Where Are The Grannies?

First, I could get fired from my job for writing and posting this. More than a week ago, my beloved and I were having this conversation about huge changes coming up on health care industries. I was throwing out all my frustrations in his ears about all the “craps” going on where I work (sorry, I can’t think of a better statement to describe my disgust). I have been working for a 24- hour Skilled Nursing Facility in Southern California for over 15 years and through all these times I’ve witnessed how the purpose of these facilities transformed from giving the highest quality of patient care to how much Medicare reimbursement will be collected. Aside from the ways these profitable hospitals and nursing homes are getting accustom to, the statistical data of client census based on Medical Conditions and age groups were remarkably modified as well. Way back on 1990, I was working as a caregiver in a residential home in Oakland, California and I can honestly say that it wasn’t really an easy job to provide care services for 28 residents with individual demands and different level of assistance needed but regardless, I really enjoyed it. Back then, the facility residents were mostly geriatrics and the biggest challenge for me was giving them and the best care they obviously deserve and providing the homelike atmosphere while being away from their families. After a year, I moved to Southern California, and began working at higher level of care facilities which most people called nursing homes. I worked from clerical assistance to managing the Health Information Department. Within my first five years of working for a skilled nursing facility, the atmosphere was not really different from the way it was on residential care facilities where I have also worked for; we have older patients occupying 80% of the total census population who usually were admitted with Diagnoses of Uncontrolled Diabetes or Hypertension, History of CVA (stroke), Early Stage of Dementia which impaired their ability to care for themselves, Congestive Heart Failure, Incontinence of Urine and Feces, Seizure Disorder, Cancer, Renal Failure requiring Peritoneal or Hemodialysis, Altered Level of Consciousness, Colostomy Status and Dehydration or Malnutrition where they require Gastrostomy Feeding, TPN or IV hydration. I saw nurses who have gotten into enjoyable conversation with them while care was provided. The paper works the staff was doing were concise yet never get them in serious troubles with the health department inspections. Their time was significantly utilized mostly on their patients, which was why we hardly had complaints from them or their families. Now, it is very disappointing to see how this grandeur focus was shifted to making money and “getting away” with it. The geriatric population is now diminishing and the increasing number of younger residents with History of Drug Abuse and Alcoholism became so overwhelming. Now, we are dealing with clients of 45 years of age and below, mostly with Severe Mental Illnesses with Bizarre and Sexually Inappropriate Behaviors, AIDS, Hepatitis, History of Tuberculosis, and Withdrawal Syndromes. Truthfully, they were inappropriately placed in nursing homes but because all of them have Medicare coverage (God knows how they got those) they became “patients” who required 24 hour nursing care. The government imposes regulations after regulations which squeeze the proprietors and administration for Federal OBRA, Health and Safety Code, HIPAA and Title 22 (State) compliance. Do they really care about the services rendered? NO! They only passed these laws because they knew that most healthcare facilities won’t be able to follow through all these guidelines so then they can most likely issue citations for violations that would cost the owners thousand of dollars on penalties. Here is where the question of “Which really comes first, the egg or the chicken?” becomes appropriate. Evaluating the situation, which one really caused the nursing homes failure to operate the way they were intended for? Is it the legislation that keeps on imposing laws for supposedly implementation of “higher standards of care” via scary inspections on facilities for “higher fines”? Or is it the nursing home administrations that focus more on profit while overlooking the goal to provide care? Either one of them or both is responsible, although I know for sure who suffer the most in this dilemma, the NURSES. I see them taken away from what they were taught in nursing school. They become a lot more exposed to huge liabilities and abuse allegations while not getting sufficient supports from their employers, which may also put their licenses on jeopardy (where lawyers mostly feast on) while getting their brains more twisted off dealing with more psychiatric than medical conditions while lacking proper trainings on such. They give more hours within their shifts on chart documentation to show “proof of compliance” and “higher reimbursements” rather than getting involved with their patients’ activities of daily living and health needs. Now while writing this, I just remembered this Warner Bros. cartoon character, Yosemite Sam after being defeated by Bugs Bunny in their little battle saying, “If you can not beat them, join them.” Perhaps I would prefer, “If I can’t swallow their water, I must spit it out.”