SENIOR CITIZENS SQUEEZED BY NURSING HOME PROFITABILITY AND CALIFORNIA LAW REQUIRING MORE CARE FOR ELDERLY

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There’s no question it takes a special kind of person to provide compassionate care for the elderly. Bathing, feeding, medicating, attending to other daily needs of patients is a lot to ask for from the me now generation. Care giving for the elderly takes a lot of energy and thoughtful attention. There is tremendous value for this kind of work for the elderly in today’s society. But it doesn’t pay very well, which begs the question: Where does the position of caregiver for the elderly fit in the overall structure of today’s generation of aging baby boomers and broken millennials?

We’re not spending a lot to pay for difficult work like nursing care, that much has been established beyond doubt. Stressful work and low wages is a difficult combination to overcome during a questionably down-turning economy, but that, according to one group, is what we’re facing in our fight to protect the rights of our growing geriatric population.

They say our elderly citizens who require nursing care need qualified caretakers. Yet, it takes money to find someone who knows how to care for seniors and to be able to pay them, and the entire industry is scrambling for the almighty dollar that it takes to do so.

Latest available state data indicates CNAs are undervalued in the industry. Certified nursing assistants in California made an average of $13.96 per hour in 2016. That’s just a few dollars above the minimum wage and less than what some retailers pay sales clerks, who don’t need to spend the money or time getting licensed to work.

In a July 13, 2018 article for the Los Angeles Times, Ethan Millman describes how elderly healthcare matters in California have become hostage to this nursing home drama which is attributed to new state legislation that went into effect in July that puts even more “pressure on the state’s 1,000-plus nursing homes”, Millman writes, “which some in the industry say could be forced to turn away or even discharge patients as a result.”

ARE YOU KIDDING ME? OR IS THIS A BLUFF BY THOSE WHO RUN PRIVATE NURSING HOMES?

The new law tightened staffing requirements for direct caregivers and added new ones specifically for certified nursing assistants. Millman cites the new legislation as being championed by organized labor and patient advocates.

Under that scenario, we’d have the union representing nursing assistants, which pushed for the law, acknowledging that nursing homes face a challenge, but saying there is an overriding health-and-safety issue behind the new legislation. “There must be enough direct care staff to meet the quality care needs of nursing home residents and ensure a healthy workload for every caregiver,” Millman quotes an unnamed SEIU representative as saying.

The problem with this angle of course is that it places undue emphasis on the value of a CNA in this particular equation. The beginning of the statement is true — “There must be enough direct care staff to meet the quality care needs of nursing home residents,” period. Nobody of sane mind could conclude otherwise. We need better care for our seniors, and we must figure out how to pay for it. Whether every caregiver has a healthy workload or not is up to the caregiver’s skill set versus the demand for such a skill set in the everyday industry marketplace, and it’s a problem for the CNAs union to deal with, not state health care legislators. This aspect has nothing to do with the well being of the nursing home resident, whose need for quality care giving is being debased in the debate.

QUALITY OF CARE EQUALS QUALITY OF LIFE

As the new legislation reads, effective July 1, 2018, California Health and Safety Code section 1276.65 requires skilled nursing facilities, “except those skilled nursing facilities that are a distinct part of a general acute care facility or a state-owned hospital or developmental center,” to provide 3.5 hours of direct patient care each day, which is up from 3.2 hours. That’s 3.5 hours per day that the nursing facility caregiver has to directly care for a patient.

But what stresses out nursing home operators the most, and what seems to be the central theme of Millman’s writing, is California law’s first-ever requirement that “skilled nursing facilities shall have a minimum of 2.4 hours per patient day for certified nurse assistants.”

That means 2.4 hours of the 3.5 direct care hours per patient day must be filled by CNAs. And so the L.A. Times article is framed front and center around the nursing home gripe. Certified nursing assistants cost money. They have to be trained. Profits are shrinking. The big bad wolf is blowing down our door. What the article doesn’t tell us is that monies not spent toward better patient care get deposited into shareholders’ bank accounts, and that’s really the rub of this whole picture.

PRICE INFLATION HAS NOT HIT THE NURSING INDUSTRY

The Los Angeles Times article has framed this issue as a battle between the government enacting the law to provide more skilled health care to nursing home patients versus the burden it places on nursing homes to provide CNAs to fill the required hours.

The article portrays the nursing home industry as being in a quandary with the new legislation because, industry consensus says, it is difficult to get qualified CNAs to begin with, and now the requirement of 2.4 hours by a CNA is too tremendous a burden on the industry, especially in less populated rural counties. They say half of California’s counties are designated by the Public Health Department as having a CNA worker shortage.

The nursing home industry, through the Los Angeles Times article, sets up the CNAs as the tipping point of much broader issues. These are the men and women who work the front lines in home nursing, dealing hands-on with our wheelchair-bound seniors, those we pay privately and with tax dollars to give compassionate care to our elderly parents, friends, and relatives, yet price inflation has not hit those employed by the nursing home industry the way it has the rest of the economy, and we’re not getting our money’s worth. And who’s going to pay for it most?

QUALIFIED CNAS ARE SCARCE

When one studies what’s plaguing the home health care industry the areas for concern become obvious. Low wages and a high-stress working environment are not an attractive combination to offer a hungry, caring job seeker. When you add the prospective CNAs being required to take 100 hours of clinical training and 60 hours of classroom instruction, people are going to be looking for other types of employment.

They’re not going to take the time and expense to receive training through what amounts to be about 700 state-wide programs, many that are offered at community colleges, adult education programs, and for-profit schools, with most charging several hundred dollars to complete. Most people don’t have several hundred dollars or the time and inclination to make the effort to become a CNA. They can’t afford to.

Then you add the fact that nursing homes have just plain eliminated free in-house training to recruit workers basically because profits are down. No one has the money to pay anybody for anything. The nursing home industry cites tighter budgets. Those who want to become CNAs don’t have the money to go through the education and training to become CNAs. And senior citizens, their families, and the government don’t have enough money to be able to afford nursing home health care for seniors to enable them to spend the last months, weeks, or days of their lives in a compassionate and dignified manner.

THE NURSING HOME INDUSTRY CITES TIGHTER BUDGETS, BUT NEEDS TO LOOSEN PURSE STRINGS

This is the crux of the issue centering the problems cited by Millman. Nursing homes are owned by corporations owned by their shareholders. The list of corporations owning care facilities across America is short and those that do are locked in a dog-eat-dog battle to the death with each other and converging industries to suck in what dwindling profit margins there are left. Mergers and acquisitions are rampant in all areas of health care.

Who has time or resources for patients? The nursing home industry is making across the board cuts in staffing, training, and compassionate care for their senior residents. This is happening across the country as evidence mounts that those who own nursing homes should be loosening their purse strings and offering training and better care at their rural facilities, because their senior residents are suffering at an alarming rate as a direct result of their industry-wide, self-imposed budget cuts.

UNCLE SAM NEEDS TO LOOSEN HIS PURSESTRINGS AND COVER THE COSTS OF HEALTHY HEALTH CARE

Nursing homes come in all shapes and sizes. Some are more upscale and receive private pay for income, with much of the rest coming from Medicare.

In California, the majority of nursing homes draw more than half their revenue from Medi-Cal, the state program that provides health services to low-income residents, which the industry complains doesn’t cover the cost of care.

This only exacerbates the shameful problem that pay isn’t high enough across the industry to provide for adequate and dignified care giving for our ailing senior citizens. Both private nursing home providers and government health agencies must be willing to budget more money into healthy health and nursing care for seniors. Private care facilities, many of which are run through giant real estate trusts or conglomerates, must find a way to operate their holdings to actually benefit those who seek their services. A new model in the way of doing business industry wide is mandatory, or they are simply going to go out of business. Nobody can afford their poor service.

CONCLUSION: CALIFORNIA SENIORS ARE TAKING A BRUTAL HIT

The proof is in the pudding. Just ask the California state auditor who singled out the California Department of Public Health for scathing criticism regarding skilled nursing facilities and their lack of performance of necessary “inspections or issued timely citations for substandard care.” They cite absent effective oversight and substandard quality of care, a deadly combination. This apparently means the reason the nursing home industry continues to fail our seniors is because the government isn’t doing its job by monitoring them adequately.

The California governmental agency responsible for nursing home operators rightfully took a hit for having allowed poor care to proliferate at nursing homes around the state, with the number of incidents that could cause serious injury having increased significantly in recent years. The California state audit concludes that the California Department of Public Health’s failures in oversight increase the risk that nursing facilities may not provide adequate care to some of the state’s most vulnerable residents. Safety and accountability problems at nursing homes across the United States are rampant, says the California State Auditor.

Federal inspection reports show that infection control is routinely ignored in nursing homes across America. To exacerbate matters, the Trump Administration has scaled back the use of penalties to punish nursing homes that put residents at risk of injury. This compounds the issue cited by the audit where in a vast majority of cases government investigators found problems that could severely harm patients, the public health department failed to cite or fine the facility involved. Who’s watching out for the seniors?

It is disturbingly clear that the public health department in California is not holding nursing homes accountable for what amounts to be crimes against the elderly. Neglect can be criminal. The government needs to regulate this industry. It also needs to make sure there are enough beds in nursing homes that can be attended to for 2.4 hours per patient day by a registered CNA, and 3.5 total hours of direct skilled attention each and every day. Government health agencies and the nursing and home care industry are going to have to be brought together in the most unlikely of marriages, or a large segment of our growing numbers of senior citizens is going to dwindle and suffer at a much greater rate than is necessary.

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DYING WITH DIGNITY; WHO FAILED THE ELDERLY WOMAN? THREE GIRLS? THE ASSISTED LIVING FACILITY THAT HIRED THEM? OR WAS IT US?

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It really doesn’t make any sense, but that’s just a sign of our times, right. Make jokes, flip the bird, smoke a vape pen. Feed a habit. Ignore responsibilities. Disrespect life. Who cares?

They’re just kids, though, right, so they can be easily forgiven. In this case they were responsible for a 76-year-old-woman who’d just suffered a stroke and lay dying in a Georgia hospice. Nothing to worry about, right? Third page news.

When I first read the story on Newsweek.com, it seemed so obvious where the blame for it all should fall, and of course it did with the arrests of the three young women / girls who made the video. I call them girls because that’s what they are, two 21-year-olds and a nineteen year old; lacking in development of working conscience, little if any consideration of consequences for their actions, a lack of maturity and a stunted development of sense and responsibility. Many teens suffer from these same symptoms. Adults too. It’s contagious in today’s society. It’s the way our kids are wired; breathing computer games, iPhones and chemtrails instead of life’s realities and healthy nutrition which swirls past them undetected.

So I call these three clueless young women kids because they did what kids do. Only different. Only indifferent – indifference being the operative word here, by all parties involved. Indifference manifests in many forms and in this case as childish, careless inattention that happens when kids are given too much responsibility by someone who shouldn’t be giving it to them at all. With responsibility comes a price that many senior healthcare facilities seem unwilling to pay.

SO WHAT DID THE KIDS DO?

The kids did the despicable on June 13 inside Bentley Senior Living in Northminster, Georgia. Too much responsibility for two 21-year-olds and a nineteen-year-old teen who would later be charged with exploiting an elderly and disabled person and for their dereliction of duty. The elderly woman would soon die. She had a stroke and the senior facility was waiting on a hospice nurse. It was going to be an extensive time before the hospice nurse would arrive, so it was the job of these three girls to closely monitor their patient until the hospice nurse arrived.

The dying elderly woman was said to have had difficulties swallowing and moving around, and there was a threat that she could choke or fall from her bed. That’s why the girls were there, to make sure that didn’t happen.

But the girls weren’t really concerned about responsibilities or their patient, because, well, after all, they are millenials. And sometimes millenials get bored or their ADD symptoms kick in and they just don’t have the time or attention span in their little heads to care for dying, bedridden seniors. Face it, healthcare in a senior home does not resonate at the same excitement level as iPhones, videos and Snapchat.

One of the girls decided to bring them all to life at once, and suddenly there was no more boredom. Now one of the girls was making a video and someone else was smoking a vape pen, and there were profanities and one of the girls was making obscene hand gestures into the camera. And it never occurred to their three millenial minds to do anything about the septuagenarian woman laying motionless from a stroke in the bed in the background.

When the girls were finished with their production they would post it on Snapchat labeled “The End.”

SO WHOSE FAULT IS IT ANYWAY?

It wasn’t just the girls involved in this who were culpable. Sure the girls were callous and indifferent with their duties, and they were rightfully arrested and charged with elder abuse. But my question is where were all the adults in the room when this was taking place? Who was these girls’ supervisor at the time this infamous video was being made? As the associated news articles might suggest, this is not necessarily an isolated type of incident, one where fate had these three girls gather in this room to commit this heinous deed on a one time basis only.

WHY IS THERE NO DIGNITY IN DYING?

The question here is whether there is such a thing as dignity in care giving at senior nursing homes anywhere? I want to know where the concept of dignity with dying is in relation to where America’s priorities are. Sure an employee of Bentley Senior Living discovered the video a couple days after the incident and the police were notified, but what if that employee hadn’t seen the video on Snapchat? There was going to be no dignity in dying for this 76-year-old woman either way. Could this have been avoided?

Did anyone really do the research to see who these girls were before they were hired to care for dying, bedridden senior citizens? Did these girls have any experience in caring for the elderly? Did any of them produce passports when they applied for their jobs?

COULD ONE OF THEM HAVE BEEN AN ILLEGAL?

One of the girls might have been in the country illegally. This creates a whole new series of issues when it comes to home and healthcare for the elderly. How can we hire people we can trust to care for our elderly when we don’t even know where they come from?

An article on onlineathens.com reports that the two twenty-one-year-olds were released on bond after their arrests and the teenager was reportedly still being held for U.S. Immigration and Customs Enforcement. Why would Immigration and Customs hold a perfectly legal woman? Was the nineteen-year-old in this country illegally? If not, then why the immigration hold?

BENTLEY SENIOR LIVING SAYS THEY ONLY HIRE LEGALS

There have been no claims that the three girls or Bentley Senior Living had anything to do with the cause of the elderly woman’s death. According to NBC affiliate 11alive.com, Bentley Senior Living at Northminster delivered a statement claiming that no resident’s condition was compromised as a result of this “unfortunate event.”

Bentley Senior Living says that all employees must produce the required documentation that proves they are either U.S. citizens or legally permitted to work in the United States – which the three girls did. “We do not hire illegal immigrants,” the Bentley Senior Living statement reads. “An ICE detention does not mean an individual was working illegally.”

Then what does it mean? The two girls without ICE detentions are out on bail. Either way this is only one instance of abuse that happened to get caught on camera. There was no disputing the evidence in this case, and there may have been other types of incidents. The 11alive.com article quotes Jefferson Police Detective Jay Parker as saying police have been called to the facility prior to this instance, but never for anything as serious.

OUR SENIOR CITIZENS DESERVE BETTER

The bottom line is our senior citizens deserve much better than what they’re getting, and their lives depend on it. Dying with dignity is an important act with spiritual significance. We all deserve respect from those who care for us. This case of the three girls is evidence of abuse against a fragile segment of our society. The sad part is we know these kinds of events run undisclosed in the many corners of the elderly healthcare world. We have a greatly aging population merging into a society that has no true infrastructure in place to adequately care for them or the financial resources to hire the qualified people to run it.

Seniors in the private sector and senior military veterans are aging at a time when America does not put her resources toward their benefit or improvement of the quality of their last days alive. The entire healthcare system, including basically all of Western medicine, the governments that oversee healthcare, and the pharmaceutical complex, are all involved and intermingled and they won’t change their model of practice until we change them.

The aspect the article of the three girls brings up at its core is about the money being spent to hire competent caretakers at for-profit elderly care facilities to care for aging senior citizens in a dignified and appropriate manner. These issues will ultimately have to be addressed by those who represent the elderly and our military veterans. It takes money to hire better and more highly qualified people to care for our elderly. Hopefully this article will help bring needed attention to these serious issues.

Our legacy as a generation and as a nation will be measured by how much humanity we express toward the vulnerable segments of our population. Resourceful healthcare for our elderly and veterans must be a number one priority in all our communities.

Senior citizens are amongst our wisest and most valuable resources. There is so much wisdom and insight we can gain from them if only we take the time to listen. Their voices are soft. Listen closely. Give peace a chance. Make putting profits in shareholders’ pockets by sedating our elderly a secondary factor to providing better quality of life to our growing, aging population. This will only come through major changes to our healthcare paradigm and how much we pay whom to take care of our elderly. The old axiom that you get what you pay for has never been clearer. Just ask the three girls we put in charge.