Nursing homes: Quality staffing means quality care

Nursing home patients receiving medication. (Photo: ChameleonsEye)

In the past decade, California has invested billions in improving nursing home care, yet for too many nursing home residents that investment hasn’t amounted to any improvement at all in the quality of the care they receive. How is this possible?  According to nursing home caregivers of SEIU, the dollars haven’t consistently translated into improved staffing levels.

Aixamar Ruiz’s dream growing up was to become a nurse.  She left her home country of Venezuela to pursue a better life and a career in the nursing field. But here in California, her dream of helping others has become a daily exercise in frustration.

She recalls the heartbreaking reality of short staffing by telling the story of a dying woman who was calling her by name as she was rushing from patient to patient.

As a caregiver in an Orange County nursing home, her style is to take care of every need she sees: emotional, mental, or physical. If she sees a resident whose nails need to be clipped or needs help with their grooming, she’s there. She talks to and connects to her patients. But this extra effort is almost impossible to sustain when she is caring for nine or more patients, and recently on her performance review, the extra TLC she provides became a negative: “you’re good at what you do, but you spend too much time with each patient.” She hopes her management would reward rather than reprimand caregivers like her who go the extra mile for our loved ones.

Ruiz and other caregivers in nursing homes do critical work. They are trained to help patients with daily living, post-hospital and post-surgical care, and restorative rehabilitation services. They serve over 340,000 of California’s most vulnerable citizens: seniors, people with disabilities, and people recovering from serious illness or injury. At some point in each of our lives, one in three of us will need to spend time in a nursing home.

Graciela Pennington works as a caregiver at a nursing home in the Imperial Valley, where her connection to patients often means they are asking for her by name. She recalls the heartbreaking reality of short staffing by telling the story of a dying woman who was calling her by name as she was rushing from patient to patient. To Pennington’s lasting regret, the woman passed away without having her trusted caregiver at her side to hold her hand.

Ruiz’ and Pennington’s individual struggles to provide quality care within the constraints of their workload reflect deep structural problems in the nursing home industry as a whole in California. California’s minimum staffing ratio for nursing homes is just 3.2 hours per day of patient care, far below what is needed when you consider patients need help bathing, being turned to prevent pressure sores, eating, having diaper changes, and following other medical orders.  The standard hasn’t been updated in decades.

That’s why caregivers like Aixamar and Graciela say that they are constantly on the run – just trying to avoid disaster rather than providing the care they want to: attentive, careful, and humane.  Study after study shows that without proper staffing, patients are at risk of unnecessary falls, illnesses, and injuries, and workers too are exposed to greater risks of workplace injury and violence.

It’s no wonder, then, that the federal government years ago recommended a significantly higher standard of 4.1 hours of care per day. While many nursing homes exceed this standard and many are well above the minimum, there are a significant number of bottom feeders, homes that, year after year, staff just at the level needed to keep within the law.

This must change, and nursing home workers throughout the state are working tirelessly with Assemblymember Ian Calderon to make the change by passing Assembly Bill (AB) 2079 – the Safe Nursing Home Staffing Bill. The bill will address chronic understaffing at nursing homes by requiring all facilities in California to meet the federally recommended staffing level.

Aixamar shouldn’t have to worry about negative evaluations for providing good care. Graciela should have the time to hold a dying patient’s hand.  We must do everything in our power to support their passion and talent for providing care to those who depend on them.

Ed’s Note: Laphonza Butler is provisional president of SEIU Local 2015 and  president of SEIU California.


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