3,181 Comments Posted by Lynne

Wow! Great poem!

Ha! Ain't it the truth? Although everyone needs TWO fridges - one for cold drinks & beer and one that has an icemaker. :-)

Now Tony, are you gently suggesting I wrote this? ;-)

Ha! Good point!

Yahoo! I've been waiting since 5/24/05 to hear this! :-)

Owwwwwwwww!!!!!! 8`-(

Well, durn, you sure got a reaction out of me when I first read it! 8`-)

The number of humorous but incredibly tacky things I want to say in response to this have me sitting here, paralyzed . . . . . . 8`-)

Nah, I WISH it were true that many of the people who have come here have had their opinions changed by what they have read. However, unless people have to deal with something directly it is easier to believe what popular culture, such as movies and TV, tell you. And what reliable sources THOSE are, eh? ;-)

For most situations, and not just in this field, no one seems to care much about what happens unless they somehow become personally involved or they read or hear something about it. And journalists rarely write positive stories about systems that work because that is boring and honestly doesn't sell very well.

I am all for investigative journalism. That is how my field made most of its advances, I am sorry to say. We had the tools and the technology to make things better many years ago, but we didn't have the public funding because we didn't have public support. It took someone breaking stories about how bad things were to shake up the public to push for increased funding. Sadly enough, however, people somehow didn't quite get that the problems were NOT just the result of evil staff but were the result of no money and no on-going public clamor for things to get better. The history of the field, as is the case with many others, consists of nothing happening, a scandal finally coming to light, and money subsequently being thrown at it and it alone to "make the problem go away." People in all fields of human endeavor are "penny wise, pound foolish" and want to save money by taking short cuts or ignoring things until they have no choice but to look them in the eye rather than planning proactively and spending the money where it counts - up front.

Unfortunately, when negative conditions finally come to light, what you have is a scrambling toward finding someone to blame, and the system that created it gets a free "bye" card, and so the same situation "amazingly" recurs over and over and over. And over.

And over.

And again, all we do is shake our fingers at the poor schmuck staff who ended up in this field, accusing THEM of being the cause of all the misery, because they are the least powerful employees on the food chain. And we "pity" the poor people who were "tortured and abused" by the system. If you pity someone they become less than human - what you want is empathy, because empathy means that it could happen to you and to me and we feel "for" the person, not "about" the person. I pity animals, but I have empathy for humans, and that is what makes me an activist in this field.

And once again what I am saying probably doesn't make any sense at all to most people, so why am I such a schmuck to keep writing this? Maybe I *DO* need my meds adjusted after all. "Doctor, heal thyself!" :-)

So . . . . . . you are telling us you run into rotting corpses on a routine basis? If I were your girlfriend I'd be a little wary right about here. ;-)

Gotta love those violently red "bodily fluids" bags!

Well, *MY* bad - I thought bdhsnake MEANT "ECT"! 8`-)

That's why we don't use these any more. :-)

Caution: Rant Ahead. :-)

To get a better feel for the types of standards expected of various facilities, here are some examples. This does not cover facilities for people who have a mental illness, as I do not work in one currently and am less familiar with their regs.

If you run a facility for people who have intellectual disabilities you are funded by the Centers for Medicare & Medicaid Services or CMS - formerly known as HCFA (Health Care Financing Administration). These folks administer the Medicaid and Medicare programs. A facility that provides services to people with intellectual disabilities (formerly called mental retardation) is known as an Intermediate Care Facility for the Mentally Retarded, or ICF-MR. For more information about this, go to:
http://www.cms.hhs.gov/

People who receive funding for ICFs-MR are surveyed using the following set of regulations:
http://www.cms.hhs.gov/m...intermcare.pdf
These are the ones I personally am the most familiar with and which I use to do our monthly mock surveys.

A number of states have additionally asked their facilities and programs to be surveyed by The Council on Quality and Leadership (formerly The Accreditation Council for Developmental Disabilities). They have additional sets of guidelines - "Personal Outcome Measures" and "Quality Measures 2005":

http://www.thecouncil.org/misc/cdrom/

If you have a facility that is funded for people who have need of skilled nursing services (SNF) you are surveyed using the following regulations:

http://www.cms.hhs.gov/ma...107c07.pdf

The place I currently work has two separate sections of campus; one for folks under the ICF-MR regs, one for folks with skilled nursing needs (SNF). Our campus is surveyed by both agencies.

Many hospitals or facilities also try to get accreditation under the Joint Commission on Accreditation of Healthcare Organizations or JCAHO. JCAHO has differing sets of accreditation standards depending on the specific population being served.
For example, here are their standards for assisted living facilities:
http://www.jcaho.org/h...ted+living/index.htm
Here are their standards for long term care facilities:
http://www.jcaho.org/h...care/index.htm

Additionally, facilities must meet code for the following:
->OSHA (Occupational Safety and Health Administration):
http://www.ilo.org/pub...osha-gnh.htm
->HIPAA (The Health Insurance Portability and Accountability Act of 1996):
http://www.cms.hhs.gov/hipaa/
->National Fire Protection Association (NFPA) 101 Life Safety Code:
http://www.dads.state....L90.61.htm

As an FYI, I always chuckle when someone tells me they got 100% positive ratings on a survey. This usually means that money is tight and the surveying groups are being asked to be a bit loose with the regs, or it means that a larger pattern hasn't been discovered by the surveyors, which is what you really should have before you start issuing citations, given that all facilities will always have at least a handful of areas of noncompliance.

Surveyors are like police officers. It is impossible for most of us to get through a 24-hour period without breaking a law of some sort, especially those laws we aren't familiar with but are still on the books. A police officer is supposed to figure out whether any of the one million illegal things we all do every day is of sufficient magnitude to warrant an arrest or whether there is a pattern of things that occur that makes him or her feel the need to send out a message that this is a law that needs to be followed. Littering, changing lanes without a turn signal, not following antiquated blue laws that are still on the books, jaywalking, etc., occur every day. There is a reason for many of these laws. However, at what point do you actually enforce them or consider that someone is a criminal for breaking them?

Remember too, because of the recent increase in federal budget dollars directed toward Iraq, hurricanes Katrina and Rita, plus other exciting things that are happening in our world, the federal folks are discussing slashing the Medicaid and Medicare budgets or doing away with many of the programs altogether. Most facilities that serve people with these types of needs are not currently in a financial place to afford many of the things that they are asked to provide right now. How do you think things are going to look in ten years if they cut these programs? We will be right back to where we were 50 years ago when they realized why they needed to fund these sorts of programs, and ironically, this may be seen nostalgically as one of the few times we were able to provide programs, services, and safeguards to people with severe needs.

A final FYI is this - we are trying to change the focus of our systems from "blame" to figuring out WHY problems occur. We now actually encourage the reporting of problems because if we always assume it is the person causing the problem and not the fact that the system may be faulty, we can't do anything to fix it. The danger in admitting a problem is that you often then have someone come in and play the finger-pointing game ("Oh look! They received a citation! They must be 'bad'!"), you are forced to be reactive and not proactive, and then you can't fix the problems:
http://www.ddssafety.net/...management.pdf
http://www.ahrq.gov/clinic/ptsafety/chap40.htm

Sorry, Puddleboy, you have to give up being your own self! 8`-)

No, kau, Puddleboy is a real person and he is correct.