Fighting For Family Members in Nursing Homes

Whether your family member is in a nursing home or rehabilitation facility short or long term it is extremely important to be vigilant about their care. While many assume this is the responsibility of the facility providing care, do not become complacent and assume this is what actually occurs. Reality is often different. Many family members overlook or excuse the small things. A person not bathed frequently, a dirty room, increasing confusion or anxiety. There are so many things that can and do happen and if left unchecked continue to progress and become critical.

Consider the case of a father who had surgery and went for short term rehab. As a result of the surgery, this individual because anxious and extremely depressed. His daughter, knowing that dad had episodes of mental illness all of his life discussed this with the facility staff who mentioned it to the on call physician. The physician, having no background in mental health, prescribed ativan, a medication typically prescribed to calm anxiety. This worked for a brief matter of time until dad became increasingly depressed, a risk to self and according to the facility required 24-hour supervision which the family was forced to pay for privately if they wanted their father to continue to receive care.

More concerns were expressed by the daughter. The physician, again having no background in mental health, requested that a mental health social worker visit and make recommendations. The social worker proceeded to recommend an anti-psychotic medication that the physician prescribed. Unfortunately, dad had an immediate psychotic reaction from the medication and was transported to the local hospital emergency room for medication issues. In spite of the daughter requesting that the hospital emergency staff find a way to have her father evaluated from a psychological standpoint, they simply sent him back to the nursing home under 24 hour supervision.

This is a clear case of a daughter recognizing the needs of her father and the system failing to respond. The daughter, highly educated and intelligent, had no idea how to work within the system to achieve the desired result for her father. Fortunately I was contacted the evening of the hospital emergency room event and spent the next day having her father complete the requisite admission tests for acceptance into a psychiatric evaluation center.

It is important for families to understand that the health care system has limitations; that skilled nursing and rehabilitation facilities have limitations to the care they can provide. Even physicians, many who are general practitioners, are limited in their expertise. And that eventually the time comes to consult individuals versed in the situation with access to a wide range of resources. It is easy to assumewhat we know; yet more difficult to admit we lack the expertise to care for a family member. Many individuals experience panic in failing a family member because they do not know what to do. The best course of action is to admit help is needed and contact a professional who can help navigate the system.

Best Practices: How to Identify the Best Practices to Improve Productivity for Your Hospital

Google the words "best practices," and you will find about 75 million internet pages addressing the topic. Google "hospital best practices" and the list shrinks to a mere 9 million web pages. That this two-word phrase so quickly became a universally-recognized part of the management vocabulary is hard evidence that consultants have been at work.

It's all about timing (and a few other things)... Add the buzz word-like popularity of "best practices" to the staying power of a much abused saying "There's no point in re-inventing the wheel", stir in the culture's insatiable hunger for instant results, and shake well. You now have the potential makings of real trouble.

"Best practices" have been defined as "documented strategies, activities and approaches shown through research and evaluation to be effective in achieving the highest levels of excellence in productivity, profitability and competitiveness." Part of the concept's appeal is its elegant simplicity. Find the best way to do something and copy it. Problem solved. Ah, if only it was that simple.

Famed management guru Peter Drucker described the modern hospital as "the most complex social organization ever designed by man." That complexity is a fact. For that matter, so is the department head's frequent claim of "uniqueness." Every hospital differs from all others in literally thousands of ways. These differences exist even among peers that share the same basic mission and challenges. Here is a short list of hospital-to-hospital differences that can be found in countless combinations and permutations of combinations, each with tremendous implications for productivity, profitability and competitiveness:

• Systems and Work Process Factors
  
  • Patient access.
  
  
  • Nursing care delivery.
  
  
  • Medication administration.
  
  
  • Order entry.
  
  
  • Results reporting.
  
  
  • Care documentation.
  
  
  • Patient discharge.
  
  
  • Supply inventory and control.

• Organizational Factors
  
  • Organizational structure.
  
  
  • Planning.
  
  
  • Information dissemination.
  
  
  • Employee work schedules.
  
  
  • Patient appointment schedules.

• Resource Factors
  
  • Clinical equipment.
  
  
  • Information systems.
  
  
  • Supplies.
  
  
  • Human resource numbers, skills and training.
  
  
  • Physical space adjacencies, size, and layout.

• Business Assumption Factors
  
  • Mission and vision.
  
  
  • Strategic goals.
  
  
  • By-law requirements.
  
  
  • Resource commitments and constraints.

• Organization Cultural Factors
  
  • Management focus.
  
  
  • Work ethic.
  
  
  • Employee commitment and buy-in.
  
  
  • Medical staff expectations.

The greatest shortcoming of the "best practices" concept in the long term is that it serves to stifle management creativity. Imitation by definition cannot produce progress. It would be more accurate (and instructive) to re-label the "best practices" concept to something like "best practices that we know about--so far!" More practically, the sheer number of performance-defining variables makes it impossible to identify with certainty those "strategies, activities and approaches" that can or should be universally emulated. The likelihood that visits to "best practices" hospitals will identify an exportable "cause" of high performance that will work in your hospital is vanishingly small.

Is it not interesting that the same managers who are quick to employ the "uniqueness argument" as a defense against adverse performance comparisons are usually among the first to insist that the best way to resolve the variance is to import a solution from "high performers" in their peer group? Aren't these the very departments that were previously claimed to be so dissimilar as to make performance comparisons invalid? (Note: These differences do not negate the value of benchmarking so long as peer groups are selected correctly.)

Although imitation has been described as the most sincere form of flattery, as a technique to advance performance improvement in the modern hospital it may not produce the best results. After all, it does not matter in the least that Mercedes Benz has the best transmission in the world if that transmission cannot operate in your Buick.

We suggest the following approach to applying the "best practices" concept in any hospital:

• Look inside your organization first! Identify performance limiting factors. Consider both the cost of "fixing" those factors as well as the cost of not fixing them. These may involve:


• Systems and work process factors.


• Resource factors.


• Organizing factors.


• Business assumption factors.


• Hospital culture factors.


• Specify target outcomes. In other words, describe the conditions the hospital wants to exist as a result of resolving performance-limiting factors. Quantify them when possible.


• Select, develop, and implement the solution that will work best in your hospital. Consider the institution-wide effect on all departments, the medical staff, and other stake holders. In some cases, the best solution can be internally designed or purchased "off the shelf." In other cases, a customized solution may be necessary.

It is during this last step that you might consider emulating "best practices" from other hospitals or industries but only after the potential solution has been thoroughly evaluated to insure that it fits the unique operating and cultural characteristics of your hospital.

Hospitals have expended much treasure, time, and energy attempting to import "best practice" solutions that had great initial surface appeal but ultimately proved to be unworkable because of internal factors. The solutions that will work best in your hospital will necessarily be those that most closely match your organization's unique characteristics.

穢 1990-2011 Frank J. Brady & Associates, Inc.

Advocate For Senior Citizens - Protecting Against Abuse and Fraud

Ruth is 87 years old this year and has been living alone since 1997. She is in good health, however the daily chores around the home became increasingly difficult. Ruth turned to her church bulletin and found a ‘Home Care Company’ advertised.

Ruth is not unique in the fact that she is widowed and lives alone. According to the ‘2002 A Profile of Older Americans’ published by the Administration on Aging ([http://www.aoa.gov/aoa/stats/profile/4.html]) 41% of women age 65 and over, are widowed and live alone.

“The ad was in the church bulletin, I assumed this was a good company,” her voice cracking from the pain and embarrassment this home care service eventually caused her.

Unfortunately, Ruth is also not alone in the fact that she became victim to fraud. According to U.S. Senator Larry Craig, past ranking member of the U.S. Senate Special Committee on Aging, ‘Vulnerable elders are being abused, neglected and exploited within their own homes and communities at an a alarming rate.’

“The lady they sent to me was well groomed, she was polite, and I had no reason to distrust her. You could tell she was from a good family …” Ruth went on to justify how quickly she was robbed of $4,200.

Barbara Mascio, founder of Senior Approved Services, states “Ruth’s story was just one of many incidences of abuse that I learned of while employed with a national home care company. The stories of abuse and fraud against this precious generation became the driving force behind the creation of Senior Approved Services.”

Senior Approved Services actively assists in protecting seniors by helping to connect them with businesses that have a verified history of providing excellent care. “We remain actively involved, a link between the senior receiving care and the business providing the care.”

“We are building a nationwide network of services, resources and products that seniors and their family caregivers can feel safe in contracting with. We are inviting all those concerned with the right of all seniors to receive excellent and safe care to help.”

Elder Abuse Prevention in a Nursing Home With a Spy Camera

As the general population ages, more of our elders spend their final days in a nursing home. If you think they are free of abuse there-forget it! It has been reported that one of six nursing homes or assisted care facilities report some type of elder abuse. That is a scary stat.

The abuse can come in many shapes and forms-verbal, psychological, physical of course and mental abuse are all reported. For patients with Alzheimer disease abuse seems to be higher with theft being much more common.

If you have loved ones in such a facility how do you go about catching it? One of the best ways is with a hidden spy camera or common spy camera foe elder abuse prevention.

There is a new generation of spy camera with a DVR built in. These new high-tech hidden spy cameras are basically simple board cameras hidden inside everyday household or office objects. The more common the better. Most are working products that can further carry out the deception. Some examples include clock radios, tower fans, air purifiers, exit signs and more.

The DVR has an 8 GB SD card that can record up to 144 hours of activity. Motion activation is a feature along with area masking and a date time stamp. The motion activation feature could allow up to a weeks' recording depending on the activity level.

These new DVR hidden spy cameras make covert recording of potential problems very easy and by comparison very cheap. Be proactive and stop elder abuse with your folks now.

When are you getting one?

Doctor House Calls at Assisted Living Facilities - How They Help Families and Residents

I'm here with Margie Veis, the Executive Director of Summerhill Villa, an assisted living facility in Santa Clarita, California.

KH: How long have you been doing this?

MV: I have been an executive director for ten years, all of them at Summerhill Villa.

KH: One thing I really liked about mom's gerontologist was he came here, actually making house calls. The fact that mom didn't need to go to his office was a real benefit to me and brothers. Is that a trend among doctors that have patients in assisted living?

MV: I know the few physicians that do that. I'm probably not knowledgeable enough to know if that's a trend or not, but I know in Santa Clarita there are a few and we utilize them.

KH: It occurs to me that having the synergy between the staff and the doctors watching out for the parent all the time is a huge plus.

MV: It's great when we have a good relationship with the physician that we know is going to answer our fax or answer our request when we pick up the phone and say: "We have these concerns. What do you think?" and work together to better treat our residents. It's a great benefit.

KH: Families might not get that at home - that constant awareness of what's going on with their parents.

MV: No, because if they're at home it's up to them. Here they have many different sets of eyes looking out for their parent. They have food servers, they have a nurse, they have an administrator, an activity director, a bus driver, the house keeper - everybody is looking out for their best interest versus it all just being on the family.

KH:: Or whomever they hire for home care.

MV:: Or whomever... Right... If they have a caregiver, it's only one perspective.

KH: And it's not 24/7.

MV:: Not unless you pay for 24/7 care.

Caregiver Certification and Training Programs

Employment as a senior caregiver brings fulfillment beyond a paycheck.  Job duties include assisting with meals, laundry, medication management, daily exercises, bathroom visits, bathing and maintaining a clean household.  In addition, companionship is an important part of senior care as friends may have passed away and family members may live far away.

What are the employment opportunities for senior caregivers?

• Nursing Home Nursing Aide


• Hospital Nursing Aide


• Assisted Living Nursing Aide


• Senior Home Care Agency Caregiver or Nursing Aide

What certifications are required?

Nursing homes and most Assisted Living communities will require caregivers providing hands-on assistance to be certified as a nursing aide or home health aide and some senior home care agencies also require certification for some assignments.  However, the specific certification varies depending on the requirements of your state's department of health.

Training for most certification programs requires classroom work, along with field work where the caregiver will work in a hospital or nursing home with the supervision of the trained staff.  Most certification courses for nursing aides and home health aides require the following for admission:

• High School Diploma or Equivalent


• Criminal Background Check


• Turbeculosis Skin Test


• Reading Comprehension Exam


• English Competency


• Drug Test


• Minimum Age of 18

A state exam must be passed for final certification.  The cost of certification programs can be from $600 to $2,000 and often financial aid and grants are available, especially through community college programs.  Caregivers increase their job prospects by becoming certified and are able to show potential employers that they have an understanding of the basic skills needed to safely provide care for a senior. 

If you are thinking of obtaining certification, research programs early and talk to other certified caregivers to learn about the challenges they experienced.

Pass CNA Exam and Earn Certification

The importance of CNA Exam can be best understood by the fact that, if you pass the exam, you will get registered with state Nurse Aide Registry. The registration also provides legal working permission in the hospitals, long term care facilities and other health care settings.

CNA Exam is also known by different names, such as Competency Evaluation Test, Certification Exam and Licensing Exam. The Exam is regulated and managed by the State Board of Nursing (BON), and administered through BON, D & S Technology, American Red Cross, Prometric and Pearson Vue.

But, it is also true that to get the eligibility to appear in the Certification Test, a student must attend and complete the state and OBRA-87 approved CNA Training Program. Though, training programs can be attended through various schools, community colleges and technical institutes, the programs offered by the American Red Cross in 36 states of America are termed as the best.

In few states, such as Hawaii, Massachusetts and Georgia, the American Red Cross is authorized to administer the required Nurse Aide Competency Evaluation Exam (NACEE) also.

Massachusetts Red Cross CNA Exam

Any student, aiming to get certified in the state of Massachusetts as a Nurse Aide, must complete MS State approved Nurse Aide Training Program and sit for the Red Cross offered NACEE.

The Nurse Aide Test has two separate parts - the Written/Oral Test and the Clinical/Skill Test.

The Written/Oral Test comprises of 60 multiple choice CNA Exam Test Questions and administered in a group setting. The time limit offered to complete the test is two hours. The students have the option to appear for either written test or oral test. The Oral Test is provided through a CD player and only ARC Regional test sites conduct the oral tests.

Clinical/Skill Test is offered individually and administered in a scenario, where candidates are asked to replicate providing care for a resident. The test administrator evaluates each skill demonstrated by the individual candidate on a live model.

Both the Written and Skill tests are independent of the each other and can be taken in the same day by the candidates. If any candidate fails in one test, he/she is still permitted to sit for another test. The candidate has to pass both tests to earn Certification.

The candidate is offered four chances to clear the written test and three chances to pass the skill test. The failure to pass the exam in the offered chances, require retaking and completing CNA Training Program once again.