Friday, October 01, 2010

How to Pick a Nursing Home: Talk to CNA's, Staff

While looking at nursing homes for my mother, I always asked the tour guides if I could talk to the nurses’ aides. This seemed to me a logical request. After all, these were the women — and they were all women — who would spend the most time with my mother, who would notice small changes that raised big questions, who would make her feel cared for. Or not.

“They don’t do that,” I was told almost everywhere I visited.

I soon realized why. In casual conversations in hallways and dining rooms at more than a dozen facilities, I found only one nurses’ aide who had been on the job more than six months. I was witnessing in real life one of the most dismal statistics in long-term care: More than 70 percent of nurses’ aides, or certified nursing assistants, change jobs in a given year.

Then came the tour guide who didn’t say no. “No one has ever asked that before, but why not?” the marketing director of a New Jersey nursing home said in response to my request. He said he would ask three aides then on break if they wanted to talk to me. They said yes.

I asked how long they had worked there. One said 12 years; another, 8. The third answered: “I’m the baby. I’ve been here four years.”

I decided this was the place for my mother. These women used the word “we” when talking about the nursing home, making clear that they felt a sense of ownership. And it seemed significant that the marketing director asked their permission before allowing me to impose on their break time. Moreover, he trusted them enough to leave me alone with them in the break room.

That was 10 years ago. I do not know exactly what I would find today, but the overall situation has not changed. The reasons for the high turnover rate among nurses’ aides are the same as they were then: low wages ($10.48 an hour on average), poor benefits, high injury rates and lack of respect on the job.

What has changed is that the industry, the federal government and the states have all identified the turnover rate as a crisis in long-term care, particularly with demand poised to soar as the baby boom generation ages. Researchers have found that high turnover in a facility corresponds with poor quality of care — more bedsores and more use of restraints, catheters and mood-altering drugs. That is, more reliance on medicine and technology, less on relationships.

“Cycling in aides who don’t know you is very disorienting and upsetting, and the resident is the one who suffers on the quality end,” said Peggy Powell, a senior staffer at PHI, formerly known as the Paraprofessional Healthcare Institute, a nonprofit group focused on improving the front-line work force in long-term care.

In nursing homes with high turnover rates, certified nursing assistants tend to leave within three months, often because of inadequate training and support to juggle multiple frail, ailing residents at a time, according to Robyn Stone, senior vice president for research at the American Association of Homes and Services for the Aging. Once aides leave, everyone else must pick up their caseloads, and the stress of the job rises.

Culture change initiatives are under way in nursing homes around the country to make aides’ jobs more fulfilling — not so much through better pay, but by offering better training, more responsibility and more respect from superiors. The aides at my mother’s nursing home had all this, plus health and pension benefits.

Ericka Dickens had been there for nine years when she became my mother’s aide. She had the patience and experience to navigate my mother’s stormy moods as her dementia worsened, to notice immediately when she was feeling weak or sick. Sometimes I would arrive in the early morning to find Ms. Dickens sitting beside my mother, holding her hand and talking to her.

I hadn’t seen Ms. Dickens since shortly after my mother died six years ago. Recently I called to see if she still worked at the nursing home. I discovered that she is now in her 20th year, currently assigned to the physical therapy department. I visited her there and found her assisting a resident who looked up at her at one point and said: “Oh, Ericka, you look so good. You always look so good. You’re a good friend.”

I asked what made her want to stay in the job all these years. She said she always felt respected and supported, but the anchor for her and others is the bond with residents. (There were five other aides from my mother’s era on the afternoon shift that day, including one who had been there for 25 years.)

“We have reminiscences about this person and that person, how we used to love this one and how we used to love that one,” Ms. Dickens said. “They become your family. A few weeks ago, someone passed away, and Winnie and I went to the wake. Her daughter was so happy when she saw us, she started crying. And you feel: ‘Yes, I did something. I’m part of something.’ It’s really fulfilling.”

Monday, September 27, 2010

Lawyer: Flap in McCourt case may cost firm millions

A Boston attorney who handles legal malpractice cases said an error in a postnuptial agreement could cost the Bingham McCutchen firm millions.

“If I was a client and I lost the division of property assets based on faulty paperwork by another law firm, I would explore the possibility of going after that law firm,” said Bernard J. Hamill, a legal malpractice attorney in Boston.

At issue in the divorce case of Los Angeles Dodgers owner Frank McCourt and his wife, Jamie, is the wording of the agreement signed by the couple in happier times in 2004. Three copies of the documents reportedly use the word “inclusive” - making Frank McCourt sole owner of the team - while three other copies say “exclusive,” which would make Jamie McCourt a co-owner.

“It seems odd to have the whole issue turn on a word, include or exclude,” Hamill said. “Without seeing the volume of paperwork, it sounds like it could be a drafting error.”

Larry Silverstein of Bingham McCutchen, who once represented Jamie and Frank McCourt, denies he committed fraud when he switched a key portion of the postnup.

Silverstein was on the witness stand yesterday for the third consecutive day in the couple’s divorce trial. He rejected an allegation from Jamie McCourt’s attorneys that he and Frank McCourt engaged in fraud when the correction was made without telling their client. Frank McCourt also has denied the claim.

Silverstein says he fixed a mistake in the agreement to give McCourt sole ownership.

Jamie McCourt is seeking a stake in the Dodgers under California’s community property law.

The trial is slated to take a break today so attorneys can go into mediation, according to a person familiar with the case.

Lawyer: Flap in McCourt case may cost firm millions

Take care to read the fine print, do research

Take care to read the fine print, do research

COUNTY NURSING HOME: State finds fault

The Illinois Department of Public Health found three irregularities at the La Salle County Nursing Home in September.

In the first case, a staff member did not report suspected verbal abuse of a 100-year-old resident by a certified nurse's aide. According to witnesses who spoke to the IDPH, the aide acted like a "warden in a jail" and the aide's voice was "elevated and rough." One witness said the aide yelled at the resident, "Don't you dare stand up," which further agitated the resident. This happened the evening of Aug. 1. The aide accused of the abuse worked a double shift that day from 6:45 a.m. to 11:15 p.m.

Another CNA was suspended three days for not reporting the other aide's verbal abuse. The IDPH said Thursday the process of taking action against the aide connected to the abuse is under way. La Salle County Board member Gary Small, R-Utica, who is chairman of the board's nursing home committee, previously said the aide was not a county employee, but rather was a temporary worker from an agency that provides aides when needed.

In the second case, a resident had an allergy to bananas and is not to eat the fruit. However, Aug. 10, the resident was served banana cake, ate it and had to be taken to a hospital emergency room. A staff member believed the food was spice cake.

In the third case, a registered nurse did not promptly perform cardiopulmonary resuscitation on a resident July 17, instead leaving the resident and going to get help. The resident died and the nurse was fired. The nurse had been a nurse two years and the incident happened at the end of a 24-hour shift for her, according to an IDPH document.

The administrator at the time of these incidents was Dr. Amjad Hussain, who resigned Aug. 13 after six months on the job. The current administrator, Chris Csernus, took over Aug. 24. Csernus could not be reached for comment.