by Cindy Hasz
American Reporter Correspondent
San Diego, Calif.
August 18, 2002
A GRASSROOTS CALL FOR NURSING HOME REFORM
SAN DIEGO -- California is the only state in the nation that has a law regarding patient-staff ratios in nursing homes. Or so I thought until last weekend.
I was doing online research as a follow-up to the "Lilliputian" incident, involving a fight with a particular nursing home, when I realized that the bill in question, Assembly Bill 1075, signed by Gov. Davis in January of this year, had been gutted before it reached his desk.
The golden ratio that was to be in effect by January of 2002 was 7:1 (patients to direct care staff) on day shifts in California's nursing homes. As I tracked the evolution of the bill I realized with grief in my heart that it has basically been shelved while the Department of Health Services comes up with a ratio the industry will support.
Fine print reads something about snowballs in hell.
I was amazed that we had come so close to actually setting real, measurable standards for humane care in our nursing homes only to be sabotaged at the midnight hour.
Now these ratios may not mean much to you if you aren't familiar with nursing home culture, but just consider this: It is not at all uncommon for nurse's aides to have 10 to 15 elderly patients on the day shift. Ask any aide who isn't afraid to lose their job, and they'll tell you that taking care of that many patients well is next to impossible.
Yes, there is good, old-fashioned arithmetic that measures the quality of elder care in nursing homes, and it's called patient-staff ratio.
Currently the only math in California law regarding how many patients one nurse's aide may have at one time is an esoteric formula that no one but nursing home owners know how to calculate.
That law mandates 3.2 direct patient care hours per patient per 24-hour day. Sounds decent ... but what does it mean? What does that number actually look like in a home? And while every nursing home administrator huffs and puffs that they are in compliance with this ratio, few will show the public their numbers.
The new law, AB 1075, will require nursing homes to post the ratios (when they are set) in plain sight for the public to see. Being able to actually do a body count of how many aides and nurses are on the floor will go light years towards improving California's inhumane nursing home elderly care system. But when, oh when, will it become a reality?
MediCal reimbursement is lousy, not even covering the true costs of an elderly person's daily care in most nursing homes. As much as these nursing homes charge for care (they average $4,500 per month.), such 24-hour nursing care is actually costs them about $6 per hour. So the industry, understandably, will squawk when its required to pay more in staffing costs while their profit margin on MediCal beds is already so slim.
So California is trying to increase MediCal reimbursement to go along with the new laws aimed at better care in our nursing homes, where tens of thousands of our elders currently languish.
But I have stopped holding my breath. And so should you.
Is it really impossible for the owners of our nursing homes to put one or two more nurses' aides on the floor per shift? Is this really too much to ask? No - not if they make up the cost difference in the one place they don't want to look: the administrative budget.
No matter how admin types wheeze and whine about not being able to increase their staffing costs by $200-$400 a day for essential, care-intensive day and p.m. shifts, they can find the money if they must. Cut out Christmas bonuses and the extra-cushy benefits for top managers and better care will soon become affordable..
Tighten their corporate belt so they can actually take care of patients? What a concept!
What I have realized this last two weeks is that unless you and I step up to the plate, many thousands more of our precious elders will suffer neglect and institutionalized abuse before the laws in our state, let alone the nation, actually have teeth.
I started thinking about what we can do now to change things. This is what I have come up with:
Eventually, market pressures brought to bear by an informed public with online databases will put the mangement on notice that we will not tolerate the continued neglect and even abuse of our mothers and fathers, friends, sisters and brothers.
None of us can do it alone, but together, organized in every community across the nation, we can put an end to this shame that lies like a curse over the most frail and forgotten of our society.
We simply cannot wait for the someone else to move this mountain for us. Cindy Hasz is a nurse and writer living in San Diego. She can be reached at email@example.com