Category Archives: VETERAN

OUTRAGE…ONCE AGAIN

REPOST FROM MAY 31, 2014

 

OUTRAGE

MAY 31, 2014

OPINION:

Public rage today is impotent; it has no mechanism to produce consequences.

Glenn Greenwald, With Liberty And Justice For Some, Picador, New York, N.Y., 2011, p. 152.

 

Richard Martinez, the father of mass shooting victim Christopher Michaels-Martinez, speaks to the media on Saturday. Photograph: Michael Nelson/EPA

 

It saddens us to see the outrage of the father of one of the victims. A victim in the most recent killings in California. An image falling on eyes with short memories. Unfortunately, we don’t share his outrage for long, if at all.

We are not reminded of his permanent emptiness on a daily basis. The empty bedroom; the bed not slept in; the bicycle leaning against the garage wall; the toys no longer strewn all over the living room floor. It’s when the victim is a family member or friend that we express our outrage. Then we feel the anguish, the sorrow, and the daily reminder of loss.

We barely showed our outrage over the killings at Sandy Hook. The horror of Sandy Hook was not strong enough to produce a sustained dialog. Those thoughts were quickly replaced by the joys of our own Christmas experience. Soon the faces were forgotten. The families eventually tried to move on. Some started campaigns to stop the senseless violence, but not many supported the effort to curb the killing that has become an everyday occurrence.

The reality?

Few people care. We are too embarrassed to show our outrage; too politically correct; too afraid to express our deepest feeling; too insensitive to share in the emotions.

We are a nation of people that don’t care. Unless it happens to us, our family, our friend, our neighbor; we don’t care. We have insulated ourselves. The constant barrage of death and despair in the media acts as an insulator. Once we get tired of it, we turn it off, move on, and forget.

The anger and raw emotion demonstrated by the father of a victim may open the wounds of those that have shared his experience, but, in fact, his passionate expression of anguish will quickly be forgotten. Just as those faces from Columbine, Aurora, and Sandy Hook. Images that have faded and been forgotten. Their sadness and outrage are forgotten until the next tragedy.

We are confident that the mainstream media will remind us of the next tragedy in infinite detail.

The next time you walk past your kid’s bedroom and see it a mess, smile and be grateful the child will be safe asleep there tonight. The next time you find the bicycle in the middle of the driveway, get out of your car and move it. Be grateful it’s rider is safe inside the home. Show your love and gratitude, not your anger.

Share Richard Martinez’s sorrow for a brief moment and be thankful it is not you. Be filled with hope that your loved one will not be the next victim of the senseless wave of violence. Then, turn off the thought like the TV, and move on.

Media has conditioned us to forget. We forget because we are helpless.

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SIX YEARS LATER

According to figures supplied to me by my nursing home, their turnover rate in 2015 was a staggering 41%.

When I asked the Director of Nursing what her goal was for reducing turnover in 2017, she looked at me like a deer in the head lights.

She gave the impression she had no idea what I was talking about.

I wasn’t surprised.

It begs to ask what they talk about in staff and Quality Assurance meetings.

Because of direct care workforce turnover and callouts, managers are forced to pull nursing staff from one unit to another creating a mediocre resident experience to all those affected. Rather than isolating those unit managers with the highest turnover and using the existing management’s expertise to mentor those that need help and direction, they continue to move staff around diminishing the quality of care to each affected resident.

The obvious fallacy is that there is no one with experience, expertise or desire to deal with turnover.

My nursing home has had nine years to fix the problem.

Staff turnover is not unique to my nursing home but exists industry wide.

My nursing home is quick to tell you, and proudly so, that their turnover rate (41% in 2015) is below the national average (44.4% in 2013).

The condition has been so pervasive that even the aging state and federal inspectors can only identify the problem through numbers supplied by the nursing home.

Surveyors are ill-equipped to offer solutions. It is also not their job. They are, in fact, nursing home “monitors.” They just tell you that you have an employee turnover problem.

Does anyone believe that those numbers are an accurate reflection of reality?  Of a commitment to quality care? Especially when it’s a state agency inspecting another state agency?

I don’t think so.

I believe that there is an unwritten code that says that one state agency doesn’t disparage another state agency. Particularly one with the word “Veterans” in the title.

There is no correlation between the numbers on paper and the quality of the care provided. It’s disingenuous to think otherwise.

Recently I engaged an RN in a robust discussion about employee turnover and the switching of nursing assistants to other units to fill short staffing and call outs.

She adamantly stated that the quality of care had not diminished on her unit as a result of management pulling CNAs from her domain.

“Each substitute was certified and qualified. They were all certified.”

She had lost sight of the personal assets a permanent CNA or LPN brings to the profession.

A CNA brings the unseen skill set of knowing each residents’ preferences. Not just one, but all twenty residents in the dining room.

The unit manager’s priorities are no longer focused on resident’s comfort and dignity, but instead, satisfying the administrative timeline for paperwork, reports, and meetings.

The following day at the breakfast table I witnessed an LPN that no one had seen before, uncover an open, bleeding wound next to me. She began treating the wound in front of all of us. It wasn’t until I commented that the whole scenario was unprofessional that she moved the patient from the table to the hall rather than his room.

Throughout the lunch and dinner meals, I saw LPNs pass medication to residents at the tables while they were eating.

Saturday of the same week no one got me up at seven for breakfast. Breakfast is at eight, and I was awakened at eight-thirty. They were shorthanded, and I was assigned a new CNA from an agency.

The same Saturday and unfamiliar LPN on the evening shift offered me only nine of the twelve pills I’m supposed to get.

Just an example of the inexperience, absence of training, and a lack of understanding of what quality service and care are in the nursing profession. It has been replaced by administrative requirements and away from the resident’s dignified experience.

Statistics and numbers collected from paper reports in no way reflect the hidden assets and skill set that a direct care professional brings to the long-term employer.

There is no substitute for the knowledge, familiarity, understanding, and positive encouragement that the regular CNA brings into the life of the resident.

The exchange of feelings is mutual.

Regular CNAs become family. They are the friendly face residents look forward to seeing each morning. Part of my inner circle. My confidant.

CNAs look forward to coming to work and seeing their residents—their progress and they worry if there is a decline.

The direct care workforce generously share their family with those of us whose families have abandoned us. Residents know the CNA’s and LPN’s family through shared pictures from smart phones and look forward to updates: their newborn, their pets, their ups, and downs.

In return, CNAs receive from the residents support when needed, encouragement, and praise when deserved.

The direct care professionals are the lifeline residents depend on—to the end.

They are the first to ask about the test result.

They are the ones that cheer for our recovery, praise our successes; they are the welcoming, reassuring smile when we return from the hospital.

The direct care professional brings incredible strength. They commit so much of themselves knowing all too well it will only be temporary and will end in loss and a feeling of emptiness.

They are the first person we call when our burdens become too heavy.

They provide us with the last hug we’ll ever get. The last hand we’ll ever hold. The last hint of affection we’ll ever feel.

They are the ones that weep secretly—silently—so that they don’t appear weak when we die.

To break that bond is hurtful, counterproductive, and produces negative outcomes at all levels.

It’s devastating!

Another reminder that the aged are but a useless commodity without feelings.

The administration’s view is that the residents will get over it.

Some may not have enough time left, but the feelings of the residents are of little concern.

Longevity in a nursing home is the greatest uncertainty looming over all of us.

CNAs are just another familiar face that soon becomes but a faded memory when removed from our lives.

Our last bit of warmth, and the acceptance that our contribution in life is appreciated.

C’est la vie.

Nine years the turnover has persisted at my nursing home. Pleas from the residents and the employees have fallen on deaf ears, and concerns have gone unresolved.

The administration continues to cling to the last vestiges of a failing, uncaring, philosophy.

 

bc

Please comment and share.

VIRGINIA’S BED-HOLD POLICY IN LONG-TERM CARE vs VETERANS

OPINION:

Bed-holds continue to be a controversial subject kicked around the long-term care industry for too many years.

Just what is a “bed-hold”?

bed hold:

A reservation that allows one to stay in, or return to, a care facility. The reservation is usually made just before relocation to the facility or during furloughs away from it (e.g., in hospital or on family visits).

Medical Dictionary, © 2009 Farlex and Partners

But who pays?

It’s particularly troublesome in state-run veterans nursing homes.

The subject gets sticky because you have two government agencies with conflicting goals. On the one hand, you have the federal government trying to ensure that the veterans are getting quality care, and the state-run Medicaid footing the bill.  Sometimes the regulations overlap, sometimes they don’t. Often, one hand doesn’t know what the other is doing.

The issue boils down to one of money. Someone has to pay for the empty space, or so it would seem. All too often, this responsibility falls to the individual resident—to pay for the privilege of returning to a familiar place—a place of comfort and tranquility—a place called home.

Let’s go back for a moment and examine the intent of the federal regulations. Clearly stated:

Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.

42 CFR § 483. 42 CFR § 483.25 Quality of care.

The federal government takes into consideration the bed-hold and continues to pay its portion of the empty room during the veteran’s short absences from the nursing home.

(c) Per diem will be paid under §§ 51.40 and 51.41 for each day that the veteran is receiving care and has an overnight stay. Per diem also will be paid when there is no overnight stay if the facility has an occupancy rate of 90 percent or greater. However, these payments will be made only for the first 10 consecutive days during which the veteran is admitted as a patient for any stay in a VA or other hospital (a hospital stay could occur more than once in a calendar year) and only for the first 12 days in a calendar year during which the veteran is absent for purposes other than receiving hospital care. Occupancy rate is calculated by dividing the total number of patients in the nursing home or domiciliary by the total recognized nursing home or domiciliary beds in that facility.

On the contrary, the state of Virginia makes no provisions to cover the bed-hold for anyone—including veterans.

The residents at the veterans’ care centers have taken the time and what limited resources that are available to them, to decorate their rooms. Rooms filled with cherished memories—memories from a lifetime of accomplishment, service, and sacrifice, only to have it all taken away by an unexpected medical event requiring only a brief stay in an acute care hospital.

The Virginia Department of Veterans Services must submit to the state legislature a request for funding to provide deserving veterans the peace of mind they deserve—that they will not be uprooted once again and will be able to return their home.

 

Please comment and share. Thank you.

bc

REPOST FROM APRIL 26, 2014

DEPARTMENT OF VETERANS AFFAIRS: A GLIMMER OF HOPE?

OPINION:

VETERAN

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.

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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]

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SENTIMENT LOST: Sympathy, Care and Kindness

OPINION:

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.

Please comment and share.

bc

A BOOK LONG OVERDUE ( REPOST FROM 2014)

PERSONAL

A BOOK LONG OVERDUE

MAY 24, 2014 LEAVE A COMMENT

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.

KIDS 3

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.

bc

PROJECTING THE PERCEPTION OF CARE AND CONCERN

 

OPINION:
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.

cropped-WORDPRESS-PORTRAIT2.jpg

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.
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MIGUEL: AN INSPIRATION

 

OPINION:

 

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

 

bc

RESIDENTS’ RIGHTS: LONG-TERM CARE

OPINION:

RESIDENTS’ RIGHTS: LONG-TERM CARE

Ignoring residents’ rights is the most common form of abuse found in long-term care facilities. It goes largely unnoticed and unreported. It doesn’t leave bruise marks or fractures, but it can be equally insidious and painful—leaving permanent scars on the mind.

Residents’ rights are written on paper and trashed by the administrators of long-term care homes. They are considered trivial and get in the way of their day to day operations. Much more essential to management is meeting financial and administrative objectives—glossing over residents’ rights knowing that such abuses are difficult to detect and harder to prove.

The elderly are a commodity. Keep them comfortable, make sure they’re given medications, they’re clean, fed, hydrated; make sure they don’t fall and control and contain all grievances.

Nursing homes smooth over residents’ rights complaints using vague and elastic terms. They use words like: typically, generally, many, and few, when answering questions. The administration will avoid specifics at all cost. Direct, honest answers will not be forthcoming. The intent is to reduce all accountability on the part of the long-term caregiver.

Long-term care providers get away with these abuses because residents are thought to suffer from cognitive deficiencies or have delusional thoughts brought on by medications. That’s why abuse of residents’ rights is so pervasive. Residents are intimidated and given misinformation from perceived figures of power. They only believe what they are told. Residents don’t know the alternatives and don’t question authority.

I have raised my concerns to the administrator. They have been met with insincere and condescending responses receiving attention for only the short-term—then ignored and quickly forgotten. Rights abuses are trivialized and left unresolved. The trust between me and the administration has been severed.

I served my country with honor—to protect and defend the Constitution. Now my inalienable rights have been stripped from me.

I am a resident of a long-term veterans’ nursing home. I have no cognitive impairments. I am my responsible party, and my rights are being abused.

The abuse of my rights has left no visible signs—no bruises, no broken bones. However, the emotional scars; the anger and the frustration can never be erased, forgotten, or forgiven.

bc

NOT IN DEFENSE OF DONALD TRUMP: THE BIGGER ISSUE

 

OPINION:

The comments made by Donald Trump are indefensible, yet they were his thoughts. He has a right to his opinions and is free to express them. That is why the founders of this country were adamant about the First Amendment. That is also why they used the phrase, “We the people….” in the Constitution.  They didn’t say, “We the corporations….”

Intimidation, money and power are the favored tools of censorship. We cannot let the corporations dictate what we can and cannot see or hear. Particularly the communications companies that virtually control the flow of all information we receive ( Univision,” has the largest audience of Spanish-language television viewers in the world, according to Nielsen Media Research.”). There is no distinction between government censorship and monopolistic corporation censorship.  Mainstream media already caters to the whims of government as to the content of the information we receive.

We are entering the gates of the proverbial slippery slope if we allow major corporations to censor what we, as individuals, shape our opinions. We, as the people, have the right to hear and see what we think is an appropriate source of truthful information and entertainment. It is naïve to believe we cannot decide to boycott Donald Trump shirts and ties or not buy the products that sponsor Celebrity Apprentice and the Miss USA Pageant. Those decisions should be left to the free market and the people.

Recognize too, that media corporations have the right to choose those people they do business with.  But, they too, have an obligation to the consumer to present fair, objective, and occasionally entertaining content. All too often, mainstream media acts as irresponsibly as those of the ilk like Donald Trump. I find their actions as deplorable as surely as I would find government censorship.

I will miss Celebrity Apprentice. I found the program marginally entertaining and sometimes a welcome distraction from the usual dribble found on network TV.

Donald Trump’s words and expressions offended many people. Let those that were offended dictate the consequences without the help of controlling corporations. Corporations seize influence and favorable legislation through powerful lobbying machines. Corporations do not—and should not—manage public opinion or the creative process through intimidation and censorship. Censorship is censorship regardless of who does it.

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