Nursing Homes Are Full Of Elephants

The nursing home industry has a lot of elephants; no, not the four-legged kind with a trunk, the kind that are in the room taking up a lot of space that you have to tip toe around and not mention.

The first elephant is staffing. Nursing homes live or die by their staffing, The quality of care starts to decline if nursing is staffed at less than 4.04 hours per resident. That means a resident would receive an average of 4.04 hours of nursing care from someone, either a registered nurse, licensed practical nurse, or a nursing assistant, also called caregivers. Eighty percent of the direct resident care is provided by the nursing assistant.

Trailing behind the large staffing elephant are some of her offspring. The first baby elephant is the fact that many nursing homes never plan to staff at the 4.04 level. There is no federally mandated level of staffing, only the vague directive that there must be enough staff to meet the residents' needs. Many states also decline to require minimum levels of staffing, and many of the ones who do set such standards set them too low.

Another little elephant is the complication of staff members who call in sick, shrinking staffing levels further. Often there isn't anyone to call to come in on short notice. The workers who are there have to pick up the slack and do the best they can. Staff members are forbidden to mention they are working short. Residents and families usually realize this, from the longer time it takes for call lights to be answered and for cares to be completed.

What does this mean to the nursing assistant on the floor, trying to take care of the residents assigned to her? Instead of being responsible for dressing, bathing, toileting, and transferring eight people, she's often responsible for twelve to fourteen, or even more. She also needs to assist some of those residents with meals, get them ready for appointments, and answer their call lights. she's doing her level best to take care of folks, and she's working like a little donkey in a salt mine. She knows she wont' be able to finish everything, and she leaves work exhausted and discouraged.

Nursing assistants have a caregiver personality. They find joy and satisfaction in helping people, but they're only human, and can only work at that pace for a limited period of time. Pushed too far, they burn out and find work in a competing industry that isn't as physically and emotionally demanding. That is why the rate of caregiver turn over exceeds one hundred percent in some facilities. Nursing assistants barely are trained before they're moving on, and someone else is hired to take their place. The residents have to again get used to someone new helping them with personal care. They don't like it, would you?