Traditional nursing homes really DO suck

This has become my number one best seller, in my writing world anyway.  Maybe more people are waking up to the fact that at $1,500 a week for room and board, they are not getting what they pay for, at least their loved ones are not.

As long as the Medical Model is still practiced in traditional nursing homes, there is NO good quality of life for the people living there.  Living there is just another phrase for: being trapped there.  Yes, a traditional nursing home, touting the Medical Model will always, always, be run for the convenience of staff, and staff alone. 

 My son recently needed antibiotics, as I was reading the label, it started me thinking, again, about how staff dispense medicines in traditional nursing homes. Nowhere on my son's prescription did it state: Dispense however you please.  You can dispense in a group all at the same time, for staff convenience.  The label has specific instructions as to when and how the medicine should be taken.  The nursing home I once worked was willy-nilly about dispensing medicine at Every breakfast, to Every patient at the Same time daily.  This is not right, no matter how you slice it.  I once suggested maybe medicine cabinets in each room would be best.  I was told that anyone could then get the medicines.  Well there is a wonderful invention called a padlock to cure that.  Translation from nurses: "Well Then we'd actually Have to do our jobs properly and it might take time, effort and caring on our part."  You should not be surprised because given the human warehouses these places are, the let's herd old people like cattle, mentality of nursing homes, it makes sense.  To THEM anyway.

Another funny thing I noticed while working there, was the sole owner was older than dirt, himself.  For the most part he had Nothing nice to say about old people.  People who live in glass houses.  But since 'older than dirt owner' had money, HE didn't relate to those in his peer group.  Funny how that works.

This book Should be a good seller, especially to college Social Work classes because Social Work does not come from books.  Social Work comes from real life, real world experiences.  When I was about to graduate from college, many, many students said: "But college has Not taught me Everything I Need to know about this profession."  They were right, it cannot possibly teach you ALL you will need to know.  This book is a good teaching tool unless instructors are afraid the truths in this book will scare students.  It Should scare students because it should keep them on their toes.  It should teach them about human dignity.  It should teach them about old people being human too, not just cattle to herd and shuffle to activities, to showers resembling a car wash, to dispensing medicines all at once to everyone (contrary to label instructions), and to Stop bullshitting loved ones at care plan meetings.  Teach them that, while nurses Love to be head cheeses, they DO NOT know it all about your loved one.  YOU are That expert on that subject because you've known your loved one Longer than ANY staff.  Staff NEEDS to LEARN that nurse aids Should be invited to care plan meetings Because They Are the primary caregivers, NOT nurses who mostly push medications.  So I'm grateful this book has picked up with sales.  If Anyone Cares in our society, then the Truths in this book will be of concern to all. 

To those who have bought my book and read it, I thank you.  To those of you who have not, you Should as one day YOU Too will be old. 

St. ATM

Watching the news today, there was a barrage of ads touting how wonderful some nursing homes are.  Some bragged how 'profits aren't important, their residents are' and some flaunted five star ratings.  Ha. Ha. Truth be known, Medicare five star ratings are seriously flawed and may mask some serious deficiencies.  It's been found that the five star rating relies too heavily on self-reporting by the nursing homes, omitting much negative information reported by state inspectors.  Now isn't that the foxes guarding the chicken coups? 

The star ratings are supposed to give nursing homes an incentive to improve, when in reality, most have found ways to game the system. Nursing homes know when inspectors are in their area,they notify each other and add more staff, clean up areas that they normally neglect, and sharply cut staff once inspectors are gone and go back to their sloppy ways, until the next year.  Moral of the story: do not rely on this bogus five star rating system for nursing homes.

Those who say: 'profits are not our big concern' well of course that bottom line is of big concern.  How do you think staff gets paid?  How do you think administrators make those big bucks?  By not being concerned about profit?  Oh, please. Traditional nursing homes, based on the Medical model are the pits to live in. The Medical model is set up for staff convenience only.  If huge profits are not a big concern, do you think corporations would even own them?  Hardly.  This is a billion dollar industry, owners of nursing homes aren't rich by accident.  

Traditional nursing homes need big changes.  They may have five star ratings like some Grand Hotel, and admittedly, they do charge the elderly like it is an expensive hotel, but without all the nice services one would expect at a hotel where one pays in excess of at least $1500 per week just for room and board, but they are not a nice hotel by any means.

Traditional nursing homes will never change until, you, you, and I, demand our loved ones actually get what they pay huge money for.  So all of them are the Nursing Homes of the ATM. 

Social Work in a nursing home the here and now

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Writing many blogs about doing Social Work in nursing homes and mainly talking about culture change, I realize many Social Workers are interested in the day to day workings of the job.  What does the job actually entail?  How do you handle certain situations?  Subjects like that.  To answer those questions and to be specific, is a difficult thing to do.  Why?  I personally think Social Work is part training and part talent.  Either you like it a lot, it can be a thankless job, or you look at it as just a paycheck.  Either you enjoy helping others solve personal problems, or you look at it as a paycheck and nothing more.  I emphasize the latter because if it's just a paycheck and nothing more, you won't be as good at it as you should be.  Simple as that.

 A big part of the job is the mechanics of the MDS, or now, the MDS 3.1.  MDS stands for: Minimum Data Set, meaning the federal and state agencies hope you and they can get to know all about a new nursing home person, in a few basic questions.  This always makes me laugh, because it's the equivalent of an employer hoping to know you by a resume and a few basic questions.  Can't be done, but since traditional nursing homes value the bottom line above all else, they need some pointless instrument to make it appear as if each individual resident is important to them.  Trust me, since most nursing homes are corporate owned, that too is not their goal.  The most interest those corporate nursing homes have in residents living there is how each resident contributes their bank account and the elevation of their bottom line.  I know it sounds harsh, but to me, traditional nursing homes is harsh business.  

 As far as the MDS is concerned, any nursing home you work for will call in a consultant to assist you in wording the MDS and in chart writing.  Why?  Well, it's much like using the Taleo hiring, resume process.  The consultant will give you key words to use in order to win the 'what do they want to read' game.  That's exactly what it is too, a game.  A dance done primarily for the state and federal agencies, designed to appease them.

 For example: when writing goals for each person, the goal should say:  "Resident's goal is to................blah, blah, blah."  Too many Social Workers will say:" Resident will................blah, blah, blah."  Using the word will makes it look like you are imposing your will, on them and not helping them achieve their goals. This is a no, no for examiners when combing through your charts.

Another duty of Social Workers is defining when a resident needs a 'psychiatric evaluation."  The evaluation is a part of state and federal agencies rule that no resident will be a threat to another resident.  We know this is pretty much BS because other residents have been know to hurt each other quite often.  This rule is broken a lot because nursing homes are out for money.  Empty homes equal not enough profit.  But the general rule for the psych eval is this:  If a resident is diagnosed with depression without the diagnosis of dementia, you have to order a psych eval.  I guess it is assumed by state and federal agencies that depressed people are dangerous.

Crazy as all this seems, such is the daily role of a Social Worker in a nursing home. 

  

Why doesn't someone do something?

I hear, quite often: "Why doesn't somebody do something?"  Americans seem to have forgotten they are someone.  Too often people sit back, waiting for someone to step up and 'do something.'  It's a good thing that people like Martin Luther King didn't wait for someone to do something.  He, as did many great names in history, realized they were somebody and they did do something.  Have I driven this point home yet?

I see 'celebrities' (using the term loosely here) like Perez Hilton, getting a lot of looks on their blogs because fashion, stupid famous actors and the like, seem to be foremost in people's thought.  Way too much so. Young people think they will be young forever, never grow old and nothing like old age happens to them.  Ha Ha!

When it comes to nursing homes, too many loved ones will say 'why doesn't somebody do something?'  The loved ones are somebody, they pay the bills at the nursing home, making them very important somebodies.  I used to hear many complaints as a Social Services Director, about how the nursing homes were run.  Sometimes they were families just wanting special treatment for their loved one, but the complaints were always genuinely true.  Why shouldn't all residents get special treatment anyway?  After all, they pay enough to certainly warrant special treatment.

What can loved ones do to help change the traditional nursing home environment?  

1)  They can get to know other families who have loved ones living there.  Once they get to know others, they can get together once a month and draw up, write things down, take notes and present the Administrator with their concerns.  Remember, as loved ones, you can make a difference, safety in numbers.

2)  Request small steps in making the nursing home a culture change place.  Where to start?  Well ask why the damned nursing station cannot be moved to an office and not placed in the middle of each wing.  

3) Ask why all the rooms cannot be private rooms so your loved ones do not need to undress in front of a stranger all the time.  Nursing homes can charge just a bit more and still make a good buck.  Do you invite strangers into your room to undress in front of them?  Probably not.

4) Ask why a choice of meals cannot be offered to your loved ones.  When the dietitian decides, the meals are bland and unappetizing.  Cannot imagine why your loved one refuses to eat.

These are just simple starters.  The private room one is big because everyone should have access to the window, not just the person lucky enough to have a window bed.  The removing of the nursing station immediately removes the obstacle people have to try to maneuver in wheel chairs and with canes.  Since the nursing stations are usually off limits to people, it immediately establishes the staff, not the paying customer, is in charge.  People living there pay the bills, not the staff.  Why should staff call the shots?

I hope this blog gets through to people who feel frustrated by traditional nursing homes.  Remember, it does not have to be that way.

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Can the elderly really trust doctors?

Each day I turn on my TV set and a commercial that keeps popping up that says: 'people over forty are the most likely to overdose on their prescription medications,' just bothers me. Why?  If this is so, I conclude it is more than likely the fault of doctors prescribing way too much medications for older people.

I get irked when the medical profession tries to insinuate that some people just don't know how to take their medications, or that they are drug seekers.  This may be true in a few cases, but those cases are few and far between.

True story:  I have two elderly brothers-in-law who were taking way more medications than they probably should have.  First one got sick and went to the emergency room and later on the second one did the same thing.  What sent them there?  Both were feeling ill and their symptoms got worse so they went to the ER seeking help.  Both ended up staying in the hospital for several days.  The problem, in both cases, was the doctors had prescribed too much medication for both of them.  One was taking eleven medications for quite some time.  So much for doctors checking what medications you are already on and checking to see if they would be contraindicated.  They both, when we questioned them about why so much medication said: "Well my doctor prescribed them and they wouldn't give me anything that I didn't need."  Yeah, right.

It's so easy to say: "Oh they must be senile.  Someone should set the proper amounts for them daily."  But in these two cases, both are alert and oriented times 3, meaning they are as with it as you and I are.  So don't be so quick to blame the elderly.

You can also assume that the elderly in nursing homes are protected by this sort of thing.  Think again!  A nurse in one of the nursing homes I worked at told me once: "The elderly are just fine if they can stay as far away from doctors as possible."  She didn't mean in the case of life threatening conditions, she meant that MD's like to over prescribe.  She also gave me advice of: "When you are over 50, try your best to take no more than 2 medications and you will be better off."  I suspect she was right.

Become an informed layman.  Question everything your doctor prescribes.  Tell them you want the medications where the side effect is Not death.  That may sound silly, but listen to the warnings on most commercials for prescription medications on TV.  

I hope this blog is informative and if you have a loved one in a nursing home, ask about their medications and question everything.  If your loved ones live at home, check their medicine cabinets and go with them to a doctor visit whenever possible.  Takes time, you say?  Well when you were young, they went with you to the doctor's office, why can't you take the time for them?

Just because someone has a medical degree doesn't mean they know it all, remember this, they help big pharma too many times to Not question their motives. 

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That awkward moment when you know you're done

 

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When I went to interviews with nursing home staff, I figured that all of my experience would land me a decent job as a Social Worker in one of them.  But then, when the staff would say: "I've read your book."  I knew I was done in this industry.

Are there good people working traditional nursing homes?  Yes, but, unfortunately the 'good' people working there are not the people who own and run them.  Staff in a nursing home cannot allow themselves to be caught dead associating with anyone who dares to write a book that points out all the major faults of traditional nursing homes.

Why not?  Well, nearly all working people in America today are exactly where American business owners want them: scared to rise up, scared to try changes, scared of losing their jobs and therefore being unable to support their families.  This fear may be okay for other industries, but nursing homes are an industry dealing with people and their lives, not the manufacturing of some parts you slap on a car.

Why don't those people want to change nursing homes for the better?  Why don't they want to work with anyone to make life better for their main reasons for even existing, namely the people who pay their paychecks, the people living there who butter their bread?  No, because owners and operators only give a shit about the bottom line, the 'race to the bottom' that is so prevalent in American industry today.  Sad but too true.

Well, I, for one, am pissed off about how traditional nursing homes treat the very people who line their bank accounts.  The staff very well should be pissed off too.  They should be pissed enough to want to petition for changes.  It saddens me to see American workers so impotent anymore.  So much so, they are willing to ruin the elderly residents lives than to try and clean up the flaws.  This is the thing I hate most about present day America.  

I wish more people would read my book.  Not just for sales, but to actually care enough to seek changes, for their loved ones, for the very people they actually work for.  The people they work for are Not the big wigs, but the people who line the big wig's pockets. I wish staff could realize that fact.  

These stickers are on our car window.

Social work in a nursing home, charting

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Charting in a nursing home is a very, very important part of being a Social Worker.  "If it wasn't charted, it wasn't done."  This is an understatement, at best.  State and Federal examiners go over charts with a fine tooth comb.  The years I worked in Social Work, our department never had any 'dings' or marks from the examiners.  If you do it right, each week, it pays off.

Example of someone needing psych evaluations is a good one.   You will not get a psychiatrist to come to a nursing home, unless you have super rich residents, simply because it boils down to not enough money can be made for a psychiatrist to visit there.  Most all nursing homes have contracts with psych services and psychologists are the ones who visit.  Now they can give a recommendation as to whether a person may need a psychiatrist, but you have to send them out to a psyche hospital for that.

Example of charting:  Alice (call the person by name, examiners like the personal touch), was crying today, again.  She has been tearful for several days now.  When asked, by staff, what is wrong, she cannot give a concrete answer to that question.  Alice hangs her head when talking, not looking Social Worker in the eyes.  (Even chart if she wrings her hands, has unsteady speech or anything else you might observe in her manner.)  The psych paper from Social Services was made out (questions you ask to help evaluate if they need services) and Alice's answers indicate if a psych evaluation is in order.  Social Services requested from the nurse to ask her doctor for an order for the psychologist to visit and give staff a written evaluation to see if we need to pursue any further actions.  More charting on this will be done after the psychologist visits.  

Now, saying more charting will come, means you Have to chart more after the psychologist visits.  The psychologist will ask each time they visit, for a list of who they need to see.  Keep a good list for them.

In a more minor charting situation, such as maybe you want to check on a resident weekly, but may or may not have time, Do Not say you will do that.  If you Say you will do that, you Have to do it in order to satisfy the examiners.

Example of Alice needing psych help in a facility:  The psychologist recommended Alice have a more intense evaluation in a psychiatric facility.  Social Services has requested from nurse to notify her doctor to write an order so we can send her to a facility for more help.  

Then when you transfer Alice, you make out the proper paperwork for the hospital to admit her and chart that as well.  When the Social Worker from the psych hospital calls you, she will tell you what was done, and if changes were made to Alice's medications.  When you get off the phone, chart what that Social Worker told you.  Then when Alice returns, chart what her written orders say as well.

I hope this gives you some help in how to chart. If it looks like you are writing a book, good, because the more pertinent details you can include, the more examiners will figure you are doing your job.   Happy Social Work.

 

 

Social Work in a nursing home

 

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Social Work in a nursing home can get tricky at times.    Many, many times, even the Administrator gets confused as to what is right and what is legal.  

For instance, one place I worked had a man living there who was a flaming alcoholic.  He would periodically decide to leave, go on a drinking binge with his old cronies and simply walked out of the nursing home to do so.  He was prescribed medications to curb his alcohol craving, but sometimes the cravings proved to be too great and he wanted a few drinks.

One evening, just before dinner, he walked out of the place.  One of the nurses noticed him missing and came to my office.  The next thing I knew, the Administrator was in my office, demanding I 'call the police' to have him brought back.  I tried to explain to the Administrator that since the guy was coherent, which meant he knew exactly what he was doing, the police would not drag him back, kicking and screaming.  Sometimes you have to explain that nursing homes are not prisons.  Some staff members think all residents have to adhere to all rules, like a jail, not so.  Now a nursing home can, and sometimes will, kick out a problem resident, but they cannot just kick them to the streets without making arrangements for their safety.

The Administrator didn't like that I refused to call police to drag him back.  She picked up the phone in my office, called them and then hung up a few seconds later.  I asked her what the police said.  Her reply: "They said what you just told me."  Uh Huh.  The best they could do was a well being check, not much more.

I would get told, often, by other staff that: "So and so cannot call a cab to go shopping, go home or for other reasons."  I beg to differ.  I'm telling you that they can do that.  The nursing home is supposed to be their home, not a prison by a long shot.  

If anyone does go home, AMA, against medical advice, Medicare can cut them off for services for a time and all you can really do is call Adult Protective Services to check on their well being.  Not much more if that elderly person is coherent and knows what they are doing.  

When a nursing home tries to act like a resident does not have the same rights they have in their own house or apartment, you must explain to staff that they do retain those rights, like it or not. 

Social work in a nursing home

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 Nursing home Social Work does not come without its challenges.  Simply because the nursing home population is so diverse, many people come with their own unique sets of problems.  Some of them that I encountered are as follows:

A)  We had a lady, very sweet and docile, the docile part proved to be a problem.  She had a sister who was mentally ill and, unfortunately, was also her POA (Power of Attorney).  This fact posed problems because: 1) Many times nurses and even doctors, do not understand how these forms should work.  They think a POA has free reign over making decisions for the person involved.  I'm here to tell you, they do not.  In fact a POA is only good if the person for whom it is intended is unable to comprehend simple instructions: i.e. in a coma, has severe dementia, had a stroke and is not coherent.  Remember this as a Social Worker.  That sister thought she could make any decisions she pleased even though the resident was as alert as you and I.

B)  Many times adult children, not wishing to lose their beloved parent, will have their loved one, or in the POA case, the adult child, will sign a resuscitate form instead of a do not resuscitate or DNR.  A resident is allowed to sign whichever one they choose.  But always bear in mind that they also think if a loved one is resuscitated, the person will be good as new.  No, as we grow older there is a big chance we can end up in a vegetative state, or even have to have tubes, wires and the whole 9 yards, which is usually not how most of us care to exist.  Plus, as we grow older, the resuscitation act itself, can break brittle bones, causing even more problems.

C)  One of the most difficult residents to deal with is the person who absolutely doesn't want to be in the nursing home.  Traditional nursing homes are not appealing to very many people.  I can see their point.  Convincing the person they should be there because they are unable to care for themselves is very difficult.  You probably can see why.

D)  Nursing homes that place two to a room is another difficult area.  The room mate the facility chooses may not be compatible with the person already there.  I had one lady who was determined that no room mate was acceptable.  She wanted the room to herself and so she would turn up the air conditioning in winter and turn up the heat in the crushing heat of summer.  She would always never allow her room mate to open a window for fresh air either.  My Administrator told me I needed to have the (I want my own room lady) sent out for psych evaluations.  Basically the woman was being mean on purpose and there is no cure for 'bitch.'  I did not see the lady as a bitch, she just acted bitchy to room mates.  I fully understood her position and in a Culture Change nursing home, with one person to a room, this sort of conflict could be avoided easily enough.

I'm hoping this true information will assist new Social Workers in knowing some of the problems they can face in traditional nursing homes.  I do not believe in blowing smoke up your asses.  You deserve the truth.  All the more reason as a Social Worker, to become an agent of change, encouraging traditional nursing homes to become Culture Change ones.  They are better for workers and those living there.

Thanks for reading.

 

Social Work in a nursing home

 

What does a day as a Social Worker in a nursing home look like?  I did not say typical day because there is no such thing as a typical one.  Each day is unique in itself.

First thing in the morning, all nursing homes have a morning meeting.  This is with the department heads, all of them, so the administrator has an idea what each department will be doing that day.  It also gives the administrator a chance to tell any department if they want something looked into or done.  Literally, each department head, when it's their turn, says what they will be doing.  Mostly I found it a time for nurses to ask if Social Services could change someone's room, for whatever reason, or if a resident requested a change.  Many times nurses expected us to convince a resident to change rooms or accept a room mate.   Whenever we got a new resident, the facility didn't place people together who might be compatible, they just looked for an empty bed.  As you can imagine, many residents were not happy over that situation.  This is one reason NO nursing home should have two people to a room.  Someone doesn't get a window and probably no access to the existing windows.  Many times you will face irate relatives who do not want their loved one's room changed, or who does not like the room mate.

Changing a room is not just a simple task either, you have to get a permission paper signed by either the resident or the responsible person, which is not always easy.  Then you have to place a copy of the paper in the chart and chart the reason why.  Even with the new electronic paperwork, it still has to be filed someplece and charted.

An example of charting:  Resident requested a room change due to:  then you fill in the blank.  I always charted what resident said or did, or what their responsible person said or did.  Mostly state examiners only care how the resident views things.

A behavior example:  Resident is distraught and complained about (fill in blank) or resident got into a shouting match with room mate, or hit another resident.  The hitting is where it can get complicated.  You Must check on the one who got hit, plus the hitter.  Maybe the hitter has dementia and didn't know better, or just has a bad temper.  You absolutely have to follow up, talk to the hitter, then check on the one who got hit.  You have to write what you did, and will do, to prevent anymore incidents.  Usually the nursing home's solution is to drug the hitter.

As a Social Worker you absolutely have to know when a resident's psychotropic medication is changed.  This can get tricky if the nurse asks for a change and does not bother to tell you about it.  This can happen in the middle of the night, without your knowledge.  You should be sure you have a form and request a nurse Always makes it out whenever there is a change.  Good luck on that one.  But if you do not know and do not chart it, believe me, You will be held responsible for not knowing, nurses usually toss you under the bus.

You have to know, because once a powerful psychotropic med is started, then You have to  ask, that nurses request the doctor to reduce it until gradually, the resident is off the med.  Then you have to chart if the resident is doing fine without it or not.  If not, you must have the doctor write why the person has to have the meds.  Crazy, isn't it?  Yup, it is.  Then You have to describe how resident acted without the sometimes needed, medication.  

I'm going to Warn you, in a Medical Model nursing home, staff feels it is easier to medicate a difficult person than it is to try other alternatives.  There usually Are other alternatives, but they take team work and cooperation from other departments. 

I don't tell you this stuff to scare you off.  But I think every Social Worker deserves to go in with eyes wide open.

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Social Work in a nursing home

Some days will be like this

Social Work in a nursing home can be fun, rewarding and very stressful, all in one day sometimes.  The paperwork and what you do, after the MDS's are done (Minimum Data Set is time sensitive and has to be completed in a timely fashion and must come first) what you do otherwise is dependent on your employer and maybe state examiners.  I say state examiners because once in a while, if they dig, dig, dig, an examiner will give you a list of 'residents in need of a psych evaluation, on paper, and results placed in the person's chart, within 10 days of the state's request.  Who are the residents in need of this evaluation paperwork?  Pretty much it will be residents who have come in and who 'have depression but have no dementia' diagnosis.  It is a given, by state examiners, that people with dementia have depression.  This psych eval is required to be sure other residents are safe from the person suffering depression. (You'll learn once you are hired).

Is it All like this? No, but often it is.

A good piece of advice to those Social Workers seeking employment in a nursing home is this: If, during an interview, the person tells you that you will be doing marketing as well, RUN, and run as fast as you can in the other direction.  Why?  Well the interviewer may as well say: "Frankly, our owners are so cheap they refuse to hire a marketer, so you get to do two, or more jobs here.  The reason for this?  "Well the owners and CEO insist in pulling down a 6 figure income while you run around, frazzled, making them rich by not paying a marketer."  Simple as that.

A decent marketer is supposed to be out of the office 85% of the time, drumming up business.  How in hell can you do your Social Work paperwork, be available to residents and families and take care of setting up home care and your usual paperwork and be out of your office that much?  Impossible!  

Marketing consists of: Hanging out at hospitals like a vulture, talking to older people who will be discharged and convincing them to come to your nursing home.  It's a highly competitive business with stock holders, owners and administrators pushing you to keep the building at 95% capacity. (Fill those beds with asses.) 

Unless you are a glutton for punishment, do not take that mush responsibility on.  I guarantee you one job or the other will suffer, not to mention your jangled nerves and sanity.  You must look out for your own health and well being because I assure you no one else will. 

Do not let rich companies make you juggle a 100 tasks.

Some nursing homes want Social Workers to also do, in addition to marketing; admissions.  Do not do this one either.  Because many admissions will not be until 5PM when most hospitals get around to discharging patients from their facility.  Unless you relish 12 to 14 hour days, admitting a resident; then steer clear of this extra job as well.  If you have a family and wish to see them, do not accept this extra job.  Many nights you won't see home until 10 or 11PM when your day already started at 8 or 9AM.  

Do not take on the job of discharges either.  When any resident is discharged from therapy (Medicare only pays for 100 hospital and therapy days per year), the discharge person is supposed to send a letter, or hand a letter, to the family member and/or resident who is responsible. The letter must be signed so no one can say: "My loved one was supposed to get more therapy and didn't get it."  When that signed letter (a copy of it) is placed in the resident's chart, then your ass and the facility's ass is covered.  Otherwise you can all be in trouble for not notifying the family and/or resident of this change.  This requires you to always be in touch with the therapy department, which can be difficult at best.  There is a web site where you can download this form, print it out and make copies of it.  You have to use the official form for your state. 

I hope these blogs are of help to those new Social Workers who seek employment in a nursing home.  The more you know, going into it, the better for you.  

Available at: Amazon.com. and Kindle edition

Social Work in a nursing home

Available at: Amazon.com

Working in a nursing home, these days, means an ever increasing mountain of paper pushing for Social Workers.  State examiners come in once a year and think they can know everything you have been doing in your job by checking out the paperwork you have on file.  Even with the advent of electronic paperwork, you will find yourself trying to keep up to date with case notes and the time sensitive MDS reports that need to be submitted almost daily.  That MDS remember is Minimum Data Set which is supposed to be a quick way for the facility and state examiners to 'know' each resident's likes, dislikes, their daily habits and so forth.  But MDS reports are also how nursing homes get paid.  It is tied in to Medicare payments for each resident. 

Case notes, it is safe to say you should almost write a book on every conversation, every incident you handled and anything from how a resident looked to how they responded to your interventions.  Why a book?  Well examiners seem to want every trivial detail about each interaction you, as a Social Worker, has with each person living there.  So even if you think something might be trivial, include it anyway.  This way an examiner may still ask you questions about it, but you will have every detail already recorded for your own benefit.

Some wording of case notes can be important too.  For instance, we could not write 'resident appears to be frowning' since, sometimes some residents appear to have a permanent frown on their mouth.  We had to write: 'resident appears to have a furrowed brow' which to me, seems ridiculous at best.  

Another good piece of advice:  If you are questioned by an examiner, never, ever, volunteer any information.  It is best to only answer questions asked of you, point blank, no elaboration.  Why?  Because I saw a facility get a bad write up in the Social Services department simply because a Social Worker played Chatty Kathy and 'remembered' an important part of an incident she was questioned about concerning a resident.  She suddenly remembered something she failed to write in the case notes.  The department got written up and had to write a plan of correction (which believe me, is a nightmare in itself).  That Social Worker became so upset she resigned.  I was hired to 'fix' the situation.  So do not volunteer any information.  If you recall something important about an incident, make a note of it later in the resident's chart, but do not act like you forgot it when it happened, when questioned by an examiner, they will crucify you on the spot and tag you as a bad Social Worker.  Call it self preservation.  Are you trying to put one over on the examiners?  No, they just like to blow anything out of proportion.

I recall hearing college students, just before graduation, say: "I feel like college didn't teach me everything I need to know for a job."  They didn't.  College cannot possibly teach that stuff because every Social Work agency is different and you have to learn their policies on the job.  With nursing homes, policies vary from nursing home to nursing home within the same state, even within the same city.  Administrators will tell you to 'read their policies' but that damned book is so thick you can hardly lift it.  But my advice, if you cannot read it all in one sitting, and believe me, you can't, then when something arises you may not have encountered before, look it up then, as you need to.

A good example is: Most facilities' policy when someone has even just talked about any kind of suicide (I hate myself, I no longer feel like living this way) is to send that person out for a psychological evaluation.  Can a facility go over board and act irrational about those kinds of things?  Emphatically, YES!  We had a resident in our facility, short term, for therapy and would be going home in a few weeks.  One day, while talking to a nurse, he made a mistake and used a wrong word.  In jest, he made his finger look like a gun and pointed to his head, with a smile.  Something you and I do all the time, jokingly because we knew we said something wrong.  I got 3 reports, within five minutes that Mr So and So was acting suicidal.  Of course he was not, but staff panics about covering the facility's collective asses.

These are just a few fun projects you will face when you apply to be a Social Worker in a nursing home. 

Social work in a nursing home

Basically how Social Work is viewed in nursing homes

With all the talk and buzz going on about what Americans love to call: "Obamacare" I have to write a blog about the 'death squads' so many would like you to believe it might create.  I got tired of reading: "They'll kill Grandma."

Well, in my book (literally) nursing homes have always been the 'death squads' people fear, it's just that until those who wanted to thwart the passing of health care for all, it didn't get any attention.  Will the new health care kill Grandma?  Hardly, but the nursing home you place Grandma in, just might.

I saw, first hand, how nursing homes work, always self-serving, always for their own benefit, not your loved one's, benefit.  After all, the owners must appease the share holders so this billion dollar business cranks out money, like a money machine, cranking out money 24/7.

For example:  One of the nursing homes I was a Social Worker at, decided a lady, who had been very well off and was self-pay for 10 years (that's how long it took to make her bankrupt)and now had to obtain Medicaid, it was time to get rid of her because she developed dementia and Medicaid didn't pay enough to make the extra care worth the nursing home's while.  The Administrator decided to systematically start a campaign and paper trail to back her up when the facility finally bounced her out.  The paper trail was to ensure the nursing home could win because the Administrator knew there would be a hearing brought about by her family.

There are very few reasons a resident can be bounced out of a nursing home.  The previously mentioned example I witnessed and mentioned above, was not one of them.  So basically it was an illegal action, but in one of those shades of gray areas.

One reason for getting bounced from a nursing home is: Failure to pay Grandma's bill.  Death squads from the new health care?  Well fail to pay Grandma's bill and see how fast she is evicted.  Sounds like a death squad to me, just send her god knows where due to lack of money, and you will see how much the nursing home gives a shit about her. 

This is something Social Workers and loved ones need to be aware of.  If you suspect your loved one is being bounced unfairly, you just might be right.  Social Workers should always question some actions taken by the nursing home.  I know, I know, it's hard to bite the hand that feeds you (or issues your paycheck) but that is exactly what the nursing home is counting on.  The fear of reprimand, or firing, is what ensures them you will stick up for them, taking their side, right or wrong. But I just hope you pick the right side to advocate for. 

Loved ones and Social Workers:  If a nursing home is a Medical Model nursing home, and they try to laud the 'great quality of life' being shoved down your throat:  Medical Model is Not a Good Quality of life. 

The Penn Yan nursing home I had an interview at, tried to feed me that shit, I knew better.  My comment to them?  "Do You have a nursing station in Your living room?"  I got no answer to that one. Ask it at a care plan meeting and see what your answer will be. 

Both available on: Amazon.com

Also available on: Kindle

Nursing home diaries

All books available on: Amazon.com

I want to touch more on what to expect as a Social Worker in a nursing home.  The latest book by an author who mostly covers rules and regulations, barely scratches the surface about the personal toll the job takes on Social Workers.  My books cover that subject.

The rules and regulations, except for trying to keep track of Medicare and Medicaid fraud, are bogus anyway.  Yes, examiners on the state and federal levels should make sure people living there are safe from harm, but most rules imposed by government guidelines are bogus.  Why?  Well governments, when faced with a public outcry about how 'Mom', Grandma, or Grandpa or Dad, is treated is usually met with a government response of 'Let's throw money at the problem to fix it, or let's just make impossible rules, to fix it.'  The government agencies are hoping rules, rules, rules, will somehow solve the problems.  Governments swing too far in one direction or the other.

In reality what in hell does it matter if my clothes in my closet are regulated and measured so as to be 'just the right' distance from the closet ceiling?  Why should nursing homes be run on the Medical Model without question?  Do we all want to be living in a damned hospital in our later years?  Why in hell do they need to use industrial washing machines and dryers just so I cannot have anything nice because those damned machines ruin all my clothes?

Why does staff feel the need to talk to the elderly as if they have now returned to the age of 3, especially if they are alert and oriented as you and I are?  

The Biggest question of all is:  Why in hell does staff pass themselves off as the 'experts' on elderly?  Experts on what they like, their sleep patterns, their eating habits and worst of all, what they think the elderly need?  When you attend a care plan meeting and some nurse says: "Well this is normal or not normal"  Bull shit!  Even doctors and your best scientists have hardly a clue about what happens when we grow old.  Know why?  Because most people have never before, in history, gotten to live as long as we do now.  Medical science now helps us live longer, but in the past, we didn't and therefore they had no subjects in large numbers to study.  Medical science helps us live longer, but have, as yet, figured out what to do with us when we do get old.  Stuffing us in nursing homes so we can be studied like lab rats is a good thing?  If a person's quality of life is gone, it's simply prolonging their agony, but nursing homes see it as prolonging their paychecks from Medicaid and Medicare as long as faint hearts beat.  Aren't Social Workers supposed to be agents for change, helping to make life better for their clients, not lackeys running errands in some corporate run human warehouse?    Food for thought.

Nursing home diaries

Available at: Amazon.com

I was recently reading a book which is 'a social worker's guide to nursing homes' by Elise Beaulieu, not the entire title, but a link is here.  She tells of the rules and new regulations but doesn't seem to touch on the reality of the career, or short time in those places.  I say short time because it's such a stressful job that most social workers quit after year one.

What makes it a stressful job?  Well when owners and corporations want you to knuckle under to their regulations and rules, plus federal and state rules and regulations, it's hard because all those often conflict with each other.

Owners and corporations want you to think 'don't bite the hand that feeds you' meaning them.  In reality, the hands that fee you and them are the people living there, paying to be there and lining everyone's pockets.  But the First pockets to be lined are the owners of the facilities. Make no mistake about that fact.

Institutions have become such big business that they spring up all over, from prisons for adults (both state and federal), county jails, group homes (which are nothing more than kid prisons or prisons for people with developmental disabilities).  These are billion dollar industries.

The book I mentioned also says nursing home social workers get a salary of $37,000 to $70,000...........Boy oh Boy, I'd like to work where she works.  Sorry, but usually if a social worker breaks $30,000 in one of those places, they are doing well.  She also mentions it's a predominately women's field.  Know why?  The pay is so damned crappy.

Don't believe everything you read.