Aug 20, 2018

Hidden Dangers

Written by

Carolyn Rosenblatt who is an RN, Elder Law Attorney, and author related to healthy aging and protecting our elders at and wrote the below article for Forbes.

Any family member who has had a loved one go to a rehab facility (aka nursing home) after being in the hospital may have encountered this problem. Anyone with an aging parent who has to stay in one of these facilities for more than a few days is sure to have seen it. Understaffing is the problem. There are not enough aides and of even greater concern, not enough Registered Nurses. Of course this endangers residents who have inadequate supervision.  

The New York Times recently reported on this and the piece was commented upon by a trusted resource advocating for elders, The Long Term Care Community Coalition (LTCC). The article and commentary by LTCC emphasized that many facilities do not comply with the legal requirement that an RN must be on duty eight hours a day seven days a week. Why aren’t there enough staff and what can families do about it?

As for aides, I can personally testify from experience that it is a very tough job, very physically demanding and that the salaries are low compared with other, probably easier jobs. I found it rewarding to work with mainly older people in these homes but not everyone gets satisfaction from doing this kind of work. The turnover rate of aides is generally very high. RNs can often find better paying jobs elsewhere. These facilities then use “licensed practical nurses” or “licensed vocational nurses” (LPNs/LVNs) who are significantly less educated than RNs. Less skill can mean limited ability to correctly diagnose problems and communicate effectively with physicians, other nurses, families and providers. While many LPNs/ LVNs are very good at their jobs, they cannot legally substitute for an RN, whose training is more rigorous and extensive. Adding to the problem is the fact that our aging population is growing, the need for long term care such as is provided in these homes is also growing and the number of available, quality aides is not keeping up with demand.

We can’t always predict when a family member will need to go to such a facility. For example, after a stroke or heart attack, an elder may be briefly hospitalized to address the immediate problem, the next step is to send the elder to a place for longer term rehab services, such as physical, speech and occupational therapy. Medicare will not pay for any patient to remain in an acute care hospital for long when rehabilitation is the next step. If your loved one needs any of these therapies, expect that he or she will be discharged from the hospital, sometimes on short notice, and you will be asked to pick a nursing home for the needed rehab services. Typically a discharge planner, who is a nurse or social worker will simply hand you a list of nearby rehab homes and tell you to let them know which one you want, assuming you have some to choose from.

How do you know which ones are good and which ones are not? Some people use Medicare’s Nursing Home Compare, which rates homes on a 5 star basis–5 being the top and going down from there. My suggestion is that you should never rely totally on Nursing Home Compare. The information they give Medicare is self-reported and is based on comparisons with other nursing homes. If they’re all understaffed the site may be giving you an inaccurate picture of how good that home is. Here are some tips for choosing a nursing home for a loved one. It will take work but without that, your loved one can be put into a dangerous situation.

  1. If you have a list of homes, go visit a few before you send your mom or dad there, particularly if you can do so on the weekend. Staffing on weekends is notoriously low. You’ll get the picture if you see no aides around.
  2. Use this site to learn the staffing requirements for nursing homes in your elder’s area  You want to find a place that follows legal requirements.
  3. Check out a website devoted to consumer’s interests in long term care You will find there an overview of each state’s nursing home system and licensing agencies, and a consumer’s guide to choosing a nursing home.
  4. Finally, in my book The Family Guide to Aging Parents, I discuss the issues of nursing homes in greater depth including Medicare/Medicaid citations against homes and what that means, fall prevention, skin care, contracts and how to be an advocate for your loved one in a nursing home.

There are hidden dangers in these homes and every family should be aware of them. If we want to ensure our aging parents’ safety, being aware, visiting or calling often and watching over what happens there can help our vulnerable elders as much as possible. Personal contact from family can make all the difference.


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