Florida's Greatest Resource, Part II

District Ombudsman Manager Robin Baker heads the small Tampa office that investigates complaints made by or on behalf of residents of long-term care facilities. Her district consists of Hillsborough and Manatee counties - that's 322 facilities between her, two other employees, and (at last count last week) 13 state-certified volunteers.

Robin assigned the complaint I made to one of her volunteers, who was on the case by the time I got to work that afternoon. The building swarmed with nervous employees as the ombudsman conducted his investigation. I was nervous too, wondering if I had done the right thing, or if I had jumped the gun. But it was the best decision I could have made with the information I had and I don't regret choosing the only option I thought would help the gentleman in a wheelchair

who deserved so much more care and respect.

I quit the next day and began a search for my third CNA job in two months and quickly landed at a luxury nursing home. The experience was so different from my first two jobs, from the interview to my last day three months later. The heavy work load, however, was the same, but there was a cohesion between all employees at this fancy place that my previous employers lacked. The admin demanded a lot from the nurses and CNA's, but they also respected us. We worked hard and they thanked us profusely. I got a dollar raise by the end of my first month. The best part, though, was getting to know Tampa's history through these residents, the retired social elite of my city: lawyers, doctors, journalists, mothers, and more.

I had mixed emotions about quitting. Physically, I just couldn't do it anymore. I miss folks from every facility I've worked at, but having spent 40+ hours a week for three months with the folks at the fancy nursing home had really bonded me to some of them. I made a compromise, kind of. After I quit, Ronny and I signed up to become ombudsmen.

Don Hering, chair of the State Long-Term Care Ombudsman Council, describes Florida's Long-Term Care Ombudsman Program as "a volunteer-based organization seeking to improve the quality of life of vulnerable elders who live in licensed long-term care facilities, including nursing homes, assisted living facilities, and adult family care homes." Its mission is to "protect the health, safety, welfare, and human and civil rights of long-term care facilities' 150,000 residents."

After Ronny and I completed the three days of classroom training, Don took us out for three complaint investigations and three annual facility assessments, requirements toward our certification. In January, we investigated our first complaint case solo.

I'm still learning the ropes, not to mention the politics involved. Some of the worst facilities, for example, may never be closed down. Meanwhile, some politicians have tried to get rid of the ombudsman program altogether.

Not one to fear hard work, I think I'll stick to this for a while.

Florida's Greatest Resource, Part I

In the fall of 2008 as the economy went up in smoke, professionally I went from writer to waitress to unemployed. The bad news was that I had to

find a paycheck quickly, but there was good news in that it was the perfect time to reinvent myself. Ever the do-gooder, I had yet to be completely fulfilled by my profession (the main reason I continue to volunteer).
As I looked around for work, the only job listing I came across continually was for certified nursing assistants (CNA). In one weekend I trained for the state certification exam, passed it six weeks later, and hit the pavement running. In one day I visited seven or more nursing homes. I walked in, took in the view, smelled the smells...actually, only one place smelled and of course that was the nursing home that hired me on the spot.

There were approximately 200 beds in the facility and the place was almost filled to capacity. I was told the average age of the residents was 55. This nursing home was essentially where "crazy" people without family/homes/resources were sent to be cared for. It was either this place or living on the streets.

I shadowed another CNA for less than a week then was on my own to take care of roughly 15 people (just below the state mandate of no less than one CNA per 20 residents) per eight-hour shift. I worked slowly and not just because I was new, but because I could see that the people I took care of were lonely. Caring for and talking to the residents as you fed them or changed their diapers was not a job requirement, and I quickly clashed with my co-workers, many of whom tried to show me short cuts so I'd work at a faster pace. I was taught to wash residents with shaving cream, for example, because it cut body odor without requiring water.

As with most nursing homes, the staff turnover was astounding (I was later told by a director of nursing at another facility that the norm is 300%). After speaking candidly with several of the CNA's I worked with, I learned most came from a staffing agency, which paid more than being hired as a regular full-time employee. Our supervisors were Licensed Practical Nurses (LPN's), nurses with two-year degrees, but to me their primary job seemed to be passing out medication, not to oversee CNAs that slacked on the job. I only stayed there for three weeks, long enough to find another place, any place.

Unfortunately my next job was a step down. It was at a very pretty Assisted Living Facility (ALF), which I soon discovered was not subject to all the same strict laws as nursing homes. I had already decided it was much too easy to get a CNA license in the state of Florida, but at ALF's, "caregivers" replace CNA's and licenses are not required (thus a reduced pay scale but still the same difficult emotional and physical workload). Additionally, because most residents of an ALF need less assistance than the clients in a nursing home, the ratio of resident-to-caregiver is higher.

I had a problem immediately with the administration. It was obvious that many seniors in our care required much more than just assistance, in fact, some needed total physical care. This ALF had 50 residents and only three employees on my afternoon-to-evening shift to care for them.

Another shock to me regarding ALF's was learning that the person hired to hand out medication to residents (usually called a med tech) had less training than a CNA, while CNA's are not legally allowed to touch medication at any time.

Three weeks into my job at the ALF, I was tending to one of the residents under my care who complained of extreme pain. For three days in a row the resident cried to me about the great amount of pain he was in, and for three days I reported this information to my superior. She brushed me off each time. I was not made aware of any plans to resolve the issue with the resident nor was I ever spoken to about the incident. I realized that at my ALF the administration and hands-on staff didn’t establish relationships as co-workers, and I definitely felt there was a common lack of respect for CNA's by the upper echelon of the staff.

It was apparent to me that the ALF I worked in was not a safe place for my pained resident, who couldn't walk much less care for his wounds. Because I didn't trust my employer enough to handle the situation in a timely manner, I called the phone number posted on the familiar flyer that hangs in all of Florida's long-term care facilities: the hotline to Florida's Long-Term Care Ombudsman Program.

No Place Like a Nursing Home

Acting Medicare Administrator Kerry Weems was on C-SPAN's Washington Journal Monday morning discussing the direct relation between low paid nursing home workers and the quality of residents' care. As someone who's only been in the health care field for 2 months, I've already seen enough. I'm appalled by what's considered a "decent" place.

I started working as a CNA primarily because I just needed a job. My day consists of assisting or providing complete care for the elderly by changing diapers, dressing them, transporting them from bed to wheelchair. It's sweaty, hard work and we're always given more work than physically possible. Lots of the CNA's (mostly all women) take shortcuts, like using shaving cream instead of soap (it cuts the smell, cuts down wash time). I dislike most other CNA's I've worked with, with a few exceptions. But it's also the company that owns the nursing home (usually a for-profit investment firm) that's taking short cuts. The whole system sucks, and as usual I'm driven to save the world. Or at least Florida. Or Tampa. (I'm wearing myself out.)

I started my third position in three months yesterday. It's a nonprofit facility with a five-star rating. And they over staff instead of under staff, which is the opposite of how most other homes work. Imagine that: happy employees equaling happier residents. Is that really a progressive thought?!