The Biden administration finalized on Monday the first-ever minimum staffing rule at nursing homes, Vice President Kamala Harris announced.
The controversial mandate requires that all nursing homes that receive Medicare and Medicaid funding provide a total of at least 3.48 hours of nursing care per resident per day, including defined periods from registered nurses and from nurse aides. That means a facility with 100 residents would need at least two or three registered nurses and at least 10 or 11 nurse aides, as well as two additional nurse staff, who could be registered nurses, licensed professional nurses or nurse aides, per shift, according to a White House fact sheet.
Plus, nursing homes must have a registered nurse onsite at all times. The mandate will be phased in, with rural communities having longer timeframes, and temporary exemptions will be available for facilities in areas with workforce shortages that demonstrate a good faith effort to hire.
The rule, which was first proposed in September and initially called for at least three hours of daily nursing care per resident, is aimed at addressing nursing homes that are chronically understaffed, which can lead to sub-standard or unsafe care, the White House said.
I often go to nursing homes for medical calls, and asking for basic patient information is always a treat at the crappier ones.
Pro-tip: when the medic asks you things like “What are we here for?”, “How long have they been having this issue?”, or “What’s their medical history?” you don’t actually have to answer. Just give a blank stare and say “I don’t know, I just started my shift” or “They’re not my patient”. All you have to do is give the ambulance crew the patient’s name and birthday, and even that’s optional.
Is the patient dead and you don’t know when it happened? Say “I was talking to them a few minutes ago!” even if they’re cold to the touch. Bonus points if the pt has a DNR and you don’t give it to the medic.
If all that is too much work, say “I’ll go check” and find somewhere to hide until they leave with the patient – this situation is their problem now.
I work in 911 dispatch, nursing homes are one of the banes of my existence.
Do they have any medical history we should know about?
No.
Oh, I guess they’re just putting perfectly healthy 57 year olds in nursing homes now, good to know.
Half of them can’t tell me the address of the damn place they work, which is really nice when they call from their cell phone which barely gets any signal inside the building. Sometimes it’s a crapshoot if they can even tell me the name of the facility
For whole lot of the people who work there, at least at the homes around me, English isn’t their first language, and they don’t speak or understand it very well and speak with a very heavy accent. I’m not knocking them just for that though, they speak more languages than I do, and are clearly trying to make a better life for themselves, I certainly can’t fault them for that, but it does make me a little concerned for their patients. If I, as someone with all of my mental faculties and hearing intact, can barely communicate with you, how effectively can they be treating and supporting patients who often have significant cognitive and/or hearing impairments?
Don’t get me started on the med techs. I’m not any kind of a healthcare professional, so I have only the vaguest idea what their role actually is in a nursing home, but from when they call 911 you would get the impression that they’re kept in a dark soundproof closet until they need someone to call 911, then they’re abruptly yanked out of the closet, spun around a few times, hit over the head with the phone, and told to call 911 while a strobe light flashes in their face, because they never have any idea what’s going on
Now don’t get me wrong, some nursing home staff are great, they have all of the information ready when they call, they’re polite, professional, everything I could hope for, but unfortunately they’re kind of the exception. 90% of the time when I see a call coming in from a nursing home I need to brace myself to deal with someone who is just an absolute mess, disorganized, ill-prepared, unintelligible, uncooperative, sometimes outright rude. Sometimes I consider myself lucky if they don’t just outright hang up on me halfway through the call.
Also some of them love medical jargon, and as I said I’m not a medical professional. They’ll call, rattle off a bunch of stats and vitals that mean nothing to me and aren’t going in my notes even if I could type as fast as they’re spitting them out. When I try to determine what the chief complaint is they’ll spit out something like “their potassium is low,” forcing me to ask for further clarification in plain english, so I know whether to code it as a cardiac thing, a respiratory thing, etc.
Your comment about people who don’t speak English fluently reminded me to take a moment to appreciate that there are a non-zero number of asshole racists who, by nature of being cared for by (at least in some circumstances) people of varied races, do indeed die mad.
That makes me think of my own grandfather (in a good way) I will never claim that he was the most forward-thinking, tolerant, or politically correct person out there, there were a few stereotypes and bits out outdated terminology he never quite shook (for example, the term “colored” never quite left his vocabulary, and he had a tiny bit of lingering distrust of the Japanese having served in the Pacific during WWII)
But for a man who grew up in the time he did, he wasn’t half-bad.
He was never someone who was above holding a a grudge, and he’d gladly tell anyone who would listen who he didn’t like and why. His reasons weren’t always good, he got mad at people over a lot of petty bullshit, but I never heard him disparage someone because of their race. He ended up in a nursing home where a lot of the staff was black, and we never heard a peep from him about their race, he found plenty of other things to complain about, but there was no racial bias to it, he complained about the white employees as much or more than the black ones.
Little bit of fun family history with him, for most of his life he worked as a bus driver. Buses in our part of the country were racially integrated from pretty early on so that was never something he dealt with directly, but he did drive his bus at the same time that bus boycotts and such would have been happening in other parts of the country. He never told us this story himself, we heard it from some other older locals who remembered him driving the bus. There was one particular bus stop that was near a business that employed a lot of black women, and many of them took the bus. The bus would come at around the same time the business closed for the night, so they didn’t have much time to get to the stop before the bus came. A lot of other drivers wouldn’t wait for them, but my grandfather always did, and decades later many of them still remembered him for that.
These are great tips. Can we adapt them to other industries? Maintaining information directly related to your employment is just so difficult and inconvenient at times.