From someone who works in one. Listen...some of you are entirely uneducated about nursing homes...and it shows. I see the comments: "Oh they're so dirty", "oh they're lazy". Ok, I'll give you that there are absolutely some lousy ones out there. Trust me. I know. But not all of them.
Mine has an insanely low turnover rate. Low, as in the majority of the workers have been there for YEARS! I mean 20 years plus. And we have plenty of staff. As of now, we're still negative. But...we may pop positive. And it won't be because we're lousy workers.
HIPPA has specific laws that must be followed. Insurance companies have specific rules that must be followed.
Here's where these things collide for the perfect storm.
HIPPA laws can conflict each other. For instance: In our facility the state passed a rule. Zero bed rails. Bed rails are considered a restraint. But this is a conflict for those who need the bedrail simply to pull themselves up. Essentially removing the bedrail, has cost them their freedom of mobility. They literally can no longer pull themselves into a sitting position. Those with epilepsy are suddenly in very real danger of falling to the floor. For these situations, they have to sign wavers agreeing to wave HIPPA laws against bed rails. Because for them, they prefer the freedom to not fall off the bed or fall onto the floor.
Not to mention, the lack of bed rails has suddenly thrust the workers into serious injury catagories. Without the resident being able to use bed rails to assist us by pulling themselves up a little, we've now got the added weight to bare...and trust me, we feel it daily. I'm not sure if any of you have ever had to dead lift people who are often two or three times your own weight...but it's painful. Yes we have mechanical lifts. But...we still have to constantly roll them back and forth just to get them on the pad.The pad must be entirely flat and centered underneath their bodies. The pad is then hooked to the lift. When they have no rail to hold onto and help assist by pulling themselves over....it becomes a solid push or pull from us. And with obesity being the number one cause of diabetes, heart disease, loss of mobility, strokes etc...obviously, nursing homes are typically filled with people who in all honesty, weigh quite a bit. That's not an insult, it's fact. Often their own families can't get them to the toilet on their own etc... hence the admission. Not all are there for that reason, but many are. So that's one way that HIPPA can and has backfired.
Here's another: People with dementia wander all day and night. It's a constant pacing. HIPPA states they obsolutely have the right to do so. And they should! These are human beings. At any point in time, it can be any one of us.
Now typically, nursing homes have several catagories within the facility. Skilled unit (need extra monitoring and care, typically ill or struggling). Behavior unit (usually encompassing everything from severe mental illness to dementia etc..). Simple injury recovery (where daily they go to physical therapy and later are discharged home). Assisted living (basic assistance). Hospice and terminal residents (sent in for comfort care until death). Respite care (sometimes families just need a break and then the individual goes home).
Now in all cases, there are HIPPA guidelines. Freedom from abuse and neglect. Restraints are abuse. While there are lockdown units, many homes do not have these. They have ankle monitors. These allow the residents the freedom to wander, but they alert the staff if they're trying to walk out of the door and onto the highway. These are reserved strictly for those who absolutely cannot make their own decisions. The people wearing them, do not understand bounderies or borders. They do not grasp the seriousness of the situation. They have zero concept of a what a contagion is.
Ok, moving onto insurance companies. When you are ill, your insurance company will pay only what THEY deem to be neccessary. That is fact. Currently, those with COVID are being sent home on oxygen and told to dial 911 if they cannot breathe.
Ok fine. You go home and you're only exposing your small household. Nursing homes...ARE the home. While no essential appointments are canceled, emergencies are NOT. Chest pain? They're getting shipped out. Signs of stroke? They're getting shipped out. Severe long lasting seizure? Protocol dictates...they get shipped out. But this means, they're thrust into a hospital environment where they can absolutely come into contact with COVID. Locking down the nursing home from families, can cut down on transmission but it won't prevent the spread. Insurance companies kick hospitlized residents back. They go "well the chest pain was treated...go home".
For nursing home residents...the nursing home...is HOME!
So what is the protocol for that? A quarantine unit. Sounds great right?
Wrong.
Again...there are issues. A quarantine unit is typically a closed off hallway or floor. Let's say you've got 10 people in that hall. Let's say all of them were sent out within the past 14 days to several different hospitals, depending on their families choice of location or insurance company. Then they were kicked back home by the hospital and the insurance companies.
Of those 10 people, 3 are dementia wandering residents. Nobody knows yet who may be carrying it. For all you know, maybe only one came back with it. The hallway is closed off, but LEGALLY you can NOT LOCK THEM IN ROOMS. It's a nursing home and that would be a clear violation of HIPPA. It's not a prison. It's their home. So if the ONE positive turns out to be one of those wandering residents....you have a problem. Dementia residents will not wear a mask. They have aboslutely no idea why you're even trying to reach towards their face to put one one?!?! More then likely, you will get hit, kicked, punched, bit or scratched. Because to them, you're full on assaulting them by reaching for their face. They don't even know who the hell you are. And they absoluetely will walk in and out of every room they can. They will touch things in the rooms and the people in the rooms. They don't know any better. So if the other 9 people were negative when they first came back from the hospital, they can still pick it up while sitting in quarantine.
But here's the conflict...HIPPA also dictates the right to safety!
This goes back to the bedrail conflict. Same scenario...one right is violating another right. The right to not be restrained, violates the right of another's safety.
We deal with this daily! And it's not just during COVID. This is community living. Yes there are nurses and doctors. Yes, there are crash carts, oxyen tanks, IV's , medications etc.... but those are secondary to the fact that this is their home. It's a home with medical care available around the clock. But it's a HOME. It's their LEGAL ADDRESS.
Locking the facilities to family members? ok...but it's not going to stop it from entering the building. There are still neccessary people coming and going. When people are brought back from the hospital, they enter on a gurney with two paramedics. When the state surveyors pop in to make sure everythings being done properly, they're coming from other facilites first. When the docs come in, they're coming from other facilities too.
The staff was trained and knows how to wash their hands. They know how to don PPE. They're not stupid. But they're also wearing fabric masks, when up until february...N95 was the only thing LEGALLY acceptable. You actually would have failed clinicals for saying fabric was ok for an airborne virus?!?! They're being told to wait for the positives before they bring out the N95's because there won't be enough. But we're well aware of the fact that it spreads with NO SYMPTOMS. We're all sitting on powder kegs and we know it.
BUT WE SHOW UP! We show up because we LOVE THEM. It damn sure isn't for the money. The money is terrible. COVID isn't the only exposure. We deal with every single bodily fluid and every single disease. And if we don't have the proper gear for COVID, I can ASSURE you...we don't have it for the other stuff either. That's what they mean by healthcare workers and VIRAL LOAD. It's a larger viral load all at once, on the bodies of healthcare workers. Not only are there multiple variations of COVID but...there are other diseases.
Nursing homes are not just a bunch of people who are 'old' and that's their biggest problem. PEOPLE COME IN FOR A REASON! We deal with the blood, feces, urine, pus, mucus etc... well within six feet. We see the same things as hospitals: Ecoli, Hep C, Herpes, Flu, HIV, CDiff, Syphilis, MRSA, Pneumonia, Bronchitis, Strep, Staph ...etc... We don't grow it...we accept it when they are admitted!
And I cannot begin to tell you how much it upsets me to see some of the stupid comments online. The second an article states a nursing home has COVID...somebody always says "it must be super dirty".
I could argue that if you catch it in YOUR HOUSE...YOU MUST BE DIRTY TOO!
The staff are showing up during a pandemic of epic proportions. The staff are risking their own lives and the lives of their own family members...to take care of someone elses.
TRUST ME! They're doing their level best to PREVENT IT!
We all are! Do you honestly think we want to see the people we've been caring for...the people we genuinely love...do you honestly think we want to watch that sweep through our halls? And to see their families suffer? We love their family members too. We miss them like crazy right now! Their family members matter to us. We miss seeing their daughters and sons. We miss laughing with them. We miss their hugs. It's absolutely heartbreaking to see them through windows. It's horrible to see their tears. I have a mom and dad too . I miss hugging them. I can't go visit because my job puts me in the path of this crap.. I can basically wave from their front yard. It's awful! This is AWFUL FOR ALL OF US!
Just stop passing blame. I don't blame the hospitals ?!? The same laws we have, apply to them as well.
This is a virus. It does not respect borders. And we are trying! It is so damn hard to get in the car every morning. An honestly, if COVID doesn't kill us....the stress will. So just stop the accussations and name calling. Unless you want to come and help us...we honestly don't need your critism. And I can promise you...plenty of nursing homes are hiring!
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