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Who are the People in a Nursing Home?

Posted by D. Joseph Chapman on Apr 25, 2017 in Nursing Home Negligence & Abuse

certified nurse assistantsCertified Nurse Assistant

I remember when I was a kid, I watched Sesame Street, and there was a song... Who are the people in your neighborhood. Well, this isn't your Sesame Street song. If your neighborhood is a nursing home, who are the people you are going to meet?

I started to write this post with the idea that I would be able to talk about the main people you will meet in a nursing home in one shot. Wrong. Got going and had way too much information for one post, so I will break it up.

In each of the articles for who are the people in the nursing home, we will begin by focusing on what to inspect rather than expect. While these lists are not the only questions to ask, if you ask them, and ask them again, and continue asking them, you are more likely to keep your loved safe. Be the nicest squeaky wheel you can. The nice squeaky wheel gets the oil!

What do you inspect rather than expect with a certified nurse aide/assistant?

General List

  • Brush the resident's teeth?
  • Comb the resident's hair?
  • Take the resident to the dining room for each meal?
  • Give the resident drinks?
  • Give the resident a snack?
  • Take the resident to therapy (physical, occupational and/or speech)?
  • Give the resident a bath?
  • Make sure the resident is dressed?
  • Get the resident out of bed?
  • Get the resident out of their wheelchair?
  • Get the resident out of their lounge chair?
  • Answer the call bell?
  • Take the resident to the bathroom?

Bed Bound Resident List

(sick/injured resident who has to spend a lot of time in bed, even for days to a week)

  • Do they know the care plan to avoid skin breakdown?
  • What is the most recent Braden score and what does it mean?
  • What position in bed was the resident for the last eight hours (right side, back, left side)? Should be a different position every two hours at the very least.
  • Show me the resident's heels, and the resident's low back and buttocks-point out to me where pressure sores happen--do you see anything?
  • Were blood tests done, did they include measuring albumin (albumin is the key here, if it is low, then there is not enough protein in the diet to keep up the integrity of the skin)
  • What is the nutrition program?
  • What is the hydration program--where is it being written down? I want to see it.

Fall Risk Resident List

What does the care plan say for number of care providers needed for certain tasks?

  • Transfer from bed to wheelchair
  • Going to the bathroom
  • Bathing
  • Changing brief
  • How often ask if need to go to bathroom?
  • How often ask if need a drink?
  • How often ask if hungry?
  • Do they use a gait belt when resident is walking?
  • Do they use a lift to get the resident out of bed or chair?
  • How many caregivers are necessary to use a lift?
  • How many residents is the CNA responsible for on this shift?

Let's get Practical

A certified nurse assistant/aide or "CNA" is the category of people you are going to run into most in the nursing home, and they do 90% of the work with each resident. They are certified. Makes you think they have a lot of training, to get to a certification, right? Wrong. You can become a CNA in days. Most of the major chains of nursing homes, do the certification training right on site.

The test to get a certification is put on by the American Red Cross and uses the National Nurse Aide Assessment Program. This may become more meaningful as you continue to read my thoughts, but this program is intended to comply with the federal law called OBRA, and more importantly the Nursing Home Reform Act (NHRA) which modified OBRA. The test itself sets minimal competency to comply with the NHRA and is an evaluation of knowledge, skills, and abilities. It is broken down into a practical and written portion. The written portion is 70 multiple choice questions and the practical section is made up by performing five different skills.

Just to give you an idea of what the government expects of a nurse aide (or assistant, depending on who you talk to), here is the outline of content to be covered on the test:

14% Activities of Daily Living

  • Hygiene
  • Dressing and grooming
  • Nutrition and hydration
  • Elimination
  • Rest/sleep/comfort

39% Basic Nursing Skills

  • Infection control
  • Safety/emergency
  • Therapeutic/technical procedures
  • Data collection and reporting

8% Restorative Skills

  • Prevention
  • Self-care/independent

11% Emotional and Mental Health Needs

2% Spiritual and Cultural Needs

8% Communication

7% Client Rights

3% Legal and Ethical Behavior

9% member of the health care team

One of the questions that might appear on the written portion of the exam is: What does the abbreviation ADL mean? This is a question for someone whose job is to help residents with ADL's. It's a test I suppose?

If you want to verify that one of the people taking care of your loved one is certified and being tracked on the nurse aide registry in Pennsylvania, find out their full name. Then, go here to check them out. Just make sure you have Pennsylvania Department of Health and nurse aide sections selected. Here you can enter the name of the caretaker whose license you want to verify, and get the results immediately.

If you find the nurse aide taking care of your loved one does not have a certification, write a letter to the administrator and the director of nursing (we'll get to these two in later articles), and send it to them certified with a signature required. Print off the internet page, and include it with your letter. Tell them that the person is not licensed and you don't think it is proper that this person is taking care of your loved one.  

Here is how the CNA is described on a national organization website dedicated to nurse assistants:

Who are Career Nursing Assistants?

Nursing assistants are key players in the lives of the people in their care. Each day, more than 4.5 million caregivers provide hands-on care to our nation’s frail, elderly or chronically challenged citizens in nursing homes and other long term care settings. These important workers have various titles including: Nursing Assistant, Direct Care Worker, Nurse Aide, Care Assistant, Caregiver, Hospice Aide, In-Home Care Aide, ED Assistant, Resident Assistant, Hospice Assistant, Patient Care Assistant, Personal Care Assistant, Geriatric Aide, Restorative Aide, Health Care Assistant, and many more titles you can find more here.

Duties

For a good start on what the duties of a nurse assistant are, I went to monster.com to find out what they advertised for someone who's building a resume to become a CNA.

Here is what they said:

  • Provides patients' personal hygiene by giving bedpans, urinals, baths, backrubs, shampoos and shaves; assisting with travel to the bathroom; helping with showers and baths.
  • Provides for activities of daily living by assisting with serving meals, feeding patients as necessary; ambulating, turning and positioning patients; providing fresh water and nourishment between meals.
  • Provides adjunct care by administering enemas, douches, nonsterile dressings, surgical preps, ice packs, heat treatments and therapeutic baths; applying restraints.
  • Maintains patient stability by checking vital signs and weight; testing urine; recording intake and output information.
  • Provides patient comfort by utilizing resources and materials; transporting patients; answering patients' call lights and requests; reporting observations of the patient to nursing supervisor.
  • Documents actions by completing forms, reports, logs and records.
  • Maintains work operations by following policies and procedures.
  • Protects organization's value by keeping patient information confidential.
  • Serves and protects the hospital community by adhering to professional standards, hospital policies and procedures, federal, state and local requirements, and JCAHO standards.
  • Updates job knowledge by participating in educational opportunities; reading professional publications; participating in professional organizations; maintaining licensure.
  • Enhances nursing department and hospital reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

From Monster.com

This is actually a pretty good list. Here's another description, which I summarize from a job description we got in discovery during a recent case.

They are to help residents with activities of daily living. Feeds residents and helps residents drink when the resident cannot do so for themselves. Serve between meal nourishments. Put sheets on the bed and take the dirty sheets and towels away. Take vital signs, record input and output, and change catheter bags. Watch residents and answer call bells in a timely manner. Practices fiscal responsibility in the use of supplies, equipment and time management.

The people who are CNA's are regular people. They have a job. They try to do it and then they go home. They are usually compassionate people who decided to do what they do because they like working with the elderly. That isn't always the case, so always inspect rather than expect a CNA is going to do the right thing. Additionally, the person might be overworked and under-resourced which leads to a bad attitude, frustration and cutting corners. Be nice. BUT, be the squeaky wheel.

Our law firm gets involved in cases where we can see a single incidence of neglect causes a catastrophic injury, or when a systemic problem within the organization causes harm when the company chooses to make more money rather than live up to the promises they made to the resident and their family.