National Nursing Home Week will be celebrated the week of May 10th through May 17th.  This week is set aside across the nation to remember the industry that takes care of our elderly and disabled.

While the degree of quality of care varies from facility to facility, there is one thing that never varies: the motive of the nursing homr owner to have the facility in operation.  As is true in most businesses, nursing homes are operated and owned by individuals or corporations motivated to make a profir.  While some may feel that there is nothing wrong with this motivation, the problem lies when profit-making takes priority over the quality of care that the nursing home resident receives.

Nursing homes are regulated by federal and state mandates intended to assure a minimum standard of care for the infirm.  Unfortunately these regulations, while numerous but needed, do not guarantee that quality care is either delivered or received!

In Texas, nursing home regulations require that licensed nurses be on duty and that trained, certified nursing assistants provide the unskilled care required by those no longer able to care for themselves.  On the surface, this appears to be a good thing, but that's where it ends.  Texas has NO real resident-to-staff ratios that are truly effective.  In the past six and a half years, I have worked in several nursing facilities, and I have seen the ratio of certified nursing assistants (CNAs) to residents as high as 15 or 16 to 1!  And while I'm on the subject of resident-to-staff ratios, I'd also like to point out that most of the facilities where I have worked, the ratio of residents to social workers has been 100 to 1, or even 125 to 1!  Yet nursing home bosses insist that social workers perform other unrelated duties such as admissions, marketing, answering the phone, and at one facility, picking up meal trays, because the nursing home lacks sufficient CNAs to perform this task!

Nursing home management likes to count the licensed nurses in their interpretation of "safe" ratios, but in reality this is misleading when nurses are bogged down in paperwork that is required for maximum revenue and for adherence to state regulations.

At mealtime, some residents who are bed-bound or who prefer to take their meals in their rooms must sit in their own urine and waste because the limited number of CNAs are busy passing out trays or feeding residents who are unable to feed themselves.  This waiting time can range from 45 to 90 minutes before CNAs are finally able to attend to residents who need cleaning and changing.

While the Department of Aging and Disability Services, along with nursing home bosses, harps a lot about protecting the dignity of nursing home residents, this usually amounts to mere talk, since the state will not develop and enforce true resident-to-staff rations, and nursing home management is not going to do anything that adversely impacts their bottom line.

Other factors that contribute to substandard care for nursing home residents include:

1. Poor morale among nursing home workers.  This is caused by low pay, among other reasons.  Wages for CNAs range from $8 to $13 per hour, but the amount of pay is solely at the discretion of the nursing home management.  CNAs seldom get a full 40-hour week.  Other factors contributing to low morale are a lack of good fringe benefits (upward mobility, pensions, and healthcare), favoritism, disrespect by management, and unbearable workloads. 
   
2. State and federal regulations that are excessively documentation-oriented rather than actual-practice-oriented.
3. Texas is one of the lowest paying states for nursing home Medicaid reimbursement.  Nursing home resident advocates agree with nursing home management on this reality.
4. Nursing home workers in Texas are for the most part unorganized and defenseless against management abuses.
5. Management mindset views individuals in nursing homes in monetary figures rather than as human beings in need of care.  While most nursing home residents do receive care, it is usually done in the least expensive manner, which has both positive and negative results.

1. The Texas Legislature must become more realistic in its funding of nursing home Medicaid, as current Medicaid reimbursements are insufficient.
2. The Texas Department of Aging and Disability Services must enact and enforce stricter and safer resident-to-staff rations.  While consistent documentation of care is good, documentation in and of itself does not guarantee actual delivery of care!  This is especially true when staff are overworked, underpaid, demoralized, and not given due respect!
3. The United States Congress must pass the Employee Free Choice Act (EFCA), giving nursing home workers (and workers in other professions) stronger, much needed protection of their right to organize a union on the job.  Present labor laws are insufficient and poorly enforced.  Workers are subject to harassment, being spied upon, and unfairly fired for exercising their right to organize.  EFCA does not eliminate secret ballots, as bosses spuriously claim.  Instead, it will eliminate employer injustice toward workers seeking to organize. 
   
4. Along with passage of EFCA, nursing home workers must overcome their present feelings of being powerless, fearful and discouraged.  They must come to realize that only by uniting with each other can justice indeed be achieved.  Only when workers receive justice can patients be assured of adequate care.
5. Family members of nursing home residents must become viilant in ensuring that their loced ones receive adequate care.  This means organizing Family Councils that are supportive of nursing home workers in their struggle for on-the-job justice!