursing (DON) in nursing homes are white females while the majority of nursing assistants are individuals of color. Too often racism is manifested in the attitudes of DON's and nurse managers towards nursing assistants. This destructive process has a tremendous negative effect on any attempt to improve quality of care.
All these hindrances are left out when care is brought to the house.
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