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Raise the Bar for Elder Care

October 04, 2003

Federal regulators started with a good idea: Bring extra staff into nursing homes to help feed patients who cannot manage the task themselves. Mealtimes are so harried at many nursing homes that food is cold and unpalatable by the time patients get it, and trays are sometimes whisked away before the food is touched, much less finished.

Feeding elderly patients isn't a trivial task. Malnutrition and dehydration are common risks. Given their multiple disabilities and medications, many patients eat slowly and with depressed appetites.

Lesser-trained, part-time employees could help, but a now-pending federal rule won't foster that goal. Instead of using the feeding assistants to supplement overworked nurse's aides, homes will be able to simply replace better-trained people with minimum-wage workers with eight hours of training and no test to determine whether they learned anything. In other words, no additional staff, just lower-paid, less knowledgeable staff.

The rule also doesn't require homes to have a nurse directly supervising the assistants or providing emergency help, even though about half of nursing home patients have trouble swallowing and can choke. The feeding aides cannot move patients out of bed or to a better sitting position for eating, since that requires the training level of a nurse's aide.

Nursing home operators say they need quickly trained staff because of the shortage of trained nurse's aides. But even nurse's aides are required to have fairly minimal training -- 75 hours under federal rules, less than two full-time weeks. California requires about twice that. Most or all of that training takes place within the nursing home and can be completed within a few weeks, including as paid time on the job.

Hair stylists and dog groomers undergo far more training, notes Pat McGinnis, executive director of the California Advocates for Nursing Home Reform.

There are plenty of trained nurse's aides, McGinnis said, but turnover is high because pay averages less than $10 an hour and the chores are often strenuous and unappealing.

If nursing homes cannot hold on to aides, she wonders, how will they ever find good feeding assistants, who would be paid minimum wage and get only a couple of hours of work a day?

Good question. The Department of Health and Human Services should answer it before the rule goes into effect, scheduled to happen in a month. Two congressmen have asked the department to rewrite the rule, inserting higher staffing and safety standards.

Should that fail, California officials have the option of ignoring the rule. A better approach, though, would be to raise the bar -- as the state has before on nursing homes -- by setting standards for training and staffing that would make feeding aides a welcome addition to mealtimes, not a subtraction from overall care.

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