PHInational.org

The deaths of six residents over six months at an assisted living facility in North Carolina have intensified the state’s debate on the adequacy of training and supervision of unlicensed medication aides.

Medication aides are direct-care workers who are permitted to administer medications in assisted living facilities in North Carolina.

Thomas Goldsmith of the News & Observer reports that state public health officials concluded in December that poorly trained staff and unsafe diabetic care resulted in the transmission of a hepatitis B infection amongst diabetic residents, who were on average age 70.

An investigation by the North Carolina Division of Public Health found that the infection was spread between residents by unlicensed “med techs” who reused glucose monitors and other devices. The agency also found that no staff member was designated to coordinate infection control.

Med techs who work at North Carolina assisted living facilities, formerly known as adult care homes, are not required to be licensed or have state-approved infection control training. Goldsmith reports that they “may get only one-on-one training from a nurse on diabetic care.”

In the 1990s, the North Carolina Board of Nursing had proposed a uniform set of standards for medication aides working in all long-term care settings, but such standards have only been required in nursing homes.

Scope of Practice

The tragedies also fueled the discussion on whether med techs employed at North Carolina assisted living facilities should be permitted to administer glucose tests and insulin injections.

John Buse, M.D , Ph.D., former president of medicine and science at the American Diabetes Association, advised that many people manage their own diabetes but cautioned that facility owners and managers should “understand that insulin is a drug where the margin for error is very small.”

PHI commented on the case for this article, noting that quality long-term care depends on “not only training but decent wages and benefits and career advancement opportunities.”

North Carolina is one of six states to receive a Personal and Home Care Aide State Training Program demonstration award to develop and pilot test curricula for personal care aides working in homes and facilities.

– by Deane Beebe

The North Carolina Medical Journal‘s March/April issue contains a suite of articles on long-term care, including two about the state’s direct-care workforce. Read the full story

Melanie Rogers Jones 12/15/1965 to 3/13/2010

PHI mourns the loss of Melanie Jones, a certified nursing assistant (CNA) who was a tireless advocate for direct-care workers in North Carolina and beyond. Read the full story

“I think the movement to improve the nursing home as a workplace and the movement to improve it as a place to live are coming together in a very positive way, so that a nursing home can be both a better place to live and to work,” says Thomas Konrad. “I think those tendencies reinforce each other.”

Konrad is one of the authors of the Workplace Interventions, Turnover, and Quality of Care Report (pdf) released in June 2009 that details the effects of three distinct workplace interventions aimed at improving staff turnover rates and quality of care in North Carolina’s nursing homes.

Read the full story

Pinelake Health & Rehab

PHI’s thoughts and prayers go out to everyone affected by last Sunday’s mass shooting at Pinelake Health and Rehab, a nursing home located in Carthage, NC (“Suspect’s wife sorry for NC nursing home shooting,” AP, April 1).

According to the AP story, seven residents and one nurse were killed. Robert Stewart, 45, has been charged with first-degree murder in connection with all eight deaths.

Stewart’s estranged wife, Wanda Gay Neal, is a nurse’s assistant at the Pinelake facility and was present at the time of the shooting.

Dr. Saundra H. Spillman, executive director of the North Carolina Direct Care Workers Association, told PHI that the incident was an unexplainable act of violence and expressed her sympathies for the workers and residents there as they try to move on from this tragedy.

“I don’t know if people know how hard it is for staff when they lose residents to illness. To deal with it in a normal sense of aging and disease process is one thing, but to have to deal with this…you don’t even think about this happening to this group of people. …This work is a challenge in good times but in times like this, you really have to pull together.”

McKnight’s has published a column by Dr. Eleanor Feldman Barbera that offers strategies for dealing with a tragedy (“Coping in the wake of the North Carolina nursing home shooting,” March 30).

The July issue of The Gerontologist is devoted to findings from the Better Jobs Better Care research and demonstration project. BJBC, which began in 2002 and ended in 2006, was the largest initiative in the nation ever created to address the high vacancy and turnover rates of direct-care workers by improving the quality of direct-care jobs. The initiative involved changing both public policy and employer practice. Demonstration grants were made to groups in Iowa, North Carolina, Oregon, Pennsylvania, and Vermont.

A nine-page overview lays out how and why the project came into being, the problems affecting the direct-care workforce, and how awareness of and responsiveness to those problems is changing. The essay is by Robyn Stone (pictured), executive director of the Institute for the Future of Aging Services, and PHI President Steven Dawson. FAS and PHI conceived of BJBC and provided technical assistance to the grantees. Funding was supplied by the Robert Wood Johnson Foundation and The Atlantic Philanthropies.

Among the findings detailed in the issue:

• Direct-care workers across long-term settings identified more pay, improved communication, better supervision, and being treated with respect as the most important things employers could do to improve jobs.
• After accounting for satisfaction with wages, benefits, and advancement opportunities — good basic supervision was most important in affecting CNAs to stay in their jobs.
• There is a positive correlation between CNA job commitment and resident satisfaction.
• After accounting for satisfaction with wages, benefits, and advancement opportunities, good basic supervision was the most important factor behind commitment to the job. Read the full story