11.25.2008

where's the care?

48 pound disabled woman dies and launches an investigation of over 1000 new jersey group homes for developmentally disabled adults. Link. Discussion here. This is what people are saying.

Where's the nursing care? The care of adults with developmentally disabled adults has gradually been shifted over to Unlicensed Support Personell.

I worked in one of these homes. Not in NJ but still. In general I thought the clients started receiving better care once private companies bought up all of the group homes that our state was hemmorhaging. The home I worked in was one of these recently-privately-owned group homes. From what I saw, it seemed to me that the clients got better care in these privately run group homes, and for labor that was literally half as expensive.

You can't get away from, however, the fact that we were taking on the daily responsibility for things like getting the clients fed and washed and even administering medications(many states, in case you did not know, allow unlicensed personnell to administer medications after taking a short class, but only if it's for care of the developmentally disabled), all for 10USD an hour in one of the richest states of the country.

The nursing care I saw my clients receive? One monthly checkup by a company RN.

That means that somewhere, someone was responsible for keeping track of this person's weight, and initiating actions based on the information he or she has collected.

Was this person an RN, in this case?

I'd like to think not, but there's the distinct possibility someone may find themselves up before NJ's state board of nursing or department of public health or whatever they got goin on down there.

My first impulse, having worked for one of these companies, would be to -go over the documentation-.

Who is managing these people's care? If it's not someone trained and licensed to manage care, you might run into problems.

Oh, wait, here it is, from the article:

The Division of Developmental Disabilities caseworker responsible for keeping tabs on the woman has been suspended, the home's license has been revoked and state workers are checking on the well-being of all 1,255 residents of similar homes, the officials said.


"The ... caseworker responsible for keeping tabs on the woman". Read that carefully.

After nursing school I looked back on that work I did at the group home with a new appreciation of how dangerous what we were doing actually was. None of us had any ability to interperet vital signs, and could only do automatic BPs if the RN (who had..i dunno..20 homes assigned to her?) called us and told us to. Knowledge of the drugs we were administering was very low. All we were concerned about was giving it on time, 'lest we point-out of our med cert cards. Adverse reactions and side effects were only screened for vary rarely, and not by us.

Even saying all of this, they got much better care than they would have in an institutional setting.

What I'm saying is that this is the concequence of privatizing the health care delivery system -too much-. If you've escaped entirely from the grasp of the system that licenses and certifies what you're doing, the very mistakes they're there to prevent will start cropping up.

Once you've made the decision that some people are, depending on their diagnoses, only worthy of having a caseworker "keep tabs" on them, what's next?

Hey, what we're doing could be really profitable if we try to make as much money as we can doing it!

A human being will recognize that someone is wasting away to death. A corporate entity will not. We've all benefited somehow from the Limit to Liability, but ultimately we are not valued by it as much as increasing shareholder return.

The larger concern here is how to provide adaquate nursing care to this population. Any ideas? Really the only thing to do is join up. Your Team is down over two million votes (projected nursing shortage in..i dunno, less than a decade from now), and the margin is growing all the time.

Now, think about this group-home business being transferred over to eldercare. When I worked in a group-home, getting nursing home patients out into four-person group homes in a suburb somewhere seemed like a great idea. Now I'm not so sure. Nursing would be edged out once again, "supervising" maybe 80 clients in 20 homes.

The emphasis now seems to be put on either high technology or volume of patients. Would it be different if there were more nurses? Maybe, I don't know. I know the shortage of masters degree nurses is a big factor, since the pool of people availible (nevermind willing) to teach is small. There's no shortage of pre-nursing students.

Is the rarity of our profession part of some other entities higher purpose? Is someone making a buck off the nursing shortage? Think about it.

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