After losing a beloved patient, nursing home caregiver Luz Sanchez said she learned a powerful lesson: "You cannot have a heart of stone to be a caregiver, but you should know how to separate your personal life from your job."
With over 15 years of experience, the occupational therapist was training a patient on how to use her hands and arms, which had been damaged by severe arthritis. "I was obsessed with helping her recover so she could go back home, but that never happened," said Sanchez, who is Colombian.
Sanchez, who works at New York's Fort Tryon Center for Rehabilitation and Nursing, said she has worked with patients in very difficult situations. She said she seeks to transmit a sense of security and optimism to those she helps, especially those who are working to overcome illness or injuries from accidents. "I am responsible for bringing them back to an almost normal life," she said.
In 2017, roughly 1.4 million individuals in the U.S. — including 1 in 10 individuals age 85 and above — are in a nursing home, according to "The Best Nursing Homes," an annual survey by US News and World Report (USNWR). There are 15,640 nursing homes in the U.S. that have been certified by the Center for Medicare and Medicaid Services (CMS). About 70% of them are private businesses.
For Sanchez, dedication and compassion are the secrets to success. "That's what all of us caregivers should have," she said.
She discovered her passion at a very young age, helping her mom take care of her grandmother and great-grandmother. Because of a history of depression in her family, she always kept her mom in close sight.
On a daily basis, Sanchez works with long-term care patients and also with those who need short-term recovery. She trains them on how to use their phone, how to read and write, to recognize addresses and to solve problems on their own. "Elderly people with disabilities have a slow recovery progress," she explained. That's why caregivers should be patient.
Importance of family
A patient's care plan establishes the length of the stay and the services needed. Part of Sanchez's job is to train patients' family members to know how to provide proper care for their relatives once at home. Most of them are not capable to assist or help their relatives to overcome their difficulties, she said.
"Motivation is key for families when helping their loved ones recover," Sanchez said.
A study on the recovery of older adults after having a hip fracture, published in the Journal for Aging Research in March 2017 reinforces this idea: "For those living with a spouse or other relative, family was often described as being instrumental for support with daily activities and encouragement to engage in rehabilitative exercises," the authors wrote.
Michael Karash, the manager of the Fort Tryon Center, emphasized the importance of meetings for families to receive updates on their loved ones’ care plan. Those meetings are organized at the nursing home every three months for patients with stable conditions, or per the family’s request. They help both family members and the patient remain realistic about health problems and recovery time.
Family participation is also important when choosing a nursing home. "I always tell people to come visit and talk with other residents and family members, because that's the best way to know if the residence is suitable for the relative," Karash said.
For those without family, the main source of support is usually the care center’s staff, like Sanchez. That's why her patients call her a variety of names, including 'doll', 'Colombia' and 'linda' (pretty), she said.
"One thing that never fails when I recruit staff is looking for a big smile. That says a lot about the caregiver’s personality," said Karash. "Hiring the right people is a challenge because we want individuals who are passionate about what they do."
According to Robert Burke, a professor of Health Management at George Washington University, there is a shortage of well-trained individuals in nursing homes, like certified nurses. Fewer and fewer people are seeking licenses to become nursing home administrators.
Burke warned that young students in the community aren't fully aware of possible job opportunities and careers in the field. "Students don't get the opportunity to really spend time in a nursing home," he said.
There is also stigma about working in a nursing home. Many believe that working in these centers is a second-tier job. "More people need to understand that this is a noble profession," Burke said.
Laws in place
The past 40 years have seen an increase in standards for quality care in nursing homes, Burke said.
The Center for Medicare and Medicaid Services (CMS) has been working since 1987 to improve nursing home care, especially after the implementation of the Patient Protection and Affordable Care Act (ACA) in 2010.
Based on a 2016 report on the need for higher minimum nurse staffing standards for U.S. nursing homes, a lack of qualified workers is the system's biggest obstacle.
According to the report, low turnover rates, having a large number of professional staff and consistency are all strongly associated with high quality.
At Fort Tryon Center, there is one nurse per seven patients during the day and the ratio of nurses to patients goes down at night. As measured by US News and World Report, nurses provide 3.55 hours of care per patient (the national average is 4.15), but the overall rating of the center is above the standard in the U.S.
Sanchez has worked at Fort Tryon Center for a decade.
Fort Tryon Center has 205 beds, many more than the national average of 108.6 beds per facility. The number in 2009 (108.4) was almost the same, which comes from an analysis from The Henry J. Kayser Family Foundation (KFF), a non-profit organization focusing on national health issues. Texas (1,207) and California (1,198) are the states with the most nursing homes, followed by Ohio, Illinois, Florida and New York, according to CMS data.
Reports about the shortcomings of these services have declined since 2009, says the KFF report and in November 2016, new programs to improve the quality of care were implemented under the ACA.
However, cases such as the death of 14 residents at the Rehabilitation Center in Hollywood Hills, when Hurricane Irma hit Florida, still reinforce the stigma. "There may be more than one bad apple out there," says Burke, but also — he emphasizes — what people hear " is always the bad news rather than the good news."
To verify licenses: On the website of the National Association of Long Term Care Administrator Board's (NAB) website, you can check the professional credentials of many nursing home administrators in each state.
For a complete panorama: Read the study of The Henry J. Kayser Family Foundation's study on the shortcomings on infrastructure, staff and residents of US nursing homes.
Traditional rankings: Since 2009, the US News and World Report's "Best Nursing Homes" list is a guide for seniors and their families in the country. This assessment is based on the Nursing Home Compare database from the Centers for Medicare & Medicaid Services (CMS).
Reviews from residents and family members: Senioradvisor.com is the largest senior living review site for nursing homes in the US and Canada. It provides unbiased reviews from residents and their families.