It's a numbers game.
    I learned something interesting this evening at the facility. I was talking about staffing with one of the CNAs. It's a little different than I perceived. The floor my mother is on has thirty-four beds; two per room. It is almost always full. When one bed empties it is filled almost immediately. My mother's floor, the CNA explained, is "mostly Medicare", therefore it is granted three CNAs per shift (there are three shifts). My perception told me that there were two CNAs per shift, one on the "low side" (the lower half of the 17 numbers) and one on the "high side". There is, however, a third CNA I thought was a floater among all the floors. Turns out this aid isn't a floater but belongs on Mom's floor. I've noticed the "extra" throughout my days and evenings. This CNA often handles what I would call the Group Work: Taking stats, managing the meal and drink carts and performing as an extra hand when necessary.
    The CNA with whom I spoke told me that the Medicare floor gets the extra aid. The other floors, of which there are three (and, I assume, house people who are on Arizona's version of Medicaid, ACCHHS, and other payer systems), are apportioned only two CNAs per floor per shift. I'm not sure about the RNs. Mom's floor is assigned two per shift, one for the high side and one for the low side. I had assumed the other floors also were granted two RNs, but now I'm not so sure.
    At any rate, the ratio of CNAs and RNs per patient load is actually lower than I'd heard before Mom was admitted into the facility, but, I can tell you, it's still impossible. I'm keeping random notes on how long it's taken, here and there, for Mom's call light to be answered by a CNA. Sometimes the response is quick: 1-15 minutes. More often it takes about 15-30 minutes for a response. I've recorded more than a few occasions in which response has been from 45 minutes to over an hour. And, believe me, the CNAs are never, ever, malingering. If you can't find any in the hall it's a better than safe bet they are all tending to someone on the floor. The nurses, if they are not on the floor at their medicine carts, are either working hard to control the volumes of paperwork required on each patient or are directly working with one of the patients on their side. I hear that both nurses and CNAs take breaks but, I'll tell you, I have yet to observe one on a break and my guess is that many of them either cut their breaks short or don't take them.
    So, you know, I'm not sure that there is anything in any facility that could be termed "The Cadillac of Care", but, apparently, unless you are willing and able to pay privately for care (not, I repeat, not through private Long Term Care Insurance), the best you are liable to get in a facility such my mother's is a floor on which there are 1.5 CNAs and 1 RN per 17 beds; too few to guarantee evenly adequate care and, believe me, too few to politic into special care circumstances. These busy, panting people are too overwhelmed to conduct political manuevers.
    Considering that everyone I talked to as I was involved in finding a bed for my mother recommended two other facilities (sister facilities for business purposes), neither of which ever had a bed available, I'm wondering, now, how much better the circumstances are at the favored pair of facilities. I'm guessing that the difference is minimal and may have more to do with things like consistently working toilets and facility cleanliness, although that's just a guess. Even if the ratio of workers to patients were 1 CNA & 1 RN/10 patients per shift, from watching the activity on my mother's floor day after day, I can tell you, that would still be one hell of a load.
    Which is why, out of desperation, over the last two days I've been changing my mother instead of waiting for her call button to be answered. I've been watching and helping (very minor help) the CNAs do it and, although I'm slow and clumsy, I managed two successful changes alone, one in bed and one standing. Tonight, though, my mother did something that has happened before and I've watched the CNAs handle but haven't yet negotiated. I screwed the process up so much that, in the end, it took me, an RN and a CNA to fix it: My mother peed while being changed, wetting the new brief, her already cleaned self, the soaker pad and the bed clothes. It wasn't that I freaked...it was that I discovered I simply didn't have the technique to handle this advanced form of the procedure on my own...and, in trying to do it, anyway, made it worse. The CNA to whom I chatted about staffing and I laughed about it afterward, including my exasperated epithet (uttered low, I assure you, but, apparently, not low enough), "Jesus Fucking Christ", that brought the nurse into Mom's room. A few minutes after the RN offered to help me she admitted that she'd never done CNA duty, which is a specialty unto itself. We were both relieved when the CNA delivering meals entered the room and immediately stepped in to help us. By this time my mother had taken offense at all my and the RNs attempts and had securely locked her legs in protest, which makes it difficult to finish applying a brief. As well, she'd peed yet a second time during changing, which involved yet another cleaning and another pristine brief but, luckily, not another set of bed clothes.
    Trust me...this was not an isolated or even uncommon incident. As my CNA chat partner said, "Welcome to the wonderful world of CNAs. All you need, now, is a name tag and a paycheck."
    "Forget the name tag," I said, "most of the patients already think I work the floor. [Which is true...as I walk the floor I am often asked to do this or that...and, if I can do it without challenging protocol, I do, knowing that telling someone who needs a waste basket, for which one stroke victim asked me, today, to press the call button is a risky enterprise, at best.] I want to know when I pick up my check."
    Later.
- posted by Gail Rae @ 20:07   email  this post