Category Archives: OPINION:


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.



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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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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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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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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.






I am a resident in a nursing home. I am also the “responsibility party.” That designation means that I, and I alone, control my destiny while adhering to the policies and practices imposed by the nursing home. Policies and practices under which all residents and nursing homes must adhere. The policies and practices are outlined by the Centers for Medicare/Medicaid Services Manual—the U.S. Government. These guidelines are designed to protect the resident from abuse and assure that they receive the medical and palliative care they deserve. In the case of most residents, a family member, attorney, or a trusted friend is the responsible party. This is because most residents in nursing homes are perceived to have suffered a cognitive decline and are no longer able to carry out financial transactions or make sound decisions that affect their well-being. It is the “responsible party” that makes those decisions while conforming to the safety, comfort, and security of the resident.

As such, the relationship between the resident and the “responsible party” must be one of trust, understanding, and advocacy. The responsible party must have an intimate knowledge of the history, habits, and wishes of the resident. That is why the “responsible party” is usually a caring, involved, knowledgeable, family member. Unfortunately, this is not always the case.

I attended a “Family Council Meeting” as a resident/responsible party. Since my nursing home has 160 beds, my expectation was that the community room would be filled close to the capacity. Surprise, surprise! Initially, it was me and four other individuals. We were later joined by four others. Two of the other eight were individuals associated with the same family member. In total, only seven residents were represented. Seven residents represented out of a potential of 144 if the facility is filled to 90% capacity. Just under 5% of resident’s family members showing interest.

This is a grim statistic if it realistically reflects family interest and involvement. Significant regarding the level of accountability demanded of nursing homes. I see many family members frequently visiting residents, celebrating birthdays and holidays—some even come daily—showing genuine concern for their loved one. I also see family members discussing issues with nursing assistants, nurses, and social workers. These one-on-one conversations have little effect on the overall governance of the long-term facility or the care received by the resident. There are just too many different individuals involved with the care 24/7 to talk to one CNA or a charge nurse. At every shift change, someone new will take over, communication between shifts is weak, and accountability will be entirely different.

If this is indicative of the apathy in terms of concern for a family member in long-term care facilities, seniors are in big trouble. Older adults are left in the hands of a culture dominated by management more interested in meeting administrative and financial needs than the needs of the residents. Older Americans face a future with little support and even less advocacy.

Advocacy groups, although well intentioned, face an uphill battle with such apathy. As it turns out, advocacy groups may be the only hope for the aging population as family members couldn’t care less. Family members are glad to shed the responsibility of an aging family member and place them in long-term care thinking that they are getting the best care possible. The long-term care facility will make all the assurances in the world and paint an optimistic picture, but this is a well-crafted illusion. Some admissions personnel are not aware of what goes on in their facility. Department heads will shield the administrator from reality while ensuring their job security. Administrators are in denial—after all, their primary responsibility is fiscal in nature—filling the coffers of the corporation.

If families turn over the care of the loved one to unknown entities, why not give the advocacy responsibility as well? The evidence in my sample shows this is what’s happening. Unfortunately, advocates are underutilized and overworked.

The enemy faced by the elderly is silence. They are in a place where they have no voice. The professional advocate may be the only resource available; a well-intentioned,  underinformed, and overworked substitute family member. The information about the advocate, the name, contact phone numbers, and mailing address are all given to the responsible party during the admissions process or posted on an obscure bulletin board, soon to be forgotten.

The involvement of family members, as shown in my experience, has been superficial, assumptive, and depressing. Family members were given the opportunity to discuss their concerns and quality of care with the Director of Nursing or her assistant openly, yet less than 5% of the residents were represented. Is there a communication breakdown? Will no one listen? Nursing homes are reluctant to place undue emphasis on advocacy involvement for fear of operational meddling.

An advocate, no matter how good or how dedicated, cannot not know the life history, the habits, what gives the resident pleasure, the feelings, of every resident. At best, it is merely a temporary bonding. Lacking is the established and reinforced trust, confidence and intimate knowledge of the resident’s past, present, and future aspirations. The professional advocate can offer only sympathy, but no empathy.

A feeling of fear, emptiness, isolation, anger, and abandonment fill the soul of the resident.

Absent is any mechanism that offers meaningful, lasting, social support.




McGuire Veterans Medical Center endangers forty additional veterans. Security, safety, and needed emergency services are being jeopardized.

With the completion of the new forty-bed wing at Sitter and Barfoot Veterans Care Center, it brings the total to over two hundred employees and veterans at risk.

Sitter and Barfoot is a long-term facility for veterans honorably discharged from active service that need rehabilitation or long-term skilled nursing care. It is a nursing home.

Sitter and Barfoot is situated on the property of McGuire Veterans Hospital, yet security and emergency response falls to the Richmond City Police, Richmond Fire Department, and outside or city ambulance service.

In what could only be attributed to a cost-saving effort, the most direct route to Sitter and Barfoot is through a gate that is closed and locked at dark, and twenty-four hours a day on weekends, and holidays. The locked gate impedes all emergency vehicles; ambulance, fire, and police. This mistake causes emergency responders to take a more circuitous route through McGuire’s main entrance, putting over two hundred of the most vulnerable veterans and state employees at risk. Veterans that suffer from dementia and Alzheimer’s; many are unable to walk, and all suffer from medical conditions requiring skilled nursing care.

It is a fact that in an emergency, every second counts. The closing and locking the gate slows the response time for all emergency vehicles responding to life and death conditions—delays with dire consequences. Life-threatening delays.

For the safety, security, and well-being of employees and aging veterans, it is critical that Sitter and Barfoot be patrolled and the gate open 24/7.





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.




Sitter and Barfoot continues to place residents and employees at risk through its poor hiring practices.

In the last three months, new hires have been put through five days of orientation and worked on the floor caring for residents only to be let go after failing background standards.

Most recently a new hire, not even completing his fifth day of orientation, was caught sleeping shortly after clocking in.  When confronted with his indiscretion, he became belligerent and confrontational to the extent that the Richmond city police had to be called to escort him from the building. Because of his erratic behavior co-workers had become fearful for their safety.

City police complained that they had to take a circuitous route because the main gate to Sitter and Barfoot was locked closed. The gate is secured every night and twenty-four hours a day Saturday, Sunday, and Holidays. This causes unnecessary and dangerous delays in all emergency response times, further putting residents and employees at risk.

These conditions are exacerbated by the anticipated opening of a new forty-bed unit and the rush to get it opened on time in July.

Sitter and Barfoot has a history of poor hiring practices and keeping quality personnel for the non-traditional shifts. This condition has worsened in recent months.  Going back as far as 2010 and 2011, Sitter and Barfoot has shown a lack of concern in their hiring practices.  The Virginia Department of Health, the ineffective agency that inspects nursing homes, noted in their June 10, 2010, annual surveys that: “At time of job offer the H.R. Department will confirm verification of license/certification is in the personnel file.”  The Department of Health further stated that: “If the verification has not been obtained/confirmed the new employee will not be allowed to work.”

Those directives had not been addressed a year later. On June 23, 2011 the Health Department cited Sitter and Barfoot again with the following:  “This requirement is not met as evidenced by:  Based on staff interview and facility documentation review, the facility staff failed to operationalize [sic] policies for screening employees for 3 of 5 employees (CNA A, LPN A, other B) in the survey sample.  The facility staff failed to conduct background check, reference checks, and timely licensure verification.”

Apparently, the leadership and the administration of Sitter and Barfoot did not take the safety and security of residents and employees seriously in 2010.  They took the recommendations of the Health Department and did nothing—they provided no action or follow-up.  Now, five years later, it appears little has changed.

The Department of Veterans Services, the state governing authority over Sitter and Barfoot, continues to collect state paychecks oblivious to the risks at their nursing home. They too are complicit in the neglect of veterans and in doing so, should be held accountable.