(Editor's Note: With this column, Jean Donahue returns to writing her popular column
Practical Caregiving. Jean's writing frequency will be biweekly, and you will find the same warm and practical advice -- based on her experience -- that marked Jean's 100+ columns before she left for her own version of "caregiver respite." We're pleased to welcome her back, and Jean looks forward to once again receiving your emailed questions and comments at ASKJEAN@caregivershome.com.)
It’s good to be back. I missed all of you!
The December 5 issue of The Caregive'rs Hotline
highlighted a situation where a certified nurse's aide (CNA) from Iowa was fired because she notified the family of a resident/patient about what she described as poor care. On top of that, the professional caregiver was denied state unemployment insurance. It turned out that she saved that person's life.
I wrote a Letter to the Editor to the Des Moines Register (our newspaper that covers the state of Iowa) about that situation. My letter was published on December 12. To my surprise, I received a letter from a lady in a different city who said she had been fired for reporting abuse to the Board of Directors of a care facility, instead of to the family. She did receive unemployment insurance, but that's little consolation for losing her job for trying to do the "right" thing. She reported the problem through the chain of command at the nursing home instead of going to the family, and that's the more appropriate routing, it seems.
She said every family member should watch for signs of bad care because it happens more often than we want to believe. One problem is that if someone reports abuse, they will lose their job. Then they would be in the situation she is in. After 14 years working as a CNA, she can't find a job in that field. She said, "I was told I knew too much!"
Remember the old saying, "sweep it under the carpet?" For those of you who haven't heard that term (it might be a Midwest saying that my parents used from an earlier time), it means you don’t talk about or tell anyone about any problem that is embarrassing or illegal. Well, this type of thing has been swept under the carpet too long. It does happen. We all need to be on the alert for it happening to our loved ones.
Don't assume that your loved one is properly cared for just because they are in a state-certified facility. That facility is run by people, and people do the actual care. And, of course, no one is perfect. The CNAs, nurses, and other employees at the facility are quite often overworked and underpaid. Sometimes they work well over the 40 hours a week we all expect to work.
The good ones get frustrated because they can't do what they believe they need to do. They don't have enough time. The employee background check does not always show that someone may neglect those under their care. It will show if they have been charged with anything, but too often they will simply get fired if they neglect someone. They can then go on to another facility and get a job where they neglect more people. It can be a bad cycle.
Another thing to remember is that quite often, there are not enough state Inspectors to adequately check-up on these facilities -- at least I would call it adequately check-up on the facilities. To adequately check-up means they would visit often enough and at various times to see what is being done wrong as well as right. I haven't checked each state to determine the total number of inspectors, but I am instinctively sure the number should be at least doubled. I hear about too many facilities having problems all over the United States for there to really be enough inspectors today. They are doing what they can, but they need more people. And this problem will worsen as the elderly population continues to grow.
Below is a copy of my letter to the Des Moines Register. Please read it with your loved one in mind, and do a little extra to make sure they are well taken care of.
The Nov. 27 story "Nurse Aide Fired for Alerting Patient's Family of Poor Care" is a very sad commentary about how something necessary can turn into something very, very bad. Too many people in nursing homes suffer neglect and are left to suffer and die because of inadequate care.
There are ways to watch the care your loved one is receiving. Drop in on the nursing home at various times of the day and night, unannounced. Eat meals there occasionally. Get to know the staff as friends, rather than as subordinate people. Talk to the nursing home's doctor. Learn the procedures for complaints.
There is something else everyone should know: There are the official procedures and regulations, and the "unofficial" procedures and regulations. The unofficial procedures and regulations are how things actually work in that particular home. To learn those, you need to watch and listen when you are there. Observe what is going on in the facility.
In an ideal world, that nurse's aide would never have been put in a situation where she had to decide between letting an elderly person die from neglect or make the phone call she made. However, this is not an ideal world. We all need to be on the watch for bad care. Some day in the distant future that could be you or me who is being neglected.