When staff shortages in long-term care reach a level where it affects my quality of life I can no longer remain silent.

Much of the industry has yet to embrace the concept of PERSON-CENTERED CARE PLANNING (PCCP). It is interesting that the Federal Government has accepted the principle along with the obvious benefits to resident care that accompany it.

Central to this concept is the belief that the resident or responsible party is fundamental to voicing his/her preferences as to the care received. The government has made it an integral part of the annual inspection and nursing home certification process. The MDS (Minimum Data Set) 3.0 mandates certain policies, procedures, and questions to be asked of the resident if the long-term care facility is to participate in Medicare/Medicaid. Specific questions about the resident’s preferences as to his/her environment and quality of life.

Section F of the MDS 3.0 assessment includes, “Preferences for Customary Routine and Activities.” Questions like:

  • How important is it to you to listen to music you like?
  • How important is it to you to be around animals such as pets?
  • How important is it to you to keep up with the news?
  • How important is it to you to do your favorite activities?

I cannot emphasize enough that the resident or the responsible party read each line of the MDS assessment form and understand its significance in obtaining the necessary and desirable care.

An important aspect of the PCCP is the recognition of the resident’s need for stability in their daily routines. Staff shortage causes a disruption in the individual’s expectations and places the resident outside his comfort zone. Inconsistencies and repeated assignment changes have an adverse effect—often upsetting the resident for days at a time.

‘‘Minimum Nurse Staffing Ratios for Nursing  Homes.’’

CMS’s own study reported that facilities with staffing levels below 4.1 hours per resident day  (HRPD) for long stay residents may provide care that results in harm and jeopardy to residents (Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report, 2001, Abt Associates).                           16/pdf/2015-17207.pdf  pg 42200

A report by the National Association of State Units on Aging, published in 2005, entitled, ‘‘Nursing Home Abuse Risk Prevention Profile and Checklist’’ concluded that understaffing and inadequate training of NAs [nursing assistants] are major causes of abuse, especially for individuals with dementia.  pg 42224

Residents in a long-term care suffer through enough indignities each day. The changing of staff only worsens the condition. To have a constant parade of strangers come thru my room to attend to my daily needs, to help me dress, to help me shower, is unsettling, to say the least. I have my routine, a certain sequence of events, a certain way I prefer things to be done. I have to repeat my desires with each and every stranger from each and every department.

The regular staff knows:

  • What time I like to be awakened
  • What my morning medical requirements are
  • How I like my bed made
  • That I don’t like the overhead light left on
  • I like my door left open in the morning after I’m dressed
  • I like the bathroom door closed
  • That I drink a small milk and small prune juice for breakfast
  • That I want my personal coffee cup filled with only hot water in the morning
  • For lunch and dinner, I drink regular coffee
  • I provide my ice and cold drinks for my room and dislike being interrupted
  • Laundry personnel put my clothes away in the proper drawers
  • They know what time I prefer to go to bed

All the above contribute to my comfort and a feeling of contentment and control. My expectations are met.

Staff members working extra shifts to fill in for shortages can only result in a decline in the level of care residents receive. Three and four days of sixteen hours each increases the risk of injury to the resident, the staff, an increase in med errors, and a premature onset of employee burnout. It results in an unhealthy work environment. Nerves get frayed, tempers are short, and instances of resident abuse rise as does friction between employees causing more turnover.

A report by the National Association of State Units on Aging, published in 2005, entitled, ‘Nursing  Home Abuse Risk Prevention Profile and Checklist’’ concluded that understaffing and inadequate training of NAs are major causes of abuse, especially for individuals with dementia.

The research showed that nursing assistants in 10 Philadelphia-area nursing homes selfreported  [sic] abusive behaviors over a one month period. During this period,

51 percent reported yelling at a resident in anger;

23 percent insulted or swore at a resident;

8 percent threatened to hit or throw something at a resident;

17 percent excessively restrained a resident;

2 percent had slapped a resident; and

1 percent had kicked or hit a resident with a fist.    pg 42224

Administrations cover up understaffing by transferring staff from one unit to another. One such employee had her assignment changed three times in forty minutes. This just spreads the resident  and employee disruption and dissatisfaction throughout the entire population.

The following is a benefit analysis for proper staffing:

How Does Consistent Assignment Benefit Residents?

Residents do not have to explain to new caregivers how to care for them day after day.

Staff can respond to resident needs more quickly, confidently and naturally when they know the residents.

Residents are more comfortable with the intimate aspects of care when they know their caregivers.

Residents with dementia are much more comfortable with familiar caregivers.

Residents can have stronger relationships with staff.

Staff are more likely to detect residents’ clinical problems early when there is consistent assignment.

Residents have more choice and control.

Residents participate more in activities.

How Does Consistent Assignment Benefit Nursing Home Staff?

Staff members know individual resident’s preferences, needs and routines.

Staff give better care and can be more organized when residents and team members are known.

Having meaningful relationships with residents increases staff job satisfaction.

Staff absenteeism decreases.

Staff have more positive attitudes.

How Does Consistent Assignment Benefit Nursing Homes?

Nursing homes have better staff and resident satisfaction.

Nursing homes have better quality measures and fewer survey deficiencies.

Nursing homes have fewer family complaints.

Nursing homes have decreased staff injuries.

Nursing homes have lower staff turnover and absenteeism, which help reduce costs.

It’s difficult to understand why, with the positive gains to be made by proper staffing, that understaffing continues to be a chronic problem in long-term care. Prolonged staff shortages and high turnover are a direct result of the administration’s mismanagement and their lack of concern for the care and well-being of their residents and their employees.



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Representative Jeff Miller’s [1] bill, H.R. 4031, Department of Veterans’ Affairs Management Accountability Act of 2014: [2] Does it go far enough fast enough?

It is no secret that the Department of Veterans Affairs has serious problems. A crisis created throughout its hierarchy; a problem that creates delays in service resulting in needless anxiety, frustration, and frequently, death. [3]

The bill, ‘‘Department of Veterans Affairs Management Accountability Act of 2014,” will allow the Secretary of Veterans Affairs to remove members of the Senior Executive Service (SES) for performance.

Why not hold all management to the same accountability standard as the SES? Senior bureaucrats have stripped away any incentive for personal accountability and diminished responsibility throughout the organization. Those on the front lines of customer service should be as accountable as the seniors. It will do no good if senior management does not have the ability to dismiss unproductive or incompetent employees for performance shortfalls.


Civil service supervisors are unaware of the image their operation projects to the public. They no longer view their area of responsibility from the customer’s viewpoint, but instead, are busy responding to the whims of their supervisors and the occasional out of control grievance. Leadership is unaware of what happens on the front lines — under staffing, long lines, distracted, unresponsive, rude, and condescending employees. Employees are more focused on the timing of their next bathroom break or their cell phone vibrating than the client standing front of them. Supervisors have become too busy with a backlog of other priorities. Priorities designed to present ambiguous numbers and false positives. Priorities totally disconnected from the chaos that continues up-front, unabated. Priorities mandated by civil servants that are even more detached from the public’s perception of their operation.

H.R. 4031 makes no attempt to untie the hands of SES. SES is at the mercy of the lower chain of command with neither the ability nor the desire to make appropriate changes when necessary. There is little incentive to expend the energy or the resources to even meet, much less to exceed the veterans’ expectation. To change and insist on accountability throughout the Veterans Administration would require a fundamental transformation in the workforce and personnel practices. That is not likely to happen. The desirability of government employment would diminish. One of the well known perks of a government job is job security.

H.R. 4031is a step in the right direction and deserves support, but does little to untangle the mess created by mismanagement and poor planning that has plagued the Department of Veterans Affairs. H.R. 4031 will not be the silver bullet. Continued pressure on our representatives is imperative. The motivation of the department to self-govern has proven that they are more concerned about furthering their own interests rather than those of the veterans. Carefully concealing and shrugging off incompetence ensures a backlog of work and strengthens the employees’ grip on job security. Government can no longer protect the incompetent and unproductive civil servant. … Regardless of their position in the hierarchy.

“Despite the fact that multiple VA Inspector General reports have linked many VA patient care problems to widespread mismanagement within VA facilities, and GAO findings that VA bonus pay has no clear link to performance, the Department has consistently defended its celebration of senior executives who presided over these events, all the while giving them glowing performance reviews and cash bonuses of up to $63,000.00” [4]






My project started with a simple question: How do nursing homes discipline disruptive and inconsiderate residents?

The motivation for this project was my appreciation for, and a reasonable expectation of, continued calm. My stay in the nursing home has been relatively free from noisy interruptions from other residents. For the most part, it has been a quiet existence, and I’ve been able to pursue my interests uninterrupted. However, my concern has always been having a noisy, inconsiderate resident move near me. How does the nursing home administration manage, control, or remove such disturbing individuals?

The simple answer? They don’t!

Nursing homes ignore the problem and those innocent residents subjected to the objectionable noise are left to cope with it. Residents that continually scream and holler throughout the day and night are soothed and quieted by a CNA (Certified Nursing Assistant). If that doesn’t calm the unruly resident, little else can or will be done. The nursing home is more concerned with the individual’s rights rather than the individual rights of those in the immediate surrounding community.

“Many screaming residents are ignored or isolated because their behaviors are so disruptive.” pg 47

I have found that the problem has grown into a science of its own. Psychologists have filled this vacuum and have capitalized on finding solutions to the problem through seemingly endless studies and an equal amount of solutions. None of which are being actively applied in nursing homes.

The issue is referenced by different names: Verbally Disruptive Behavior (VDB), Problematic Vocalization (PV), Repetitive Disruptive Vocalizations (RDV) or, Disruptive Vocalization (DV). All are easily searched on the Internet.

One of the initial interventions, the simplest and least expensive, is the introduction of music to the screamer’s environment.

The Effect of Music on Repetitive Disruptive Vocalizations of Persons With Dementia by Julie A. Casby, Margo B. Holm. file:///C:/Users/User/Downloads/883.pdf

I can say with a high degree of certainty that interventions have never been considered in my nursing home.

One study suggests that the responsibility for intervention falls squarely on the shoulders of the occupational therapist and the activities department.

“Music appears to alter the abnormal or disruptive behaviors of persons with DAT [Dementia of the Alzheimer’s type] residing in LTCFs [Long Term Care Facilitys] (Burgio, Scilley, Davis, & Cadman, 1993). Therefore, music may provide occupational therapists with a means to decrease the incidence of RDV [Repetitive Disruptive Vocalizations ].” file:///C:/Users/User/Downloads/883.pdf page 884.

“The effects of the interventions were clinically and statistically significant, indicating the importance of providing stimulating activities a richer environment to cognitively impaired nursing home residents.”

The seriousness of the collateral damage has been misunderstood and unseen by nursing home administrators. It’s not found in the Minimum Data Set (the resident’s quarterly assessment), nor on the Health Department Survey of nursing homes (the annual inspection).

“Among the disruptive behaviors that are exhibited by nursing home residents with dementia, problematic vocalizations (PVs) are the most frequent, persistent (Nelson, 1995), and annoying (Cubit, Farrell, Robinson, & Myhill, 2007; Whall, Gillis, Yankou, Booth, & Bates, 1992).” (

“Negative consequences of PVs include increased distress or anxiety of the resident and others in the environment (Burgio, Scilley, Hardin, Hsu, & Yancey, 1996), often causing social isolation (Draper et al., 2000) and over medication (Cariaga, Burgio, Flynn, & Martin, 1991), which in turn results in higher health care cost (Murman et al., 2002).” ((

My concern is justified by the statements above. “Negative consequences of PVs include increased distress or anxiety of the resident and OTHERS in the environment….” [emphasis added].

“Screaming behaviors can provoke assaults by other demented residents.” pg 47

By whatever name, the result is the same. It not only affects the distressed individual resident, but all those in close proximity. It is a concern that the Center for Medicare/Medicaid Services (CMS) and nursing homes have ignored far too long and must be addressed.

“Verbally disruptive behaviors (VDB) are verbal or vocal behaviors that are inappropriate to the circumstances in which they are manifested. These behaviors are a source of concern because they disturb persons around the older person and may be an indicator of distress.” (  Verbally_Disruptive_Behaviors_in Nursing_Home_Residents)

The psychological/psychosocial well-being of the elderly in the nursing home community is no less important than the individual’s proper nutrition, social services or physical rehabilitation, yet it is ignored by nursing homes.



SENTIMENT LOST: Sympathy, Care and Kindness


Unknowing and uncaring family members ignore those closest to the aging at the end.

I have spent over a year sharing a table, eating three meals a day, celebrating holidays, birthdays; discussing politics, opinions, innermost feelings, ups, and downs with people who, until recently, were total strangers.  Over time, a bond is formed.  It’s the last friendship.

When a resident first arrives at a nursing home,  fear and loneliness set in. Residents reach out to those they become familiar with; those they eat with and those they connect with in activities. It is a bond cemented by the commonality of a depressing, unspoken reality.  We are all waiting to die.  That’s the reality. We are reminded of it each time someone passes.  Another empty room, another empty space at a meal table.

When a resident dies the family is drawn in to handle final affairs, nursing home relationships are overlooked. I have shared the good, the bad, the pain and suffering of my declining years with those that I have become familiar. They too have shared their history of family dysfunction and disease with mutual confidentiality. Intimate details and feelings not even shared with family.  Perhaps the family is fearful that I know too much.

I have never been given the opportunity to pay my respects; unable to express sympathy, sorrow, or sense of loss with a family I had grown to know only briefly. The deceased is whisked away.  Removed from meaningful relationships by a family that treated my friend as if he had become a burden in later life—disposing of what remains as if the dead had no friends in the nursing home. No kinships. Nothing!

I’ve experienced it twice.  Once with Clarence, who shared with me his family history in Virginia and West Virginia.  Again with Tom.  His life story spanned both Virgina and Florida.  I was fortunate to see them both just days before they died.  I don’t know if they were aware of my presence.  It was the last goodbye.

I was ignored by both families.

Fleeting, fragile, short-term friendship. Another empty chair at the table.

Such is life—and death—in a nursing home.

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Dreams were about to be broken.

I can clearly remember that July day in 1980.  It was mid-afternoon, sunny, hot, and humid.  As I reflect back, it was an unsettling time for me; the divorce, the lawsuit, and the knowledge that emotions would be uncertain.  All were weighing heavily on me.


We had finished loading the pick-up truck with the few possessions I was to take with me: an office desk and chair, a credenza, clothes, shotguns, pictures, and papers.  Left behind were the things of value.  She had custody and control over all that I was leaving behind.

My four children had gathered on the front porch to say goodbye.  Diana, 11, and Pam, 10, were old enough to understand what was happening.  They, however, had been spared the details.  They had also been prepped for the event that was unfolding.  Diana and Pam stood by trying to control any feelings they may have had.

Matt, seven, the youngest, was too young to grasp the immensity of emotions and clung to his mother’s leg.  Steve, nine, the oldest boy struggled to hold back his tears.  His mother explained to him that his daddy would be going away for a while.  I too was failing in my effort to hide tears.  As I turned to leave, Steve, moisture in his eyes, handed me a book.

Many years have passed; I have traveled many miles.  The book traveled with me from Asheville; to Raleigh; to Roanoke; to Indianapolis; and finally to Bridgeport, CT.  The treasured book always was packed and moved with me.

It was not until the late nineties that I parted ways with the book in Bridgeport. I was forced to leave the book behind due to necessary downsizing.  Downsizing made necessary by economics and poor judgment.  In haste and oversight, the book was left behind.  An oversight that I now regret. I am reminded of that book every day.

Every day I look at the picture that hangs on my wall in the nursing home where I now live.  The picture serves as a reminder of that book and what I left behind; a reminder of the pain and emptiness I’ve felt over the years.  The hurt that I’ve caused and the wounds that will not heal. I now, so very, much would like to have that book so that I may return it.

It will have been 34 years this July since I’ve seen that teary eyed little boy; that little boy offering me a going away gift.  A book that meant so much to him then — and means so much more to me now.  The book is long overdue.  No one can imagine the price paid over the years; the years of sadness and remorse, and how lonely I’ve become.

Each day I look at the picture of my four kids.  The picture serves as a reminder of that book and all that I left behind.

I am so very sorry.


BREAKDOWN OF FAMILY: The Overlooked Consequence


Nowhere in the framework of society is the breakdown of the family more evident than with the aging. With the need for two incomes to support the family, no one is home to care for the elderly. The solution to one of the most perplexing issues facing a family has been found.


“In the U.S., nursing home chains have flourished since the 1970s, subsequent to the passage of Medicare and Medicaid and the extension of public payment for nursing home residency.“ — Light, D.W. (1986). Corporate medicine for profit. Scientific American 255: 38-45.

This act has completed the acceptable end of life drama for many households. The painful and depressing disposal of the elderly in a satisfactory and a seemingly compassionate manner has now become a reality. Family members can wash their hands of the sick and dying, delivering them to the care and comfort provided by others, paid for, to a large extent, by the government. The next of kin can now pursue their selfish endeavors cheerfully and guilt-free.

The degree of disintegration in families was readily apparent when I attended a Family Council Meeting in a nursing home; a meeting of relatives and responsible parties to discuss the care and comfort of a loved one put away in a long-term care facility.  These meetings are held at regular intervals throughout the year.  It gives family members an opportunity to meet with the administrative staff, presumably to air out differences, address grievances, and ask questions. This is the occasion to talk to the policy makers of the nursing home. My most recent experience was a sad example of family apathy, lack of family concern and lack of family participation. Two concerned people showed up for the meeting in a 200-bed facility. I was one of them.

Family breakdown has been the bane of the society for decades.  It’s not something that slowly crept up on us from nowhere. It’s only now becoming a concern for those of us that have ignored or tried to justify the cause of the of the decline of the family. Family values have been replaced by the need for two incomes so we can buy the newest, the fastest, the prettiest, the biggest, and the bestest, in the ongoing, self-imposed, undeclared competition with our peers. Equality and freedom of choice in the family—without direction or leadership—is the cause of family breakdown. When each has an equal voice, each goes in their own direction aimlessly with no leadership. Fundamental principles are cast aside, and each family member goes in a different direction to satisfy their selfish desires, free of responsibility and accountability. Each is allowed and entitled to do “their own thing.”

Sadly, it is the elderly that now suffer. They suffer alone. Once again, big brother has stepped in to fill the void. Once, when families were tethered together with common goals, objectives, and family values, sons or daughters cared for their old and dying. This is no longer the case. It is now the task of the government under the guise of Medicare and Medicaid. A new industry has risen to the forefront. Now dying and death offer a profit motive to the corporate world…and it’s flourishing.

With government and private corporations cooperating, also, come the countless cottage industries of government regulators, private and public sponsored watchdogs, medical specialties, psychologist, and social workers all clamoring to get their piece of the economic pie. All are well-intentioned and overzealous at their new found treasure trough. They are preoccupied performing never-ending studies to enhance their self-interest, the results of which are ambiguous enough to affirm the need for further studies and additional funding—and stimulating their job security.

Without the breakdown of the family, they would all be out of work.



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As a resident of a state-run long-term care facility, I’ve been exposed to a management style  much different from my experience in the private sector.


The most important characteristic of leadership is to convey the perception of competency and concern. Not only in the delivery of the final product or service but for the well-being of those employees that actually perform the one-on-one service. Visible leadership is essential at the time of adversity when employees are asked to perform above and beyond the ordinary. Employees and residents deserve and expect the same from management. To do otherwise creates a disconnect between management and employees and breeds disrespect, doubt and resentment.

During the blizzard of 2016 in Richmond, no member of leadership was on site to offer direction, leadership or control over the operation during the adverse conditions. Employees were told to risk personal safety and property damage to be at work. No “call outs” would be accepted! Confidence and respect towards management were shattered. If employees are considered “essential personnel” leadership, too, must be essential. Otherwise, why do we need management?

Visibility emits not only confidence and competency but concern for the outcome of the task at hand. It brings unity and strength towards the achievement of the goal: the comfort and care of resident veterans. Invisible leadership projects the image of incompetence and indifference.



I ran across this from the National Consumer Voice for Long-Term Care and thought it should be shared.

National Consumer Voice for Quality Long-Term Care shared Max Philisaire‘s photo.

June 28 at 8:44pm ·

This has been circulating on Facebook for some time and has the feel of fiction, yet the sentiment it expresses of “see me for the whole and entire person I am” resonates across all long-term care. What do you think?

When an old man died in the geriatric ward of a nursing home in an Australian country town, it was believed that he had nothing left of any value.

Later, when the nurses were going through his meager possessions, They found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the hospital.

One nurse took her copy to Melbourne. The old man’s sole bequest to posterity has since appeared in the Christmas editions of magazines around the country and appearing in mags for Mental Health. A slide presentation has also been made based on his simple, but eloquent, poem.

And this old man, with nothing left to give to the world, is now the author of this ‘anonymous’ poem winging across the Internet.


Cranky Old Man

What do you see nurses? . . .. . .What do you see?
What are you thinking .. . when you’re looking at me?
A cranky old man, . . . . . .not very wise,
Uncertain of habit .. . . . . . . .. with faraway eyes?
Who dribbles his food .. . … . . and makes no reply.
When you say in a loud voice . .’I do wish you’d try!’
Who seems not to notice . . .the things that you do.
And forever is losing . . . . . .. . . A sock or shoe?
Who, resisting or not . . . … lets you do as you will,
With bathing and feeding . . . .The long day to fill?
Is that what you’re thinking?. .Is that what you see?
Then open your eyes, nurse .you’re not looking at me.
I’ll tell you who I am . . . . .. As I sit here so still,
As I do at your bidding, .. . . . as I eat at your will.
I’m a small child of Ten . .with a father and mother,
Brothers and sisters .. . . .. . who love one another
A young boy of Sixteen . . . .. with wings on his feet
Dreaming that soon now . . .. . . a lover he’ll meet.
A groom soon at Twenty . . . heart gives a leap.
Remembering, the vows .. .. .that I promised to keep.
At Twenty-Five, now . . . . .I have young of my own.
Who need me to guide . . . And a secure happy home.
A man of Thirty . .. . . . . My young now grown fast,
Bound to each other . . .. With ties that should last.
At Forty, my young sons .. .have grown and are gone,
But my woman is beside me . . to see I don’t mourn.
At Fifty, once more, .. …Babies play ’round my knee,
Again, we know children . . . . My loved one and me.
Dark days are upon me . . . . My wife is now dead.
I look at the future … . . . . I shudder with dread.
For my young are all rearing .. . . young of their own.
And I think of the years . . . And the love that I’ve known.
I’m now an old man . . . . . . .. and nature is cruel.
It’s jest to make old age . . . . . . . look like a fool.
The body, it crumbles .. .. . grace and vigour, depart.
There is now a stone . . . where I once had a heart.
But inside this old carcass . A young man still dwells,
And now and again . . . . . my battered heart swells
I remember the joys . . . . .. . I remember the pain.
And I’m loving and living . . . . . . . life over again.
I think of the years, all too few . . .. gone too fast.
And accept the stark fact . . . that nothing can last.
So open your eyes, people .. . . . .. . . open and see.
Not a cranky old man .
Look closer . . . . see .. .. . .. …. . ME!!

Remember this poem when you next meet an older person who you might brush aside without looking at the young soul within. We will all, one day, be there, too!”


Thank you…please comment and share.





Bullying puts an emotional drain, not just on the target of such cruelty, but on those that witness such behavior and feel the pain in its presence. The casual onlooker is ill-equipped to intervene. The observer feels uncomfortable yet feels powerless to act. They see the bullying and remain silent. After all, it’s not their responsibility.

I am a witness to bullying every day, and it disheartens me. As I inevitably lose more and more of my understanding, will I become a victim of bullying—when my cognition weakens will I fall prey to taunts and ridicule from those residents around me? It’s a harsh reality on which to ponder as one grows older. I would be naive to think that the nursing home would shield me from becoming a victim. The nursing home staff is either not aware of the subtleties of bullying, or they just choose to ignore them.

Those people closest to the victim of bullying are not the best equipped to recognize and intervene…the trained staff of the nursing home. Other residents are complicit in the act of hurtful behavior toward the victim—joining in on the muffled snickers, laughter, and ridicule—not even aware of their actions.

Even those residents with the severest of disabilities will exhibit bullying on the weakest in the crowd to deflect attention away from themselves. To them, it is a show of strength and membership with the dominant group—a show of solidarity and tacit approval from the powerful. They will join in with their peers, mocking and making disparaging remarks. The most likely targets of such mockery are those that display delusional behavior.

The response from me is only a stern look of disapproval at such conduct.

The responsibility for eliminating bullying must fall to the nursing home administration. Emphasis must be placed on training the nursing assistants in identifying the subtleties of bullying. New hire orientation must include training done by in-house leadership to emphasize the importance. The training responsibility cannot be delegated! Those in leadership positions—department heads—must show their concern, and demonstrate that they are serious about bullying. The administration must be required to share the tools available to identify bullying and be proactive in quelling its pervasiveness. All staff members have to be able to recognize and feel comfortable reporting bullying to authorities without fear of reprisal.

Family members must play and active role. They must ask questions regarding the awareness levels of the administration regarding bullying. What kind of training, what frequency and what follow-up is in place? Inquiries must be made at the time of admission as to staff development programs and where the emphasis is being placed. Nursing homes must be able to document a continuing, comprehensive education and awareness regimen for those employees that come in direct contact with the loved one. Is the training spaced throughout the year or concentrated towards the end of the year to fulfill an administrative requirement? Is the nursing home proactive or reactive in their training program that identifies bullying? What role, if any, does the social worker play in the interaction between residents?  What role does the activities department play? The staff directly involved in activities should be trained specifically in identifying bullying behavior. Observe the activities. Does one resident continually dominate and control the conversation over other residents?  Are weaker residents being ignored or appear to be intimidated during activities or are they encouraged to participate?

All of the questions above will demonstrate whether the nursing home administration is aware of bullying and committed to its control and eventual elimination.








Miguel was born without front legs.  He came from the Dominican Republic to The Mia Foundation in New York.  The Mia Foundation is the only organization in the U.S. that solely rescues animals that are born with birth defects.  Miguel does not let his disability hinder him from living life to the fullest.  He is a happy, fun-loving little boy.

Miguel was born without front legs, He came from the Dominican Republic to The Mia Foundation in New York, The Mia Foundation is the only organization in the U.S. that solely rescues animals that are born with birth defects. Miguel does not let his disability hinder him from living life to the fullest, He is a happy, fun-loving little boy:

Miguel inspires me with his limitless strength and spirit.  A little living being with an abundance of enthusiasm and happiness.  He shows complete disregard for his shortcomings and lives his life with boundless energy and joy.

I have wondered how he can live with a disability without knowing he has a disability.  Is living with a disability a learned behavior?  Someone forgot to tell Miguel that he was supposed to have two front legs.  He must wonder how his playmates function with those appendages hanging from their shoulders.

I have become a paraplegic, losing the use of my legs very late in life, and Miguel is an inspiration—an inspiration helping me cope.  Coping, not with my disability, but with my modified mobility.

Thank you, Miguel.


A disabled veteran