Local Area Has an Interesting

¶ … local area has an interesting blend of nursing homes because of the socio-economic make-up of the community. Parts of the community are incredibly wealthy, and there is a fancy retirement community in the area with an on-site nursing home that allows people to transition from their retirement homes into an assisted living environment. However, the community also has extreme poverty, and one of the nursing homes clearly draws from this population, and is no-frills. The community also has nursing home facility that I would consider standard middle-class. Interestingly enough, the staff at all three of the nursing homes seemed very similar. They were almost all minorities (African-American) in an area that is predominantly white and Hispanic. I spoke with LaTasha, who worked at the lower-income facility, Mary who worked at the mid-income facility, and Nya who worked at upper-crust facility. The staff seemed to have very similar educational backgrounds, regardless of the facility. Moreover, the pay in each of the facilities was very similar, though the ratio of patient to staff was much lower at the most expensive facility.

Given some of the other problems that the staff members discussed at the various facilities and what I witnessed when I visited the facilities, I expected understaffing to be the most common problem mentioned by the nursing home staff. However, when I discussed staffing issues with them, they did not seem to feel that staffing was the issue it appeared to be to me. Instead, the business that I interpreted as being understaffed was something that the three of them each indicated was a sign of productivity. In fact, Nya felt that there was a surplus of staff at her facility and that the idleness actually led to some staff members failing to take responsibility for their assigned duties.

All three of them suggested that communication was a significant issue in their facility. They discussed the fact that doctors were not always clear about communicating guidelines to patients, so that staff was often left to try to mediate between doctors and families in a way that complicated their jobs. The staff members mentioned that this could cause difficulties for them because patients and family members would express concerns with their familiar staff members that they might not address with doctors. This is actually an issue that is well-recognized by people in the healthcare community. AARP mentioned that, "Communication among families is so important that Medicaid and Medicare nursing homes are required to allow families to form councils that meet privately in the facility" (AARP, 2007).

Furthermore, the staff members made it clear that the communication issues were complicated by family relationships. One of the factors that they mentioned was that many times the residents in nursing homes are unable to meaningfully and reliably communicate with the staff because of dementia, strokes, or other health issues. Family members want to try to communicate resident's needs, habits, behaviors, and moods to the staff (Palmer, 2012). Sometimes this is complicated by the patient contradicting what family members have said, making it difficult for the staff to know the appropriate course of action to take for each patient's well-being.