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Staff Inattention
Advocacy councils make gains at nursing homes
By Alice Dembner - The Boston Globe - July 31, 2004
It happens at many nursing homes. A resident is left in wet diapers for hours. A meal is delivered overcooked and lukewarm. An administrator berates staff, increasing the turnover that plagues the industry.
But at Weymouth Health Care Center, families of residents who see these problems don't just grumble to friends. They bring their concerns to a family-run advocacy council that holds the management responsible.
In the last year, the group of about 30 family members and friends successfully pressed for the replacement of two nursing administrators, as well as an overhaul of the food service. Residents now can dine on fresh lobster and homemade soups.
Only a few dozen of the state's 450 nursing homes have similar strong family-run councils, but a new state law is expected to spark more. Advocates hope that the law will empower families to take control of councils at other homes that are run by management and have few members.
The law, included in the state budget, authorizes state officials to fine nursing homes that interfere with the formation of councils or retaliate against the relatives of council members who speak out. The measure requires nursing homes to respond in writing within five days to concerns raised by the councils.
"This gives the councils clout," said Patti White, director of the ombudsman program for South Shore Elder Services. The administrators "will have to listen to them. They can't just blow them off."
While Weymouth Health Care Center administrators have been receptive and responsive to a strong family council, other facilities have been less welcoming, said Mary McKenna, director of the state long-term care ombudsman program.
"Councils have been discouraged from meeting, discouraged from forming, and ignored when they bring up concerns," McKenna said. "I wish I could say that retaliation doesn't happen, but it does."
The law was proposed by Massachusetts Advocates for Nursing Home Reform, a network of family-run councils, to give teeth to federal regulations authorizing the councils. It was included in the budget after stalling as a separate bill. Scott Plumb, senior vice president of the state's nursing home trade association, said that his group, the Massachusetts Extended Care Federation, supported the law, though it didn't work for its passage. Most facilities welcome the involvement of families, he said.
McKenna said the councils can be strong forces for change, helping facilities recognize problems and working with them on creative solutions. The ombudsmen, the Weymouth council, and Massachusetts Advocates are working with families at other homes to form new councils.
Weymouth's council advocates for families who may be too timid to speak up on their own, and it looks out for residents who don't have nearby family, said president Deborah White, whose father has been a resident for four years. At monthly meetings, the council brings in speakers to educate families and answer questions and then members talk about pending problems. Last week, members questioned the facility's medical director about how he would handle a nurse who didn't follow his orders. The home's executive director reported on successful efforts to reduce the number of temporary workers.
Jerry Goldberg, who helped establish the council and stayed involved after his mother died two years ago, prepares a monthly spreadsheet of issues raised by families. This month's included complaints about a filthy floor in a day room and a thermostat set so low that residents need blankets during the day. The facility's executive director, John Kokorus, provided a written response to each item, reporting that the day room's carpet and chairs had been scrubbed and that maintenance would check on the air-conditioning.
"If they have a concern or an issue, I take it very seriously, and I act on it," Kokorus said. "They do hold me accountable."
In past months, the council also brought staff problems to the attention of both management and the state. Last October, state investigators cited the facility for failing to provide pain medication to a patient dying of cancer because nurses weren't trained in how to administer the intravenous drug. The facility's director of nursing and director of staff development were replaced.
White, the ombudswoman who monitors the facility, said the council was instrumental in the staff changes. Steve Adams, a spokesman for HealthBridge Management, the company that took over operations at the facility a year ago, said the council "brought issues to our attention."
"We listened to those concerns, did our own investigation, and did what we felt we needed to do," he said.
Adams said the council's concerns about the quality of food and lack of choice dovetailed with plans by HealthBridge to hire new cooks and offer a new menu.
"We can't tell them how to spend their money," Goldberg said. "We can make suggestions and provide volunteers. We work so they will meet us half-way. I'm not telling you everything is great here, but we're improving the quality of care."
© Copyright 2004 Globe Newspaper Company
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