Loyalty to the nursing home or the patients?

Jacob,

Allow me to tell you what happened to me when I reported neglectful "care" of my Mom and harassment of my Dad and myself when we'd visit her.

I reported a gross event of neglect to the Department of Health and with the Office of Health Care Workers AFTER raising many concerns about my Mom's care, previously.
The nursing home staff LIED to the DOH nurse, who was investigating the case - said they had to call the police on me for disturbing the other residents. The DOH nurse dropped the case.
Also, the nursing home went to my sibling (who had health proxy), lied to him and got him to agree with the nursing him to ban me from the nursing home unless I signed an agreement which limited my visiting time with my Mom and that I could not take her off the floor. ( this sibling rarely visited and was resigned entrust Mom's care to this facility without question).
My Mom died July 15th. The nursing home staff did not alert my Dad she was in the last stages. We would have removed her into a hospice situation where she would be properly cared for and have family around her. She died in a hospital gown covered by a thin sheet and alone.
I had tried to contact grassroots organizations and legal services prior to this - but because I do not have POA - was told there was nothing they could do.

That is what happened, in my case. I've since heard of similar experiences.

If you have any suggestions of what I can do to effectively report the nursing facility, please let me know.

Thank You.

Having worked as a geriatric social worker for many years, I would say report to the ombudsmen for your state's department of aging as well was the administrator of the facility. If the problem is not resolved, I would report to the owners of the facility or the corporate office. I'd then report to the state department of health. Please use a mechanical lift with yourself and another person for safety.

Well, it's logical to start with the manager of the facility. How else will you get the situation fixed? Don't go over his head until you've given him a chance to fix it. If that doesn't help, is there a higher level supervisor or owner? Unless somethng "urgent" is happening, go through the line of command first. But make no promises of silence. You could be legally responsible if something happened as a result.

If you had dropped the patient, I fear that your manager's first action would be to fire you. However, there is an order to things. There should be a system in place to request a chair repair or replacement in writing. A copy should also go to the patient's social worker. Did you do that? I would always document the problem in writing (keeping a copy for yourself) and follow up on it. The safety of the patient comes first and foremost. If anything should happen to a patient, the facility may be ordered from the state to not take any new patients or possibly be shut down depending the severity of the violation or the number of violations. Functioning wheelchair brakes are incredibly important to patient safety. With written documentation, you are also protecting yourself.

Given that this is taking place in different country from where I am I can't speak to the proper "legal" steps but my basic approach in general would be, report the problem (dangerous wheelchairs) to my direct supervisor, if no response in a day or two even just taking the chair out of service or checking all chairs for issues and taking dangerous ones out of service until they are fixed reporting the situation to the director or whoever is ultimately in charge. In the meantime I would check each chair before thinking about using it and if the breaks don't work insist on a second person to help make any transfer to or from it. This way you have followed the proper channels, made the proper people aware of the issue and are taking care of the patient as well by making sure each transfer is as safe as possible. If the business hierarchy drags it's feet fixing the chairs maybe having 2 or more staff tied up each time doing these transfers (probably should anyway but...) will push them into fixing the equipment. I can't imagine how they could justify stopping you from insisting on help when you are using the broken equipment after all you are covering their butt's as well as keeping your patient safe and it would be hard to make a case for requiring you to stop the practice without fixing the chairs. Now if they do give you a hard time about this and don't fix the problem then they probably shouldn't be in business anyway and that's when I would go to oversight authority.

I could never leave these patients without fighting for thier safety, so I believe in documentation; a paper trail, beginning with your Supervisor and on up the chain, allowing them to fix the issue. This may be what is what is meant by loyalty. You would want someone to come to you if they had an issue with something you said or did, rather than report you, correct? Fix problems at the lowest level. If they are ignored, you'll have ammunition to send to all governing oversight agencies. A safety issue should be fixed soon (like same day!). If able, look for another job if you cant put your own safety the patients' wellbeing first. A call to the local news station just may light the fire and shed some light on the situation, prompting proper attention to the faults of the facility, for the residents sake.

Protecting the patient should always be your priority. Having said that, you should always try to follow your facilities chain of command first. There will be some exceptions to this rule. Also, always be professional in your interactions with facility management. Also, do not reach out to other pt family members unless your assistance is requested. It is never ok to discuss one patient with any other patients family. If they make a safety issue report to you, first ensure the patient is safe then direct the family to the person who can handle the issue. If possible walk them to that person. Make a note for yourself of date, time and your actions to protect or and assist family. You will need to decide the level of immediate or past danger based on the event. Report to the RN you are working with that day. Keep a personal log with dates and times and who you reported to. Keep specific patient identifiers to a bare minimum.
If your DON and facilities director do not appear to be working on the problem, report to the appropriate facilities outside your place of employment. Good record keeping of event, and person reported to will help with investigations and will help protect/prove retaliation from your employer if needed.
Good luck and always just do the right thing.

I was asked by the marketing person in my mother's nursing home to post an evaluation of the home, because they "had received a few negative ones recently". I am willing to do so, but I asked why it would be assumed that one I wrote would necessarily be positive, and the answer was to the effect that I seem "easy-going" and friendly. However, just as I was when I was a graduate teaching assistant, I take any kind of grading task seriously. There are a few issues that bothered me, and she said "well, maybe you shouldn't write one". I have no grudge against them, but I won't just rubber stamp an "A" if I'm not convinced it is deserved. I told her I'm still thinking about what to say. Frankly, I don't know what the norm is among nursing homes--that is, are they normally very well run, or simply a couple steps away from a disaster--thus I'm not sure what would be considered "average". To her credit, she is being attentive to issues I present, one being that items my sister and I bring for my mother seem to disappear in spite of the fact they are well-labeled with her name.

Well now you know they aren't anonymous as you thought. That sucks. Sorry that happened to you! That is basically getting workers in trouble for reporting, and furthermore not taking care of the problem. No one will ever call again knowing that! Dept of health doesn't have to do their job by getting workers in trouble. Problem solved, case closed. That person probably didnt want to do their job. Or manager found out thru phone records it was you. Or asked who said something about the wheel chair and someone told, or overheard you call.

You should not do the transfers, or say you cant bc you hurt your back and need help or use the Hoyer. Or what if you refuse on the grounds of safety?

Maintenance should be able to fix the wheel chairs to make it safe for staff. I dont know why they cant? I've seen them put wheel chairs out of commission and use others. I didnt see them fix it, but I know the wheel chairs came back fixed. Eventually. Might take a week. They should take care of that. Can you talk to the charge nurse, or call someone from maintenance? That's their job. It's usually not a hard fix either.

I can guarentee you if the elderly person falls you will be written up and responsible. And if they break anything bc their bones are like tissue paper, the families and bosses will blame you.

Tell the charge nurse/supervisor you cant bc there are no brakes on the wheel chair. Cant use it.
Usually nursing homes have rules about moving residents, and asking for help is allowed. Or chart pt is too unsteady and falls risk today. They have to report when a resident falls. They dont want falls.
I dont understand why they dont let you get help?
Ive had training where they tell you to slowly lower/brace the person to the ground. 100-150lbs of anything will fall quickly, not in sloooo-moooo. (Like they pretend) And then add in a tissue paper frail adult. I cant hold 100lbs up and guide it to the floor slowly as its falling away from me. Even with a gait belt. Try it sometime. Not as easy as it seems. This happens in a split second. Add in a person who has dementia. They could decide they are 6yrs old and going to go to the ice cream truck in their mind. You never know.
I also heard of a well respected PT dropping a very frail 93yr old while doing pt. That day she just collapsed. He had worked with her for weeks. Family was in an uproar. Like he did it on purpose? No. He was distraught over it as was everyone. People can get dizzy and faint. They can also get equilibrium /inner ear problems out of nowhere. She broke her hip. It was an accident. They do happen. I can guarentee you elderly pts get unpredictable.
I saw an elderly gent get up and lock himself in the bathroom and fell. They got a key after that. No one had ever done that b4! He was in PT/OT waiting for transport back to his rm. He could walk short distances.

My dad fell mult times out of bed. He forgot and thought he could walk. Muscles to frail to walk. He actually fractured his skull while in a very big hospital. They werent even going to tell me. No one was around when he did it. He also rolled out of bed sev times. It happens. Not everyone automatically at fault, or didnt care. I dont think nursing staff wants fractures and death on their conscience. Most people dont.

If they continue to hassle you about the quick transfers, refuse to fix the wheel chairs. I'd have to find a place that will help the workers and get the wheel chairs fixed. They should have extras on standbye. I dont know why they dont. Sometimes even PT or OT will fix if if they want to. Depends on how they are personally. They could make the phone call if you cant. You should be able to, but depends on the site culture. I could have told my boss in recreation svs and she would do it. I could pick up oh and call.

If your manager is that crappy and cant be concerned with safety issues, I'd RUN. Dont understand why they cant fix a wh. chair?

I think what’s going to happen is that once it’s put together in a nice PDF, a report about the health department’s wheelchair visit will go up on the Israeli health department website for all the world to see and it’s not going to look to good.

However this was really cutting corners too far in my opinion. I understand we all want a luxury car and vacations in Europe, however I think this manager needed a kick in the butt. Or a new career.

I did some research about my nursing home on the health department website, comparing it to others in Jerusalem.

Actually my nursing home compares quite favorably to most. It’s a small private nursing home (36 beds) and possibly fairly pricey. It may be almost a model facility.

Which is nice on the one hand, I’m not collaborating in a slaughterhouse. 

But then on the other hand, what are the bad places like???

I will say that it’s neat, clean and smells good (thank you cleaning staff Shireen and Monera!)

However the brakes are defective on 25% of the wheelchairs which is really being ridiculously cheap and stupid. And in the few weeks I’ve been there one demented man wandered out the door and fell. Thankfully he spent a day in hospital and seems OK. But that’s neglect. The staff is responsible to prevent escapes. (This happened an hour before I came on shift.)

https://ilerlawfirm.net/elopement-wandering-nursing-homes/

If you have complaints, you have the legal right and obligation to report issues to authorities. Also, make your complaints in WRITING, sign it, and authorize the authority to share your complaint with the nursing home. If you are going to complain, then make your identity known. When I complained against VITAS hospice with The Agency for Healtchare Administration (ACHA), I did so in writing, signed the document and asked them to share my complaint with VITAS hospice.

Your first oblgation is to the patient. Follow your conscience.

This may not be what you were looking for, but based on your post I was a little surprised at your user name? Look over the names from responses, people don’t use or only use part of their names. This is a very public and popular forum and easily found by anyone.

You should always allow them to fix the problem. Note the date of all conversations. Put a formal complaint in writing to your supervisor. There should be a forum, methodology,or form to address all safety issues. If not, suggest one.
Then, if the problem isn't resolved, you have all the need paperwork to address with the health department.

What an awful position to be in! This is not about loyalty however, it’s about professional responsibility and ethics, and then of course it’s about plain old caring about another person’s welfare, a vulnerable person at that.
If you are a licensed or registered professional, your regulating body would surely discipline you if they knew of the unsafe and illegal practices you engaged in. They can assist you in dealing with situation-they will have good advice and recommendations. They have likely dealt with it before.
The facility itself or your boss part of some professional associations that would be a great resource.
For all you know, your boss’s procedures and policy may not accurately reflect those of the facilities’ owners. Had you dropped the patient and the patient died in hospital from complications, the nursing home would likely face a law suit. That’s not in their best interests.
Your state or province will likely also have workplace safety regulations that you can look up, or a department you can call.
If you are part of a union, your union representatives are a good resource too.

I am worried about your job, and I’m worried about patient safety. Your situation is serious. I would consider documenting the unsafe practices and the dates of any preventable accidents, in case you need to take them to court.

You might also see if there is an employment lawyer you could consult (some lawyer will meet with you for a free initial consultation).

To me, this is just as bad as if a hospital administrator tried to save money by having doctors reuse their gloves. The doctors would never go along with that. Neither should you.

You are likely not the only worker to be concerned with the safety issues where you work. There is strength in numbers. If you all work together on this issue, you will get the situation resolved, one way or another.

Be brave, protect yourself, and good luck.

Jacob - sorry, you're working in Israel? Your profile says New York. It makes a very, very substantial difference when we're trying to help figure out where you can turn for advice and support.

I'm at a loss as to why a NA would even need someone else's opinion. Your first obligation is to the persons in your care. You are a mandated reporter of abuse, and abuse is defined to include neglect and emotional abuse as well as physical abuse. Your manager would of course love to keep the state auditors out of the nursing home. Call your state ombudsman and tell them just what you've said here. ASAP.

People don't speak up for all sorts of reasons. Not wanting to rock the boat is one of them, not knowing who to call is another, assuming that it won't make any difference another - there are loads.

You say this is a small home - how many beds? Who owns it?

I'm in the UK and our regulations are different in detail (the apathy when it comes to dealing with problems isn't, though) but by and large the role of regulators and inspectors is more or less the same. All residential care facilities, large or small, must display information about how to make a complaint and ensure that residents and/or their representatives have this explained to them. I would be surprised if there isn't the equivalent in your workplace. What did the DoH advise you when you spoke to them?

I am wondering: are families of nursing home patients afraid to contact the department of health? I get that impression a little bit. Maybe they don’t want to anger the management?

First of all, imageimp, wow. I can understand EXACTLY what happened to your mother. Every day in my nursing home I believe that patients come within an inch of that type of fall.

And it almost happened to me when a broken wheelchair flew out from under a very elderly woman during a transfer. I was furious. I don’t know if I can print here my exact reaction.

countrymouse, I don’t think there’s any kind of rules in place. Frankly I don’t think it’s ever entered a worker’s mind to complain about something relevant to the patients’ treatment.

That be as it may, shouldn’t a legitimate nursing home be happy if the health department visits? Wouldn’t they be proud of their top notch facility? What would they be worried about?

Bottom line, the health department showed up last Wednesday at 8:00 am. Now it’s Monday night. Nothing has been repaired. Nothing.

It’s a small place. Maybe no one in house can really handle this. So how about this: Google “wheelchair fixing guy”. Pick up the phone. He comes. He fixes it. You pay him.

Am I going to have to call the health department AGAIN? I don’t understand this.

You might be interested in reading a book called "Wilful Blindness" by Margaret Heffernan. It explains how it comes about that egregious malpractices of all sorts are sustained by groups' cultures and mindsets.

All the same you are an employee of an organisation, and it would be reasonable of that organisation to expect you first of all to follow the procedure it lays down for reporting concerns and complaints. Did you?

Talking to co-workers and service users isn't it. You should first of all have taken this to your line manager. If nothing happened, then you go either further up the reporting chain, or to external regulators.

But to say you must "never" make a complaint to the health department is disingenuous and nonsensical. There are all kinds of situations that might arise when you would be morally, and arguably professionally, obliged to.

Asking your manager on what basis he claims to know that you made a formal complaint to the department of health is a fair question, certainly one I'd want answered if I were you. Did the person you spoke to agree that your report would be treated in confidence?

Anyway - so what's the outcome of this conversation with your line manager so far? Will the wheelchair(s) be repaired? What will be done to address the various manual handling problems?

I'm impressed and heartened you had the integrity and care to report this situation. Your loyalty has to be to the vulnerable and helpless people you are serving, even while you get paid by the institution/facility. Sadly, this does create a conflict with potential repercussions (as you found!), but personally I'd rather be able to sleep at night knowing I might very well have prevented somebody from being seriously hurt or even killed. I'm coming from a personal position here? My Mom died because a CNA in a NH dropped her (let her drop...) while transferring her from a wheelchair to a shower chair... Mom told her she was slipping, and then fell - breaking both bones (tibia and fibula) below her left knee. She died in the hospital 10 days later, and endured - literally - days of screaming in pain (until the last 3 days when she went on hospice and an IV narcotic drip, the hospital insisted they couldn't give her enough to cover her pain because "it could kill her"...) By that time they thought she'd had a mild heart attack, her kidneys were shutting down, she would never get up from bed again, or have any quality of life if she survived... "We" had just gone through 2 1/2 years of Hell - multiple facilities/surgeries/etc. and damage caused by neglect and abuse from the first "skilled nursing/rehab" center she was in after transfer there from hospital and repair of a broken hip & wrist. She was in the last NH for a little over a year, and while there were definitely issues I at least felt they tried, or cared to a degree... When this happened, I was so burned out - my life was hers for all that time, because I advocated for her tooth & nail, visited every day, took her to all appointments, etc. - even gave away my dog because I was never home - and what was the use anyway? I went to the owners and told them I was sure there were safety procedures that weren't followed, I was sure they would take measures to see that those procedures were followed in the future so no one else died, and I wasn't going to pursue anything any further... Mom had just completed 3 months of (outside) physical therapy - worked her fanny off - and was able to get out of the wheelchair and walk with a wheeled walker! I didn't need to use the "companion wheelchair" when we went somewhere, because she was walking into her doctors' appointments, into restaurants for lunch with me, etc. In the NH, though, she was in the wheelchair because she wasn't stable enough if she was bumped by someone/something, so... I was on my own taking care of her - no kids, no partner, no siblings - but was actually starting to think we might actually be able to get Mom home again? Would I want an aide to report a safety issue she knew about to someone who would actually take steps to correct it? You'd better believe it! Mom fought so hard to get better, and my heart remains broken...

Once we start murdering the elderly, which unfortunately is virtually going on already, the next step will be the murder of any incurablly ill. It’s not a new idea.

https://en.wikipedia.org/wiki/Aktion_T4

I really believe the age factor has a lot to do with elder neglect.

Young people, even chronically ill, aren’t treated like this. I’ve worked in a facility for very severely brain damaged children and young adults and they were well funded and everything was done the right way.

The elderly, in modern Western society, simply have little value.

The usage of VSED  “voluntary stop eating and drinking” or even lethal injection is becoming gradually more common.

https://www.firstthings.com/web-exclusives/2017/09/euthanasia-for-alzheimers-patients

It may not be long before nursing homes are replaced by pet food factories.

Maybe we should count our blessings :(

Just tell the manager, killing someone was not in your job description. Potentially, you are putting an elder person in jeopardy and yourself. "Sounds harsh, but I have know four other older people who have died, because they were dropped on their heads. They told me, as I came in the next day, your mom fell last night. BS. She can't fall, she cannot stand/walk. ALZ, etc. I said: SHE WAS DROPPED. AND THEY DID NOT CALL ME!!! I called hospice as soon as I found out, they didn't get a call either. Oh this subject just irks me.
And if I could show you the pictures, you would cry too....She had huge bumps on her head, face, arms, and bruised from head to toe...
You always hope they will die in peace... She is an angel. she did not deserve to die like that.

Well, My mom was dropped on her head from the same scenario. She died a week later. So, if you do not feel it is safe for the patient or you, you decline to move patient, tell the head of the class, to get someone to do it for you. You really do not want to kill someone. Accidents happen, I understand, but they can be prevented. She suffered, I suffered. It has been over a year, and to see my mom in that much pain, head injury, . WE all have to go sometime, but seriously, not that way. To top it off, hospice, not my gals, came in one night, and said mom was ok, no need to stick around.. If you feel she is in pain, here crush the morphine in a spoon, rub it in her cheeks every hour. By morning, mom was spewing out brain fluids or something, The hospice gal forgot to tell me to add ativan to the mix... It was not the way I wanted mom to go. No need to drop anyone. The caretaker, is a wonderful older man, and he should not have been placed in that position to do that. He got hurt too. He is a very nice man. But come on. USE YOUR BRAIN, USE THE HOYER LIFT. Broken Hip? Really, that is a death sentence to an elder person. PERIOD. An apparently head injuries. dead weight, dropped on her face.. and someone wants question the reasons to use a lifting device? At least two people should carry that burden. One to lift, and the other to serve as a cushion when elder flips and falls on their face. :(

I wonder if this is part of the general lack of value which we give to older people. Today we seem to view people like cars. The older it is the less it’s worth. This starts from age 40 and keeps going from there. Someone 80 is practically garbage. 

(Full disclosure: my 59th birthday is this month so I’m a little bit personally biased on this subject. I’ve recently seen advertised youth hostels in Tel Aviv which will not accommodate guests over age 40. Doesn’t anyone realize that the rate of violent crime of every type is so much lower after age 50? If they are worried about rape or something, then lock out the really risky 20 year olds.)

Your boss is full of it. It’s not your job to cover up violations. If there are illegal things going on or conditions that are putting people in danger, the authorities have to be told.
The alternative is to go to him each and every time you see an unsafe condition or illegal practice, and it seems as if they don’t want to spend the money required to operate a safe, clean facility. Honestly, I would look for another job on the QT. Eventually that facility is going to get some bad publicity and when it does, you don’t want to be associated with it.
I know some jurisdictions have laws that protect whistleblowers, but I don’t know if that applies to your situation.
Mister, get outta there!

I would encourage every single person to put there complaints in writing and copy whatever organization licenses these homes or over sees that they are being ran according to law.

It is easy to get into a he said she said if everything is verbal.

Where I live you provide your own durable medical equipment for mobility, so not sure if your patients can provide their own so they're not in such danger.