The following is the opinion and analysis of the writer:
As recent history has demonstrated, nursing homes can be easy targets for contagious diseases. Many are shoestring enterprises, short on revenue and staffing and with failing facilities. Nevertheless, they’re home to some 1.4 million of the frailest of the frail among us.
Why? Medicaid-funded nursing homes are often the only choice for impoverished Baby Boomers who need high-level care.
Poor oversight, underfunding and the lack of a truly professional caregiver workforce has created a perfect storm of preventable problems (think pressure sores) and early deaths. In Arizona, a 2019 auditors’ report on stalled investigations into claims of abuse and neglect at state-supervised nursing homes found some claims went 400 days without action. Some were simply signed off by the nursing homes themselves.
The report highlighted five recommendations to ensure complaints are handled properly. As reported by Howard Fischer in a May 25 Arizona Daily Star front-page article, not one of the five proposals has been implemented.
Most nursing-home staff do the best they can, but to provide compassionate care they need a functional workplace. The federal Build Back Better legislation might have helped, but the bill never made it to the Senate.
I’m not asking for publicly funded resorts for seniors—just clean, modern, humane care facilities. Centers for Caring, not crumbling warehouses. The $1 trillion infrastructure bill is now law; why not use some of that funding to replace obsolete, decaying facilities with modern nursing homes, built with standardized blueprints and software?
Among the benefits: simplified caregiver training and enhanced mobility (no need to re-orient after moving to a new employer), better data collection and monitoring, and economy of scale (reusable designs). Residents would be the big winners as caregivers focus on giving care, not on struggling with antiquated buildings and systems.
Many nursing homes are monuments to obsolescence and deferred maintenance. We have smart houses; why not smart Centers for Caring? Automation and smart machines could facilitate medication reminders, help move residents into and out of bed and other activities. Monitors could alert if a memory-care resident approaches an exit.
And every toilet should have a bidet. Caregivers would benefit from the reduced workload; residents would appreciate the dignity of tending to their own hygiene. Both would benefit from the reduced stress—and chance of injury—of assisted toileting.
Another need: more training. Federal rules require caregivers in Medicaid-reimbursed facilities to be licensed as certified nurses’ aides, with 75 training hours. (Some states require up to 150 training hours. That’s better, but not enough.)
To create a mobile, professional workforce, nationwide training requirements should include a 300-hour minimum. In Arizona, nail technicians get 600 hours of training, but that does include both fingers and toes.
Yet another need: increased staffing. There’s no mandatory staffing ratio, but most caregivers support about 10 residents—up to 15 at times. Imagine caring for 15 incontinent, confused, wandering, combative or lonely frail older adults. For that work, CNAs are paid about $13 to $18 an hour. They deserve at least $22 an hour, plus a realistic career ladder.
A reasonable staffing ratio should be 5:1 at the most. That would allow caregivers time to give undivided attention—and safe, thorough care—to each of the residents they care for, rather than rushing from one crisis to the next. Is that too much to ask?
Replacing decaying buildings with modern facilities would also reduce maintenance and utilities expenses (think solar power). The savings could be redirected toward lowered staffing ratios, enhanced training and better pay and benefits for caregivers.
After a lifetime of working, paying taxes and contributing to society, seniors living in poverty deserve skilled, compassionate care. Let’s stop letting them down.
Judith B. Clinco, RN, BS, is founder and president of Tucson-based Catalina In-Home Services Inc. and founder of the CareGiver Training Institute.
