Crisis in Health Care

At this point in my life, I have about ten years of experience in the field of Health and Human Services. My entrance into the field was my experience as a Certified Nurse’s Assistant. I dedicated to five long, back-breaking years at a local skilled nursing facility in my hometown before I decided that line of work wasn’t for me. After that, I worked as a Direct Support Professional, which is a person that supports individuals with developmental disabilities. I found a lot of fulfillment in the work, but it was also quite taxing psychologically. My particular work was conducted in a residential setting, and I stayed in this role for four years. Currently, I’m working as an Activities Assistant in a long-term care facility, primarily dealing with Alzheimer’s and Memory Support patients. In each of these jobs, I have noticed one huge, glaring problem with the way business was being conducted in Health and Human Services: determining the level of care needed for each individual.

In too many cases, patients are treated as if their needs are exactly the same as their neighbor’s. In some cases this may be true, but I have seen first-hand what can happen if this determination is not taken seriously. I’ll go back to my experience as a Direct Support Professional for this example: I was once put in a situation at a group home where one of the individuals I supported was consistently behaving in a suicidal manner, and often physically attacked her housemates. Whereas my job did include the safety and well-being of this individual, it seems obvious that someone with those types of mental issues should be seen and handled by doctors. Instead, they got someone like me who had basic CPR training, dignity training, and other forms of basic training that help workers to support individuals with normal, every day circumstances.

Even more problematic, dealing with an individual experiencing such high levels of distress made it difficult to be fully present with the other individuals living in the home, who were also under my supervision and required my support. It eventually created a dynamic where no one felt that their needs were being met, and conflict between the housemates became inevitable. There were even times where I felt that the individuals in the house were fighting for my attention. It didn’t take long for me to feel like my efforts were in vain, and that continuing down this path would be harmful for everyone involved.

As I communicated with my management team about what was happening and how I felt that the case was out of my professional range, I found that getting real support from them was nearly impossible. They would discourage contacting emergency support, even when it was clearly needed, and encourage me to “rely on my training”. Basically, their advice was for me to  just handle it myself. Problem was, my gut told me that this was not a situation that could be handled by me alone; I simply did not have the educational background and expertise to know how to handle it appropriately. It felt like what the management team really wanted was for me to sweep the problem under the rug and accept that this individual would never act any differently. Little did they know, my integrity and dignity training provided in my first few months of employment had stuck with me, and I found the idea that this individual was “beyond help” to be startling and an undignified approach to her care.

After further questioning, I found that the company’s primary focus was on the pay that they received from the state to care for this individual. Because her needs were so high, the state was willing to shovel out quite a lot for her care. It turns out, my company was willing to accept putting their employees and clients in danger to continue to get that pay, regardless of how many times I warned them of the severity of the situation and suggested that this individual needed higher care than what our company was designed to provide. To me, this is immoral, because it puts the money before the individual in service – which should be a fatal flaw for any company claiming that they provide the highest level of care for your loved ones.

Even now, in my current job as an Activities Assistant, I see the same problem. The management team becomes highly concerned with filling rooms so that their monthly income is where they need it to be to continue functioning. By acting in this way, the determination for the level of care is often the last consideration. It ends up that we have residents in an Assisted Living setting that need to be in a Memory Care setting, and we have people that are in a Memory Care setting that really need to be in a skilled nursing facility, and every other combination of mix-matching you can think of.

Blurring the lines and mixing people with highly different needs puts an unequal amount of pressure on employees whose job it is to actually care for and interact with these patients. After all, we provide these separations so that healthcare workers can be aware of what is expected of them, and provide equal care to each individual. This idealistic view often falls short, but the management staff who handled the patient’s placement never have to deal with the damage that their poor decisions have created. Imagine trying to provide equal care to everyone under your supervision, but knowing that it is impossible to do so with so in the circumstance that the company has provided. You can’t sit and have a conversation with a lonely person to meet their emotional needs when you have another patient who runs a high risk of falling but is too confused to understand that they can’t get up and walk around anymore. You have to make hard decisions and try to determine who really needs you the most and prioritize every individual’s needs. It is frustrating to say the least, because I actually do care about people and seek to provide a high level of care to everyone under my care that is both respectful and dignified.

I believe that the real problem is within management. Management staff have to be made accountable for their decisions, instead of putting the responsibility off onto the people who actually make the company run by taking care of patients. Somehow, it needs to be made clear that the money made from these institutions is secondary to providing care, because providing care is what truly brings in the income every month anyway. This means that the management team must be involved in the lives of the people that they’re managing. There is always this disconnect between management and workers in the field of Health and Human Services, and I suspect it goes far beyond just my field of work. As so many managers have preached to me in my ten years of service, we need to work as a team so that we can all be truly proud of the care we provide to our elders and other individuals in need of assistance. Until then, we’re simply falling short and failing to provide the highest level of care possible.



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