A friend called me recently and asked me to write this column. It’s about how skilled nursing facilities in California (and perhaps elsewhere in the nation although I understand Arizona is swimming in luxury by comparison) are understaffed. And the staff which does the work, not nurses, but CNAs, certified nursing assistants, are underpaid and in short supply.
As a result, helpless patients, unable to get out of bed or walk, ring for help and may have to wait hours before getting it. Here’s my friend’s sad story. She broke her hip and after surgery was sent to what is considered one of the best Medicare skilled nursing facilities in Northern California.
The first item of business when she arrived was filling out three forms outlining her food preferences. When a tray arrived, it was overloaded with food, most of which she couldn’t eat. My friend felt maybe the food service feels seniors are picky eaters so best to give them array of choices, including plenty of sweets. It turns out she was not alone. Most patients sent back trayfuls of uneaten food, an expensive and unnecessary waste. Why not imitate the hospital system? Give patients a budget of so much for each meal (in the hospital you pay for what you choose) and have them make the choice with dietary restrictions respected? You would have well-fed patients and little, if no, waste of food or dollars.
But the major problem is the overworked staff and their inability to appear when someone rings a bell for help. She did not know how many patients were assigned to the CNAs. They keep the patients clean, many of whom are in diapers, change their sheets and clothes, check their vital signs several times a day and if they are able to get out of bed, help them to a wheelchair. They are the ones who take care of all of the patients’ needs. Nurses come in a few times a day to give the patients their medicines. (CNAs are not allowed to do this). My friend said they brought her whatever was in her computer medical history, even those which were no longer necessary or, what was worse, medicine which might harm her current condition. She was relieved she still had her wits about her to refuse unnecessary and harmful medication. What about those patients who did not?
CNAs are also responsible for bringing their patients trays of foods. My friend thought this was the most inefficient and dangerous use of their time. While delivering food trays they are unable to respond to patients call for assistance. My friend fell because of this. She had been working out with the physical therapist, learning the painful path to walking again. She was exhausted after the session. The therapist wheeled her back to her room but was unable to assist her back into bed. She had to leave for another client. She left my friend in the wheelchair and my friend pressed the buzzer for help. It didn’t arrive for some 30 or 40 minutes later because her CNA was delivering food trays.
By the time she arrived, my friend was so tired she fell while trying to stand up. It wasn’t a bad fall. The CNA helped catch her. But she fell on the injured hip. The nurse came in to make sure she was OK and said the facility’s doctor would be there soon to take a look.
But the doctor never came. She finally called him and asked him to make sure she was OK and could get out of bed. He said it was not necessary and he understood it was not a bad fall. My friend insisted and said if he did not come he had to send the physical therapist to make sure she was OK and up to it.
After my friend told me this story, I discovered it was not an isolated incident. Even the most important patient could be left to suffer for hours. A world-famous pediatric cardiologist who wrote the textbook used in most medical schools and was a top star of his hospital and medical school in Southern California was in his own skilled nursing facility at his own hospital. This was before COVID and his daughter visited him one night. She found him on the floor. “What happened dad?” she asked. He said he rang for help and no one came.
The Assistance League is celebrating 60 years on B Street. Its programs include Operation School Bell which provides nearly 2,000 children with back-to-school clothing each year.
Sue Lempert is the former mayor of San Mateo.
Her column runs every Monday. She can be
reached at firstname.lastname@example.org.