Friday, July 10, 2009

On National Health Care and the For-Profit Nursing Home Nightmare Part I

My mother spent four months last year in for-profit nursing homes in 2008-9. Before that, I had researched statistics that the U.S. health care system is 1/3 more expensive than any other industrialized nations but our health is the worse of any industrialized country. I knew those statistics, but seeing up close how my mother was treated in two nursing homes, I began to understand exactly why we pay so much but get so little from our privatized health care system.

My mother, who had been in fairly good health, in her 86th year fell, broke her hip, and had immediate surgery. The surgeon instructed the nurses to get her walking the next day, and I watched as two nurses helped my mother up and gingerly walk two steps to a chair. His instructions were she needed to walk as much as possible and shouldn’t stay in the hospital. She was moved the next day to a nursing home I will call Bel Air Nursing Home (not its real name) but it is located in one of the most expensive areas of Los Angeles.

Bel Air at first glance looked like the Rolls Royce of nursing homes. The cafeteria had attractive wooden tables and chairs; there were two attractive outside patios carefully landscaped with plants in planters and more tables and chairs. The gym for physical therapy was large and well-equipped. My mother had two roommates but her own TV and phone on a bedside table in fairly large room.

The actual nursing care stank. Besides needing to walk daily to relearn how to walk, My mom need to be walking or at least sitting in a wheelchair or she’s get bedsores, but the first two days every time I visited she was in her hospital gown not even dressed. Nobody showed her how to use the overhead TV while the phone was on the bedside table outside her reach. An aide put down a pudding on her bedside table where she couldn’t reach and refused to listen to my request to put it on the overhead tray. If she was having physical therapy, nobody told me when it started but sometime it did start, I guessed.

My mom said a male patient sexually harassed her. I sat next to her while a male patient in a wheelchair wheeled into her room, wheeled past her, and then stopped by the middle patient for about 10 minutes. Finally, he wheeled his way past me out the door. I went and complained to the RN that male patients shouldn’t have such access to my mother’s room.

My mother complained that her Certified Nursing Assistant verbally insulted her. The actually nursing is done by Certified Nursing Assistants (CNAs), immigrant or black women who got a little training, do all the hard work, and are paid barely above minimum wage. Most of them seem hard working and deserve a raise but one had insulted my mom. In the central station are the Registered Nurses (RNs) whom I never saw work with the patient. Daily whenever I came in I asked the RNs how my mother was and they would read off her chart—they didn’t know my mother at all. The licensed vocational nurses (LVNs) give out medication and also I never saw any work with the patient. All the six nursing homes I saw were organized this way. After my complaint, the RN removed the offensive CNA from working with my mom.

At this point I figured the only way to get my mother dressed and out of bed was to demand a meeting with the head of nursing which I did. Preparing for the meeting, I discovered online that Medicare does inspections of all the nursing homes in the country and puts the results online (http://www.medicare.gov/Nursing/Overview.asp) including a listing of “Nursing Home Resident Rights.” I learned it doesn’t matter if the nursing home is located in the most expensive neighborhood in the city with the fanciest decorations. If you want to know what it’s really like, read Medicare evaluation online.

According to Medicare inspections in June 2008, Bel Air rated one star out of five (much below average) for health inspections, one star for nursing home staffing, one star for quality measures.My mother was there October 2008, a few months after the report. Most interesting was to me was two out of four (“minimal harm or potential for actual harm”) for two categories: “Make sure that residents with reduced range of motion get proper treatment and services to increase range of motion” and for “Develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.”

I downloaded the report and handed it to the director of nursing in our meeting. Her male associate said, “We’re working on it.” Since they were unable to come up with a complete nursing care plan, I wrote up one and handed it to the director of nursing (cc’d a copy to her doctor) asking for reasonable items such as the CNAs dress my mom daily and wheel her to the cafeteria for meals and daily activities such as bingo. The director of nursing took my written out nursing plan, headed upstairs with me beside her, and handed it to the RNs, telling them to do it. From then on my mother was dressed daily and taken to the cafeteria for meals and bingo.

A week later I was called into a meeting with the social worker, RN, and physical therapist. Na├»ve me thought they would tell me how my mom was doing. Nope. They all three asked me again and again and pounded at where I was taking my mom because in a week they would expel her. They harassed me verbally and viciously for ½ hour. I mentioned the name of the only other nursing home I knew called F nursing home. They ignored me and pounded at me with their questions. Two days later the physical therapist told me to go ask the social worker to arrange transfer to F nursing home. At this point the social worker who had beaten me up verbally then was amazingly efficient arranging the transfer. After using up two weeks of my mother’s topflight medical coverage, they expelled my mom to another nursing home.

Bel Air was, I learned, did the lowest level of custodial care—letting her lay in her hospital gown being taken care of a poorly paid poorly trained overworked staff was fine. It saved then money. The RNs did nothing until I complained. Then one of them harassed me. I like RNs—my mother was one and many of her friends were. I thought the CNAs most of them were hard working and deserved a raise. It’s the executives of the company that design the policies that provide poor nursing care but great profits for the companies. This is for-profit medical care in the nursing home—extraordinarily expensive designed to give profit to the company and extraordinarily bad for the patient. But the decorations were fine!