Trouble at homes

Dorothy Daniels speaks lovingly about the senior citizens she’s cared for, but with a touch of sadness.

A certified nursing assistant who has worked in California nursing homes since 1994, she’s seen how the elderly can suffer from neglect because caregivers are poorly paid and stretched too thin to give them adequate care.

So Daniels has lent her voice to a multi-pronged effort to reform conditions in the homes, an effort that includes union organizing, supporting legislation to increase patient-to-staff ratios and now, even the threat of a strike that could devastate an already crippled industry.

Working in cooperation with workers, residents and their family members, the Service Employees International Union (SEIU) and the Fix Nursing Homes NOW Coalition have launched an aggressive campaign to improve conditions in California’s nearly 1,200 nursing home facilities.

Employed by the McKinley Health Care Center for six months, Daniels said the unionized facility is a good one. Still, she said nurses feel they can’t always give residents the level of care they need. She likes to take her time with patients and really get to know them, but said sometimes it’s all she can do to keep them dry until the next shift.

“I got into nursing because I love talking to people. I care for them as if they’re my own mother, father or grandmother,” said Daniels, a 20-something mother of three. “My big thrill is to find out that little special thing that they like to do. Like if they like to sing or hum. Those things may seem very small, but just to find out those things about your resident, that means the world to them.”

McKinley is considered small, with just 86 beds, but Daniels said it is common for nurses to work long shifts, come in early and have 12 to 15 patients during the day. She said it would be “heaven on earth” to only have five patients to care for on the day shift.

Administrator Gary Wiemers said McKinley is staffed appropriately, although he acknowledged that sometimes nurses are asked to extend their shift by as much as eight hours. Nurses might also be called in to work on their day off to cover shortages. When asked how a strike would affect patient care, he said McKinley has certified staff in other departments who could cover shifts if necessary.

SEIU had been attacking the problem by trying to unionize more home workers, but in recent months refocused its attention on pushing for the passage of Assembly Bill 1075, the Nursing Home Staffing Ratio Bill, which last week was approved by the Assembly and is now headed for the Senate.

“Clearly there’s a crisis in nursing homes in this state,” said Isobel White, an SEIU organizer. “It’s been documented that understaffing and the incredibly high turnover of nursing home workers play a significant role in patients not getting the care they need.”

AB 1075 by Assemblyman Kevin Shelley would implement staff-to-resident ratios recommended by the National Citizen’s Coalition for Nursing Home Reform. It would mandate a ratio of one certified nursing assistant (CNA) per five residents during a day shift, one CNA per 10 residents during the evening shift and one CNA per 15 residents during the night shift.

But according to Betsy Hite, public affairs director of the California Association of Health Facilities (CAHF), subjecting facilities to massive fines for lack of compliance would be counterproductive for an industry that’s already grossly understaffed by nearly 30,000 nurses.

“We know we’re not going to be in compliance. There’s just no way there are enough workers out there to meet the Shelley Bill,” said Hite, suggesting SEIU work with the industry to come up with a more realistic solution.

But SEIU casts the situation as desperate. They say the state’s nursing home facilities are among the worst in the nation. According to an SEIU report issued by Senator Deborah Ortiz, 88 percent of the 27 nursing homes located within Ortiz’s district have been cited for resident care violations that caused actual harm or had the potential to harm residents. Only 11 percent of the homes were in full or substantial compliance with federal resident care standards.

White said such violations occur despite an increase in funding over the past two years. California nursing homes received $450 million in state funding—some of which was intended for improving staffing levels and wages. The SEIU said workers never received the wage increases.

Yet Hite said CAHF spent an additional $110 million for wages, a fact she said could be proved in an upcoming audit. According to the SEIU, caregivers earn between $13,000 and $19,800 annually.

Currently, California’s Medi-Cal program pays for 75 percent of all the care nursing home residents receive. Hite said this puts facilities in a bind because regardless of how ill a resident is, each facility receives $110 per day per resident. Payments for the doctors and nurses, housekeeping, laundry, food, prescription medicines and all of the services that are provided 24 hours per day, must be paid from that amount. This is why CAHF would like to see a system that allows more nursing hours for patients who need intensive care. They don’t believe the one-size-fits-all system proposed by the Shelley Bill would work.

“Our feeling on the ratio legislation is that it’s premature right now because the bodies aren’t there,” Hite said. “Let’s bring people into this profession. Let’s try to restore some honor to the profession of providing care for the older people. And then when we’ve got sufficient workers, let’s look at ratios.”

Standing in the chill wind outside Florin Health Care Center during a press conference held by Ortiz in April, Shirley McNabb blamed poor conditions in a different nursing home for the death of her mother, painting a portrait of a once proud woman who died covered in bruises and drenched in urine.

“I don’t want anyone else to endure such unspeakable conditions,” said McNabb. “My mother had been in nursing homes for eight years, and she was mistreated and neglected because of understaffing. This led to her death.”

As McNabb spoke, several nursing home workers stood in the background nodding their heads. One of them was registered nurse Tamika Pollard, an employee of the Florin facility for four years, and a caregiver for seven.

Pollard said she is frustrated that changes in the administration have not helped to improve conditions in the 122-bed facility. She said a typical day can be very hectic. RNs assist patients with walking and strength training, but when shifts run short of CNAs, RNs must perform general nursing duties like filling water glasses and changing and turning patients.

Pollard believes nurses should only have seven to eight patients during the day, but currently they may have nine to 18. She said the day shift should have 15 nurses, but they have been working with only nine or 10, and that Florin doesn’t want to call in extra help.

“They’re trying to cut back and they don’t want to use the registry, but then that makes us short, and then the RNs get pulled and we can’t do our own jobs,” Pollard said. “It’s been pretty bad. If we’re short of nurses on the floor, then the call lights are constantly going off. Somebody wants to get up; somebody wants to go to the bathroom. It’s hard for us to get to them all.”

Florin’s administrator, Darron Truede, denied any problems with staffing levels at the facility, and expressed concern over the negative and inaccurate media attention the center has received in recent months. In order to maintain confidentiality, he said he was not allowed to discuss specific staffing numbers, but that the levels were appropriate for the residents. He encouraged the public to come and visit the facility for themselves.

“We strive to provide safe and secure care for our residents,” Truede added.

While the problems in nursing homes continue, Daniels stays because she loves the people and the work: “I’m not afraid of a little hard work. Not one of us nurses are afraid of a little hard work. But when is enough enough?”

Daniels remains optimistic about AB 1075 passing. She wants to ensure that she and her parents will not have to suffer in their “golden years.” Daniels, Pollard, McNabb, union organizers and others continue to fight because they believe AB 1075 will make it better for everyone—especially the patients.