Trends in Long-Term Care - U.S. Senate Special Committee on Aging

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We went through the rooms, and they seemed to be walk<strong>in</strong>g around
somewhat confused, even though we did not get there until about 9:30.
This patient was seen there slumber<strong>in</strong>g <strong>in</strong> her chair, shiver<strong>in</strong>g, she
was cold and clarmny, and Dr. Bower said, "I th<strong>in</strong>k she is hav<strong>in</strong>g a
coronary."
I called the nurse, she was walk<strong>in</strong>g around the room.
I said, "Have you seen this patient? What is the temperature?"
She said 98. I said, "When was that taken?" "6 o'clock <strong>in</strong> the
morn<strong>in</strong>g."
Nobody had any idea. She was supposed to put the patient to bed,
take her temperature, and call the doctor.
She did, and came back, and the temperature was 102, and she said,
"I sent for the doctor."
I said, "OK. I will be back <strong>in</strong> the office at 2 o'clock. Call me then
and let me know what happens."
The doctor came. At this time when she called me, as yet nobody saw
her.
We had cont<strong>in</strong>ued shortages of l<strong>in</strong>en. In one place we were at, there
was no l<strong>in</strong>en.
Of course, when Dr. Bower was walk<strong>in</strong>g around with me, he kept
say<strong>in</strong>g, it is a flophouse, and this was a new, structurally good nurs<strong>in</strong>g
home-but the l<strong>in</strong>en, we got downstairs <strong>in</strong> the l<strong>in</strong>en room, there was
no l<strong>in</strong>en.
He said, we found the l<strong>in</strong>en, it was all wrapped up <strong>in</strong> the adm<strong>in</strong>istrator's
office, which was not go<strong>in</strong>g to do the night nurse any use, because
that was one of the problems, even the nurses who would try to
do, they had to have l<strong>in</strong>en to change for the patients, and they seemed
to expect the aides to take care of the patients.
They said they are not dedicated. They were not be<strong>in</strong>g given the
th<strong>in</strong>gs to work with.
We could revoke the license. We often called them <strong>in</strong> for a conference,
and very often we did, and sometimes I thought the <strong>in</strong>spectors
were be<strong>in</strong>g the victims, because the lawyers would cross-exam<strong>in</strong>e the
<strong>in</strong>spectors so much.
Senator Moss. How many <strong>in</strong>spectors did they have dur<strong>in</strong>g this time
that you are talk<strong>in</strong>g about?
Ms. HOPPER. We had approximately 35 <strong>in</strong>spectors. I had 5 supervisors,
5 seniors, and 25 <strong>in</strong>spectors, so we divided them <strong>in</strong>to boroughs,
leav<strong>in</strong>g a supervisor, a senior, and 5 <strong>in</strong>spectors per borough.
We did not need that many they felt, and they consolidated the
supervisors, one supervisor for every two boroughs, and it is difficult
for one supervisor to cover two boroughs.
If you do a proper <strong>in</strong>spection, especially <strong>in</strong> some of these like 300
beds. and we had 400- and 500-bed homes, it takes a while, because
you have to look at charts, you have to look at patients.
You cannot possibility do it quickly. Even <strong>in</strong> a small home, if you
get problems, it may take longer.
Senator Moss. How often did you <strong>in</strong>spect each home; did you get
around once a month, or once every 3 months?
Ms. HOPPER. We tried to get around once a month, and we usually
did. With the small homes, we did not. It was usually every 2 or every
3 months.
That was one of the problems, when a 30-day license was handed
out, they would have to be re<strong>in</strong>spected before the next license.