Family Councils: Suggested Agendas

Many patients remain in the nursing home setting for the balance of their lives. Their final years can either be comfortable or tragic depending on the quality of care they receive.

It is difficult for an individual family to influence the nursing home’s management to improve patient care.

The best opportunity for success in improving patient care is through the nursing home’s Family Council.

Members of the council are the families of the residents. They can set their own agendas and present the facility with their concerns which must be addressed by management.

There are care issues that are common in nursing homes. The following is an outline of several of them and how they can affect nursing home patients’ quality of life.

1. Nutrition. When there is a shortage of staff in the facility, patients who are unable to feed themselves independently, suffer.

2. Hydration. A lack of adequate fluid intake is a cause of significant problems for residents including confusion, falls, and urinary tract infections.

Residents must have water conveniently located in their room. The water container must be regularly filled. Patients must be encouraged to drink water throughout the day.

Once again, inadequate staffing is usually the underlying problem when patients are dehydrated.

3. Assistance with Activities of Daily Living. Another area of concern is the insufficient number of nursing assistants to provide patients with assistance in their activities of daily living.

These activities include: bathing, dressing, grooming, transfers to bed and chair, ambulation, toileting, and eating (as discussed above).

The Family Council through its family members can provide factual accounts of care concerns at the facility and request that the facility provide adequate staff to attend to their vulnerable patients.

If cooperation isn’t forthcoming, the Council should then request the Arizona Department of Health Services to investigate the inadequacy in the facility’s level of care.
 

Who's Watching Out for the Patients?

Nursing homes receiving Medicare or Arizona Long Term Care funds must comply with federal nursing home health and safety regulations.

Nursing homes that are unwilling or unable to provide quality care must not be allowed to retain their license to engage in business in the State of Arizona.

In Arizona, the Department of Health Services (DHS) is the enforcement agency, acting on behalf of both the federal and state governments.

DHS is responsible for ensuring that Arizona nursing homes follow state and federal regulations and provide quality care to their patients. DHS is supposed to be an advocate for nursing home patients.

Nursing homes are required to be inspected at least once every fifteen months and are to be cited for any deficiency in patient care. Inspections must occur more frequently, however, in the event a complaint is filed against a nursing home for poor care.

Poor Enforcement Equals Poor Care
When health and safety regulations are not strictly enforced, nursing homes are encouraged to neglect patient care in their pursuit of profit.

Strict Enforcement Equals Good Care
On the other hand, when nursing homes are held accountable through strict enforcement, patient care and quality of life improve.

Nursing Homes Promise to Mend Their Ways
Although cited nursing homes promise the DHS that they will correct and improve patient care, many of these same nursing homes continue to provide poor patient care.

It is up to the DHS to prevent repeat offenders from providing bad care to our most vulnerable citizens.

Failure to Strictly Enforce Regulations
All too often, however, the DHS fails to act as an advocate for quality patient care and permits nursing homes with repeat violations to continue to retain their Arizona license.

Generally, the most important health and safety regulations are those that require each nursing home have sufficient nursing staff to provide quality care to patients.

However, in Arizona, there is no minimum staffing level required. This makes the DHS inspector’s role most important and difficult. They must determine whether the facility they are inspecting has enough nurses and nurse aides while considering the medical acuity and functional level of each patient.

This is a big job and the inspectors do not uniformly take the time necessary to perform this analysis.

It is up to us to demand patient protection through strict agency enforcement of health and safety regulations.

The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialogue with and among its readers.
 

How Many Nurses Does It Take?

You’ve been told that your spouse or parent needs nursing home care.  You know that the nursing staff is important but what do you do next? First, you start by realizing that not all nursing homes are created equal.

Always evaluate several nursing homes to determine which facility best meets the needs of your loved one.

Although no single criteria should be the deciding factor, staffing levels are an important consideration in choosing a facility.

In evaluating staffing levels at the various facilities, there are a series of steps one must take. It is not easy but with some effort you can minimize the risk that your loved one will be placed in a facility that is unable to properly care for them.

Patient Needs.

What are the patient’s needs? Has the patient suffered a stroke, and now requires assisted feeding and assistance with ambulation? Does the patient suffer from dementia with a tendency to wander requiring a secured facility?

Use the following rule of thumb: The greater the need, the greater the number of staff necessary to care for the patient.

Nurse and Nurse Aides Available to Care for Patient Needs.

Arizona has no minimum requirement for the number of nurses or nurse aides a facility must have on duty at any given time.

Based on Arizona’s failure to require a minimum staffing level, Arizona nursing homes rank low nationally in the number of nursing staff available to care for patients.

The average number of nurses and nurse aides reported for Arizona facilities is 3.5 nursing hours per patient day. As a means of comparison, 82% of the states have a higher average number of nursing staff available to care for patients. Harrington, Carrillo, and Blank, Department of Social and Behavioral Sciences, University of California, September, 2008.

How to Calculate Nursing Hours per Patient Day.

1. Add the total nursing hours for all nurses on duty on any given day.

2. Divide the total nursing hours by the patient census (number of patients at the facility) for the same period of time.

Example: 2 nurses each working 8 hours in a facility that has 10 patients.

2x8=16 divided by 10 patients = 1.6 nurse staffing hours per patient day

Where to get the Staffing Schedules.

Every nursing home is required to post its current staffing schedule in the facility for the public to view.

The staffing schedule will contain information such as how many nurses, nurses' aides, and patients there are in the facility on any given day.

If after calculating the number of combined nurses and nurses aide hours at the facility, and if you arrive at a number less than 3.5 nursing hours per patient day, then you know that your facility does not even meet the staffing level of the average Arizona nursing home.

Visit the Facility.

There is no substitute for personally visiting the nursing home. Try to visit on a Sunday afternoon, as that is when most families are there to see their loved ones. Speak with several families and ask them whether they believe there are enough nurses or nurse’s aides there to be attentive to the patients.

Other Factors to Evaluate.

There are two government websites that you should look at for each facility you are considering. Each will give you information based upon inspections made by the Arizona Department of Health Services:

Finding the right nursing home is not based on a scientific formula, but instead is dependent on research and common sense. Even under the best of circumstances, family members must be attentive to the condition of their loved ones as well as the condition of the facility.

Our Next Article.

Our next article will discuss how to be attentive to the condition of your loved one in a nursing home.

The “Guardian Blog” will provide information to help both families and professionals assess and improve the quality of nursing home care in Arizona and the Guardian Blog will encourage dialog with and among its readers.