Dangerous Assumptions: Residents Should Not Assume that CCRC Staff Will Make Good Decisions for Them

CCRC staff is often overworked, understaffed and make decisions harmful to CCRC residents.

By Lillian Hyatt, MSW

CCRC registered nurses, CNAs, physical therapists and occupational therapist are often short on time and understaffed and can make bad decisions for residents. A good example of this is if a staff person decided that a resident must be sent to the hospital, but does not consult a resident’s chart to see if this is appropriate—as opposed to following the instructions in the chart given by the resident and the resident’s doctor/attorney responsible for the resident’s health care. This can result in a serious situation for the resident.

People entering a CCRC make certain assumptions. They often assume that the nursing staff will always make the proper decisions before sending them to a hospital. They also may assume that the staff person is a regular employee and not a replacement from an agency. Often, when staff members call in sick they are replaced by someone who is not familiar with the residents and can make serious errors. This is particularly dangerous when they work in the skilled nursing facility. The assumption made is that the employee will consult your chart before taking action. In the words of the famous song by George Kershwin, “It ain’t necessarily so.”

Can a resident be lost when they go to a hospital? Yes. One resident’s family was told she was on a trip when actually she was in the hospital and had been there for over a week. Another resident knew she was in the hospital and contacted her. The hospital patient begged the resident who had called her to contact the person who took care of her affairs and her health care and ask that she be told to call the patient. At that point, staff was informed not to tell people who called that she was on a trip when, in fact, she was in the hospital. Such cases are routinely swept under the rug and never discussed as a possibility that it could happen to other residents.

In one instance, a woman in the middle of a heart attack and her brain bleeding decided to take herself to the hospital in a taxi cab alone. The staff person in charge of the facilities clinic watched the patient leave and made no effort to send someone with the patient. The hospital staff immediately realized the serious condition of this patient and took steps to admit the patient. Fortunately that patient survived and began to organize the paperwork that each resident should have in their file. An entire family council meeting was devoted to inform residents of what they should be doing to protect themselves in the event of a life threatening emergency. Please note that it was a resident and not the social worker on staff who found the proper procedure and informed other residents.

Assumptions should be avoided. Hard questions about staff decisions need to be addressed particularly for staff in the skilled nursing facility who can make serious mistakes due to being overworked, understaffed and rushed at all times. People who live in their own apartments in a CCRC are particularly vulnerable because the staff person is already stressed due to the overwhelming duties in the skilled nursing facility and that staff person is the one who is called if the clinic is closed.

At one family council meeting, proper forms were distributed to residents with instructions on how to fill them out and included suggestions that included having a person in the facility who would be willing to accompany the resident to the hospital. Posting instructions on the back of the front door of the apartment is advisable or any other place that would be immediately visible to staff.

A resident or the person accompanying them should make sure that the staff person has consulted the residents’ chart and is following the instructions given there.

The information given in this column could avoid serious consequences for a resident. An ounce of prevention is worth a pound of cure.

Professor Hyatt is an AARP California policy advisor. Professor Hyatt can be seen on YOUtube on the USC School of Social Work website at https://www.youtube.com/watch?v=CMrC6o6Rm04