Holidays at Manor Care | Manor Care: Disgrace in Care

Holidays at Manor Care Sun - January 8, 2006

Earlier this month, the state conducted a routine, surprise inspection here at Manor Care Fair Oaks in Fairfax, Virginia. Like the previous "surprise" visit I wrote about, this facility had time to patch up the cracks; the holes in their patient care that, at any given time, could neglectfully swallow up any patient here in an emergency situation.

The goal during the week was to make sure that each wing was fully staffed in accordance with the law. Meeting this goal sometimes required the facility to pull out its "A-Listers" - those with nursing degrees who had long since become administrators in the front offices, to cover when someone didn't show. This happened frequently during minor snowstorms we had here in the first two weeks of December.

Snowed Over
As I said, they were "minor" snowstorms, which around the metro area means "stay at home". And people did. Unfortunately, so too did the state inspector. If the inspector had shown up, she'd have seen a valiant effort, albeit an unsuccessful one, to fully staff each floor by the "A-Listers". Things weren't perfect, but everyone got taken care of. The inspector ended up visiting the following day, when staff were eager to return to paid hours after losing a day. Everything ran smoothly as far as I know; I had a doctor's appointment in D.C. that day, and didn't see the inspector this time around. Things must have gone well; I heard later that the place received good marks.

The unfortunate thing is that the threat of inspection can't be here every day to ensure everyone consistently gets decent meals and good care. Once the inspection is complete, the facility sighs a collective breath of relief and returns immediately to its prior state of disarray. The day after the inspection, a second minor snowstorm ensured that Manor Care wouldn't just settle back into its prior state of disarray; it would sink to a level of disgrace I never thought I'd see in this or any facility.

If the inspector had been a fly on the wall, rather than a human with a clipboard in a scheduled, "surprise" inspection, she would have gained a great deal of insight from witnessing the day that followed. My floor, which should be staffed with six nurses and six nurse-assistants, had only one to two nurses and two assistants that morning to cover feeding and assisting 50 patients. Some patients weren't getting fed breakfast or out of bed until 12 o' clock, if at all. The assistants told me that some patients, those not as lucid, didn't get fed at all and many others didn't get scheduled showers. The situation worsened as word of another storm came. The evening shift operated with only a nurse and an assistant. Fortunately, many patients were in bed by the time that shift began.

Christmas and New Years
As the holidays approached, I found myself asking people about their holiday plans; first out of genuine curiosity, later out of concern for the patients here. It seemed that everyone was going to work on Christmas and take New Year's off. Manor Care requires staff to work at least two holidays - most chose Thanksgiving and Christmas. Sure enough, those two days were amply staffed. The week leading up to New Years had me worried - EVERYONE had plans, and everyone acknowledged that they had no idea how this facility was going to get by with seemingly nobody scheduled for New Year's Eve. It seemed to be an issue widely broached by staff but apparently rarely (if ever) discussed by management. Surely the place had a plan for the impending situation; and absent one, a general contingency plan to bring in nurses from an outside nursing agency. In the short time I've been here, I've learned not to expect either. In these situations I've come to expect improvisation among the few present, hardworking nurses and assistants as they shorten breaks or delay and shorten their lunches to somehow just get by, get people cared for.

Improvisation makes for good jazz, maybe even good comedy; but not good healthcare; not when lives are at stake; and not as frequently as I've seen take place here. There were two people, a nurse and and assistant, here on New Years Eve. There had been a nurse and two assistants, but one was moved to another floor that was, presumably, in worse shape than this one. Often, no one manned the nursing station - one was dispersing medications, the other responding to call lights. It was a dangerous situation, but Manor Care squeaked through it - no patient is worse off (maybe just unfed or un-showered) and the facility has the good report card to back up the image it projects.

Things must change
My needs get taken care of here at Manor Care because I'm not shy in expressing my needs and, in no small part, because the administrators read these blogs. What I'm concerned with is not just the well-being of the other patients here who can't speak up, but the fact that this facility is not doing what it is being paid to do, not doing what families expect of it, and not doing what the law requires.

Blame can be laid upon the employees to a certain extent for calling off their shifts, but ultimately, it is management and the company who are held responsible. They owe it to the patients they care for to hire qualified employees who will show up when scheduled. They have an obligation to those employees to create an environment that treats them with enough respect that those employees want to work hard, even on holidays. They don't.

Every morning I hear from different assistants how stretched-thin they are, how absolutely beaten down they are, how they can't feed eight patients during one meal time. They rarely complain about pay, but when they do mention how they get paid $9-$10/hour in an area with one of the highest costs of living in the country, I can understand why so many leave as soon as an opportunity appears elsewhere. The same job in another nursing home a mile away, that fully staffs each wing, might pay $3-$4 an hour more and be far less stressful.

The human element in healthcare allows caring, hardworking employees to be exploited more easily than in most other lines of work. If a department store fails to sufficiently staff or if employees fail to show, a department may become disorderly. Co-workers aren't compelled to sacrifice their own time to pick up the slack. If a nursing home runs short of workers, the nurses and assistants are faced with the decision to either exhaust themselves to feed and care for patients as best they can or allow patients to go unfed, unchanged, or unbathed. Anyone with a conscience would do whatever was necessary to care for as many patients as possible. But in doing so, he or she helps create a new low-water mark at which a facility can still scrape by.

How much longer before a patient slips through the cracks? At what point does a company like Manor Care change? What will it take? Does someone need to die? Do they need to be sued? I hope they change soon, and I hope it is out of concern for people, not out of concern for protecting their financial interests.

Posted at 12:57 AM

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