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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