Healthcare's dirty little secret

In college, I worked for a year as a nurse’s aide in a for-profit nursing home. Basically if you were physically capable and didn’t have a criminal record, they’d hire you. If you made it through their two-week training course, you had a job caring for the sick, elderly, and disabled for minimum wage. You had to buy your own uniforms and stethoscope. Lifting belt and thermometers were provided.

I wasn’t a CNA. CNA is a state certification and my training/experience was insufficient for that. But there was no requirement for the nursing home to hire CNAs. Most of those with certification worked for a health staffing agency and earned well over minimum wage. So the nursing home trained their own, and only called the staffing agency when they were short-handed and needed to augment staffing for a shift. Which didn’t happen often, because most of the aides were happy to work a double shift when they could, to earn the extra pay. Since I was a full-time college student with the GI Bill, I usually only worked three 8-hour evening shifts a week.

My evening shift usually went like this:

• Get the patients who ate in the dining room up, dressed, and moved to the dining room for dinner. Since there were only 2-3 aides on a hallway of about 20 double occupancy rooms, this took a while, so the first patients I prepped got to sit in the lobby or dining room for an hour or more before dinner.
• Assist a table during dinner, which meant getting drinks and helping the patients who couldn’t feed themselves. The tables were semi-circular so that a single aide could sit in the middle and assist several patients at once.
• Take my patients back to their rooms after dinner.
• ­­­Take the patients who were due for a shower to the shower room and wash them. There were separate shower rooms for male and female patients, but the gender of the aide didn’t matter, and the shower rooms afforded no individual privacy for patients.
• Return all of my patients to bed.
• Check vital signs.
• Change bedding and clean patients who had soiled themselves as needed.
• Empty urinary drain bags and record quantities as needed.
• Provide hair care and tooth/denture cleaning as needed.
• Assist the nurse as needed.
• Respond to patient call lights as needed.

Since mine was a “skilled nursing hall,” almost all of my patients had significant impairment. Advanced dementia. Advanced multiple sclerosis. Multiple amputations. Infectious disease. Aphasia. Incontinence. It would have been difficult for 4 aides to provide sufficient care on that hall. When I started the job, we were usually staffed at 3. That meant that when any lifting of a patient needed to be done, we would have to take it in turns to help each other. Then, as part of a cost-savings effort, staffing was reduced to 2. Two aides, working solo, each caring for approximately 20 high-need patients. It wasn’t possible to always wait for a teammate to help with a patient, and as a result, injuries increased.

In addition to the lack of aides, there was little physical or occupational therapy provided, no entertainment or socialization outside of meal times, and no outdoor areas where patients might feel the sun or see a tree. The nurses rolled their carts down the halls, dispensed medication, and attended to such duties as could not be done by aides, such as catheterization or tube feeding. 

The available equipment was very shoddy as well. The shower chairs were made of PVC pipe and sometimes they came apart. One patient wound up on the floor of the shower room when her chair crumbled beneath her. She died a week later. I’m sure her family was never told anything except maybe “she took a fall.” The patient with chronic bedsores finally got a special therapeutic bed. She began to show significant improvement. Her wounds started to granulate and close. But insurance would only pay for the special bed for 6 weeks. Within a week after it was removed, her wounds were back to their original status or worse. In some places you could see her bones where the flesh had rotted off. 

The work was heart-breaking, and it was exhausting. I was 23 years old and Army-fit, but at the end of a shift I could barely stand. Technically speaking, we were supposed to have one 30-minute meal and two 15-minute breaks each shift. We seldom got to take that much time. I usually found time to grab a quick bite, but I never got any other break except for a quick pee.

Then came the day I showed up for my shift and found out that I was the only aide on the hall. The other aide had called in.

“This is insane. I can’t work this hall by myself,” I told the charge nurse.

“You’ll have to. We’re short-handed,” she replied.

“We have to call the agency and get a temp,” I said. “It’s not physically possible to care for this many patients single-handedly.”
“We’re not using the agency any more,” she told me. “It’s too expensive.”

“Okay then. I quit.”

“You can’t quit now. You have to work your shift.”

“No I don’t. I quit. Right now. So you go ahead and call the agency, because you don’t have anyone to work the hall now.”

I pocketed my stethoscope, walked down the hall, clocked out, got in my car, and went home. And that was the end of my medical career. A week later, I got a job with U.S. PIRG.

Make no mistake, those who run American health care are in it for the money. Understaffed, under-equipped facilities are responsible for many injuries and deaths, of patients and of care-givers. Nursing homes are the most chronically understaffed, but it's a problem across all medical facilities, and it is a huge contributor to the burnout that causes medical professionals to leave the profession. Attrition of RNs runs about 17%. Attrition of CNA’s is about 28%. I lasted 10 months.