A direct care worker's defense of nursing homes.

The horror stories about nursing homes that you've been hearing and reading for years have given the nursing home industry a terrible public image. These sensational and sometimes shocking stories have had a devastating effect on an important public and private institution that is responsible for delivering care and services to those who need them most, the elderly and the disabled.

From a direct care worker's perspective, I have to say that we are angry. We are angry because we are beginning to understand that this ugly public image of nursing homes is not just an image of buildings made of steel and stones but, in large part, may be directed at us. We understand why some people believe that the negative reports in the media represent all nursing homes and their workers, but that simply isn't accurate or fair.

There are more than 2,500,000 direct care workers all over this country. It is unfair when they are stereotyped because of the actions of one or two bad apples, but that is what happens when the general public begins to believe that all nursing homes are the same. It was these very images that kept me from allowing my mother to be admitted to a nursing home when she first fell ill. It was these same images that formerly kept me from entering the field, and I believe that these negative images continue to keep individuals from entering the long-term care profession who might otherwise be interested in doing so.

I, for one, will not sit quietly by and allow the entire industry to be painted with such a broad brush. I will be the first to admit that some reforms are needed in long-term care, but when people say that all nursing homes are bad, I cannot remain silent.

As a member of several direct-care-worker and consumer-advocate groups that champion such causes as consumer-directed care, staffing, wages, health insurance, and other issues important to direct care workers and consumers, I am no apologist for what is truly wrong with the nursing home industry. However, when I hear or read negative stories that are ill informed and inaccurate, about an industry and a profession that I love, I will no longer hold my peace while others broadly condemn them. The nursing home industry is an honorable institution served by an ever-evolving profession. As direct care workers, we should get offended when someone outside our field speaks unfavorably about nursing homes, because that is the same as speaking negatively about us.

Most people, including many direct care workers themselves, don't know all that goes into managing a nursing home successfully. More is involved than they realize. For part of my direct care training, I participated in an experimental course in nursing home administration for NAs. Four hours a week for 12 weeks I "shadowed" the administrator after my shift was over. There was no classroom and there were no formal lectures or grades, but that experience opened my eyes to another side of the long-term care picture. One of the lessons I learned was that we all have to work together--owners/providers, workers, and consumers--to overcome the challenges that face long-term care.

During that training I was given access to various administrative records, and a glimpse at and explanation of budget items and expenses for a very large retirement community, which included assisted living, independent living, and a 75-bed skilled nursing facility. To say that I was overwhelmed by all the variables and responsibilities our administrator had to oversee would be an understatement.

The main challenge that the organization's skilled nursing facility faced wasn't that it couldn't keep adequate staffing; nor was it a question of wages or the lack of a decent health insurance package. The toughest challenge was fighting to stay at or under budget while waiting for Medicaid/Medicare reimbursement payments.

Slow payments from government agencies make it extremely difficult to manage a budget effectively. In some cases, smaller facilities that depend solely upon these payments for their financial survival can't make their payrolls and, consequently, pay raises and other benefits that all workers deserve become a distant or nonexistent dream. Some facilities struggling with this problem have even had to close down, putting their employees out of work. And this problem can, and does, breed other negatives, such as inadequate staffing and high turnover.

I am thankful to my friend the administrator who took time to show me the "other side" of long-term care. I am also thankful to organizations such as the Direct Care Alliance--a national coalition of direct care workers, concerned providers, union reps, and other advocates--and to the National Network of Career Nursing Assistants in Norton, Ohio. Well-balanced organizations like these have broadened my view of long-term care.

In this upcoming election year let us, as direct care workers, ask our elected officials about government-funded payment systems: how they work, why they are so slow, and how we can help to make them better. After all, these systems directly affect our profession and our economic well-being.

BY JOHN BOOKER, CNA 

John Booker, CNA, is a member of the Nursing Assistants Authors Group, Chair of the Male NA Task Force of the National Network of Career Nursing Assistants, a member of The Direct Care Alliance, and President and Founder of the National Association for Direct Care Workers of Color, Inc. To comment on this Guest Editorial, please send e-mail to [e-mail].