Tuesday, April 15, 2014

Sick To My Stomach Reviewing Minimal Standards SNC/LTC Faciliites for CNA's

Aides do the grunt work, the dirty work, the work "Nurses" generally believe are beneath their professional level -- both LPN's and RN's.

Over the years Mom was in a Long Term Care Facility, I've watched the services provided by CNA's, Certified Nursing Assistants/Aides, and never been able to locate details of their qualifications -- until today.

The Internet is an amazing wealth of information but sometimes you have to pose your question in exactly the right way OR stumble on the specific information while seeking other general info.

Today, I was researching general regulations and rules like how many personnel there should be on a floor attending residents at any given time. Imagine each State differs and as always, I access info on Missouri, you can seek info on your area and compare from some sites I mention in this blog that provide lists of various states or query Google or other search engines for similar information.

Let's talk about the requirements for the Aides in Missouri; these people who basically are the servers and observers of the men and women who reside in the SNC's. After all, they attend to all their personal needs including dressing, toileting, bathing, feeding (when needed) or delivering food trays to rooms and so many other functions.

My heart sank when I saw the minimal requirements in Missouri:  75 classroom hours and 100 hours "on the job" training. Theoretically, a person could attend two weeks of a "classroom/school" and be capable of going into a facility for "on the job" training" that would take another approximate 2 1/2 weeks to complete.

In Missouri, that means someone could be responsible and working solo with men and women in varying stages of physical and emotional needs including various forms of Dementia and using lifts and other mechanisms to move and turn patients that could potentially cause physical discomfort or even harm.

Read it for yourself at this link for Missouri: http://www.sos.mo.gov/adrules/csr/current/19csr/19c30-84.pdf

This link goes on to specify: "a minimum of seventy five (75) classroom hours of training on basic nursing skills, fire safety and disaster training, resident safety, rights, social and psychological problems of residents and the  methods of handling and caring for mentally confused residents such as those with Alzheimer's disease and related disorders .... followed by"100 hours of supervised on-the-job (clinical practice)" training

175 hours and an examination that isn't even standardized but each "testing" allowed to be done without any State certification of capability of the individual's actual abilities.

Mom was a hairdresser and she had to go through months of training, classes in physiology and chemistry and then had to go before the State to have a State Board examination. Not sure if that is true today but understand the course and time involved is quite a bit more than for the Aides who are daily providing life affecting services and observations for the Elderly -- at least in Missouri.

There's a whole list of Missouri schools that qualify to provide these courses and I randomly chose one:  http://www.medskc.com/programs.html

They offer many different class times/days of the week; one scheduled to begin April 18 and runs until July 18 is held each Friday from 8 - 3:30.

So, with a regular work week, "Marcie" (fictitious name) could be a CNA and responsible for the lives of elderly men and women through providing services, if she goes through the program and passes a test often administered by a facility who has the ability to create their own tests, by August of this year.

Wow! What other profession dealing with managing human life do you know about that is so minimal in its requirements for education and training?

Aides are the first line of knowledge of the individual resident in a facility yet they are given limited instruction and are constantly "on the run" to provide services generally requiring time and skills far beyond what they're allowed or trained to accommodate.

Returning to the Missouri site linked above:  "Curriculum content of the program shall include procedures and instructions on basic nursing skills in the following areas: basic hygiene techniques; bed making; personal care of residents; food service, charting; safety measures (including fire/safety and disaster preparedness, and infection control); basic preventative and restorative care and procedures; basic observation procedures, such as weighing and measuring; communication skills; methods of handling and caring for mentally confused residents; residents' rights' ethical and legal responsibilities; death and dying; and mental health and social needs."

BUT WAIT, THERE'S MORE:  "The orientation module shall include, as a minimum, the following topics: handwashing, gloving and infection control; emergency procedures and Heimlich Maneuver; residents' rights; abuse and neglect reporting; safety (fire and accident); lifting;' moving and ambulation; answering signal lights; bedpan, urinal, commode and toilet; preparing residents for and serving meals; feeding the helpless; bathing; dressing and grooming; mouth care; bed making (occupied and unoccupied); promoting resident's independence; communication and interpersonal skills." These are the directives listed on the State of Missouri cite referenced above.

SO WHAT ARE THE REQUIREMENTS FOR THE PERSON TAKING THESE COURSES AND BECOMING AN AIDE? Students must be at least 18 years of age or older, must pass Background Checks, must have a negative TB Test or Chest X-Ray, and score 75% on the Basic Education Test given the 1st day of classes -- is the statement on the Education Facility Site cited above and also detailed by the State of Missouri, which I believe uses the terminology must be able to work at an 8th grade level or above.

I remember watching many "new" hires at Mom's nursing facility where she passed and wondering how much training they had because each one seemed to be less prepared than the last one providing one on one daily care for Mom and others without anyone "supervising" or "tagging along" to train or oversee.

Think about it:  Your loved one is advancing with Dementia. New hires are arriving who are "in training" with your facility or who come from a "service" -- and family and friends and possibly you believe your loved one is "safe" and in highly "trained" and "caring" hands.

I challenge everyone to think again.

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