Nursing homes require a substantial number of staff members in order to function properly, from direct care personnel who work directly with patients, to administrative and support employees who manage records and keep facilities in working order. Because of the sheer number of people employed by nursing homes, it can seem overwhelming when you are trying to figure out who is “in charge” of your loved one. In fact, you may feel like you don't know who to turn to when you are concerned about the treatment of a resident. Understanding the way that nursing homes are organized and operated may help you develop connections with appropriate personnel and ensure that your loved one is not getting lost in the shuffle of a large long-term care facility.
Direct Care Staff
These employees have direct, daily contact with the residents of a nursing home and provide the vast majority of day-to-day care. The interaction between these employees and the hierarchy established by a particular home may be unique, but there are general patterns which direct the staffing of nursing homes.
Nursing homes are required by law to employ Registered Nurses or RNs to supervise medications and work with other staff to provide quality medical care. Some nursing homes have more than one RN or RNs that are on duty 24 hours a day, but facilities are only required to keep an RN on duty for 8 hours a day, seven days a week. Outside of those hours, Licensed Vocational Nurses (LVNs) and Licensed Practical Nurses (LPNs) should be on duty.
To become an RN, people must obtain an associate or bachelor's degree from an accredited nursing program. They then go on to take the NCLEX-RN examination and apply for a state license in the state in which they will practice nursing. After they obtain employment as an RN, they will often receive additional training on the job or continuing education.
LVNs and LPNs
Licensed Vocational Nurses (LVNs) and Licensed Practical Nurses (LPNs) work with the RN(s) to create treatment plans for all the residents. Nursing homes must have an LVN or an LPN on duty 24 hours a day in case of emergency and to administer medications and supervise the Certified Nursing Assistants (CNAs). They also monitor the residents' progress and take notes on their behavior and health. LVNs and LPNs are technically the same things; however, the term LVN is used in California and Texas while LPN is used in the rest of the country.
In order to become an LVN or an LPN, candidates usually complete a one year program or associate degree and then take the National Council Licensure Examination. After they pass this examination successfully, they can apply to work under a doctor or nurse in a medical facility or nursing home.
Certified Nursing Assistants
Although Certified Nursing Assistants (CNAs) have the least amount of training, they are often required to perform the majority of labor surrounding daily care of nursing home residents. They typically work with residents to perform daily tasks and hygiene, such as
- Brushing the resident's teeth
- General grooming
- Assisting the resident with mobility needs including walking to activities and using the bathroom
Because CNAs perform the majority of interpersonal tasks involving residents, they are often the most familiar with a resident's typical behavior, personality, and style of interaction. CNAs must be directly supervised by an LPN or LVN and should report back to them with concerns they may have about a resident's well-being or changes in their physical or mental health status such as the development of a bedsore or unusual withdrawal from social activities.
CNAs must undergo nurse assistant training in the first four months of their employment and pass a competency exam upon completion.
Nursing Home Dieticians
Nursing homes are required to keep a qualified dietician on hand as a full-time, part-time, or consultant employee. Dieticians may be certified through the American Dietetic Association's Commission on Dietetic Registration or may have demonstrable work experience, training, and education which qualifies them for a position in a nursing home. The dietician generally appoints a director of food service who works in the nursing home on a more full-time basis and manages the day-to-day diets of the residents. The director of food services should report back to the dietician, work with them to ensure that all residents are receiving proper nutrition, and alert the dietician if a patient is not eating or appears undernourished so that diets can be reevaluated.
Nursing Home Administration
The administrative team in a nursing home may consist of a few individuals or an entire team of people dedicated to documentation, scheduling, training, and disciplining residents and staff. In most cases, to become a Nursing Home Administrator, candidates will have to receive formal training from the National Association of Long Term Care Administrator Boards. In most cases, the families of residents do not interact extensively with administrative personnel after a resident is admitted to the home. Administrative staff may include human resources personnel, the accounting department, the marketing director, the medical director, and the activities or program director.
Nursing homes rely on an extensive network of support personnel in order to complete all the tasks related to the upkeep of the facility. Most of these workers do not have a lot of contact with residents, however, some, like drivers who take residents to medical appointments or local events, may interact with the residents fairly frequently. Other support staff may include chefs or cooks, servers and waitstaff, computer technicians, janitors, housekeepers, facility supervisors, and groundskeepers. In well-managed facilities, these employees should have positive and cordial relationships with the residents that they are serving.
Elder Care Lawyer in Maryland and Pennsylvania
If you believe that your loved one may not be receiving proper care in their nursing home, you may wish to explore your options for legal action. To speak to an experienced attorney working in the field of elder abuse, call Charles Gilman and Briggs Bedigian today at 800.529.6162 or contact them online.