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. 

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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Activity director in a nursing home

It's really hard to cheer people up in a nursing home.  Everyone knows they do not have the freedom they once did when living in their own homes.  They cannot go shop whenever they like, they cannot just decide to go have lunch or coffee out in the community whenever they like.

Activity Directors in nursing homes have their work cut out for them.  Before I was a Social Services Director, I was the Activity Director in a nursing home.  Corporations are so cheap, they do not see activities for seniors as anything useful, nor do they like to allocate much money for activities.  It's also very difficult to recruit volunteers to come in and provide entertainment for free.

It's kind of a myth that all seniors love to play bingo and as Boomers age, well, most of them have little interest in bingo.

There are good Activity Directors and there are mediocre ones and then of course, there are bad ones.  The one nursing home I worked at thought that Garfield cartoon movies appealed to the elderly, when in reality they liked things like The Notebook and such.  You know, real movies for adults.

I have to say the Senior Prom was another idea I disliked very much.  Most seniors liked working on quilts, having bake sales, interacting with animals and gardening.  

The Activity Director at one home, didn't see any reason to work with Social Services either in helping to alleviate what staff liked to label behaviors.  It takes all staff to help find residents things to do, meaningful things to do.

We had one lady who had worked at a department store since she was 16 years old, at 90, she missed feeling useful.  I begged activities to find her something meaningful to do, to no avail.  Hence this poor lady was pegged as having behaviors because she complained about being idle. 

If you become an Activity Director, or are one, remember all the useful and meaningful activities in your life that make your life worthwhile.

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

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.  

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Social Work in a nursing home

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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. 

Nursing home diaries

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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. 

Nursing home diaries

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The Administrator decided today to have the Activity Director try and bring in Culture Change.  I suggested Culture Change, but she wasn't listening, as usual. I get the picture, this Administrator is not truly interested in real Culture Change, she is trying to use it as nothing more than a marketing gimmick.  This pisses me off so badly.  I want to kick her in her big fat butt!

Culture Change is when the entire nursing home works together, with the Administrator, who is the only one with the authority to usher in real changes.  The rest of us are simply peons.  

Real change is getting rid of those damned nursing stations.  They can be placed in offices, not in the center of the residents' home.  I do not have one of those stations in my living room, I trust you do not either.  Medicines should be administered individually, not to everyone at meal times.  When the Administrator asked how that could happen, I told her about a wonderful invention called a medicine cabinet, just like we all have at home.  When she asked about keeping others out of the medicine cabinets, I reminded her of another wonderful invention, called a padlock.  Wow, that's a no brainer.

Make every room a one person only room so each person can have more personal items and can look out the windows whenever possible.  Nursing homes would not lose money, they can charge a bit more per room, surveys show families would gladly pay a bit more for a pleasant living space.  

Small groups can be permanently assigned to the same group of seniors every single shift, whenever possible.  Studies show that smaller groups of permanent aides cuts down on seniors' stress levels and thus cuts down on the use of psychotropic medications.  OK, I know pharmacies have a nice little racket going on forcing medications on seniors, kind of like the racket for drug testing welfare recipients.  Get over it pharmaceutical companies.  

Invite the aides for each resident to the care plan meeting because they know more about the resident they are assigned to than the damned nurses do.  Nursing homes are set up for the convenience of staff, not as a nice home for the paying customers. 

This is just a start.  But it's a good one.  No having to build whole new buildings or anything, just shuffle things around in the ones they already have.  

This can all be done, it is doable.  If you have a loved one in a nursing home, talk to other family members, press the facility for Culture Change, any Culture Change is better than none.  

There are many other changes they can do, I will list those on another blog.  But these are a good start.