What Really Goes On Behind Closed Doors in Nursing Homes, Assisted Living, and Rehabilitation Facilities? The honest point of view from a licensed CNA.

Photo by Vladimir Fedotov on Unsplash

Have you ever wanted to know what really goes on behind closed doors in nursing homes and rehab facilities? Perhaps you’ve asked yourself these questions:

• Is my loved one (or myself) in safe hands?
• What would it be like to work as a nurse or a CNA?
• What is the work environment like?
• How are residents/patients treated?
• How will I be treated if I decide to work there?

These are honest questions. I, myself, am a licensed CNA (Certified Nursing Assistant) that travels through the state in which I live, and states that I have reciprocity for. Reciprocity is when someone in the medical field applies and is approved to utilize their license in other states and countries outside of where their original license is held. The pay is very pleasant by the way.

Many people have no idea on what really goes on behind closed doors at these places of establishment. Although I have to be careful of the information I share on here (HIPAA), I will share with you funny and frustrating scenarios that I (and other CNAS and nurses) have experienced while working in nursing homes and assisted living facilities.

Why do it?

I have mainly worked in private duty, ASLs, and nursing/rehab settings, and it can be both rewarding and frustrating at the same time. The healthcare and nursing industry is not for everyone. In my opinion, I would not suggest that someone who does not care about people get into this industry. I have a heart for people and always have. All people that live or get assistance at a nursing home/rehab, are not elderly. Some have had serious accidents, recouping from surgery, have had strokes at a young age, cerebral palsy, you name it. When people hear “nursing home”, automatically they think “old folks home”. About 70% of the patients and residents live in facilities like this, while others can me much younger with different medical needs.

Being a CNA, is often perceived as:

• The low man on the totem pole
• Butt wipers
• Maids or Butlers
• The Help
• Pamper changers

It’s not about the money. Most people think that CNAs get paid very little. While that can be factual in a sense, registering with national (and local) agencies prove very beneficial financially and career wise. A typical CNA that is hired at a nursing home/rehab may earn between $10-$16/hour, based on experience. A CNA that works through an agency at a nursing home/rehab may earn twice or a third that amount. They pay is very sweet. So, where am I going with this? As you continue to read, I’ll explain how this affects how you are treated at these establishments.

What exactly is the work environment really like?

In all honesty, I cannot speak for everyone, every nursing home/rehab or hospital, because the work environment differs. How a person(s) perceives things differs, but 75% of CNAs & nurses have experienced some sort of negative environmental effects of working in these establishments. Before I started working for healthcare agencies, I worked full time at an assisted living facility and a nursing home. What a family or visitor sees in the forefront while visiting their loved one may not be the actual reality of what goes on behind closed doors. The fact is, there is a lot of competition and backstabbing amongst staff members. Favoritism is at an all time high and many residents/patients now how to manipulate the system so well that it has (and can)cost people their jobs. Although there are negatives to this career field, there is usually a silver lining at the end of the tunnel.

Photo by Eduardo Barrios on Unsplash

What goes on behind the scenes with the staff?

All work scenarios at a nursing home/rehab (even hospitals) are not the same. Any work environment (no matter what or where it is) is going to have its share of drama. Here are a few key situations that not only have I encountered, but other staff and healthcare agency workers as well.

1. Most places are short staffed. This is a common theme amongst nursing homes, ASLs (assisted living facilities), and hospitals. Sometimes its very difficult for the company to keep staff on board due to harsh work environments, bad management, and poor pay. Most workers do not want to deal with the headache most of these establishments brings, so they just quit. I’ve literally seen CNAs, therapists, and even nurses, walk out and leave places due to high stress, drama, and lack of support by other staff and management. Every shift I have ever worked, there is usually at least one call off. When it is short staffed, this affects the quality of care a patient receives as well as when they receive their medications.
2. There are cliques, manager’s favorites, and bullies. As I mentioned earlier, this can be at any place of employment. In a nursing homes/rehab/ assisted living facility, nurses and CNAs who have been at the facility the longest (we call them veterans)tend to have a lot more flexibility in choosing the assignments (assigned rooms, halls, or particular residents/patients) they want to go into. I cannot judge and say if this is fair or not, but typically, CNAs who have been there are certain length of time pick the halls/areas in which there is not as much work to do and have “low maintenance” patients. This gives them them the ability to sit back, relax, and hide in a room, while other staff work much harder on other floors. If a veteran staffer does not like their assignment, they will complain to management, or say they are sick, and leave immediately. Yes, this actually happens! I have even seen nurses do this. Often times staff who feel their have seniority over a floor typically bully and harass those who haven’t been at the facility the longest, causing people to leave and just quit.
3. Poor management. The management is these types of places can be great, while others can be very poor. I’ve seen floor supervisors, lead RNs, make crude sexual and racist jokes about others. Some management are afraid to discipline other staff (out of fear of losing a ‘good’ worker or being short staffed), so they let allow nurses and CNAs to “do whatever they please” just to avoid confrontation. There are nurses and CNAs who even tell the management what to do! Sometimes, those in management are, at times friends with some of the staff, therefore making it difficult to enforce the proper discipline and correction needed.
4. Verbal Sparring, Control Freaks, Jealousy, Gossip, and Lack of Support. You may not see it when you walk into one of these places, but indeed, there are heated arguments that go on between management, CNAs, nurses, therapists, and even those that work in the laundry department! Most CNAs and nurses feel they have a sense of entitlement to belittle and humiliate other staff that may not be as skilled or popular as others. I’ve seen nurses get jealous of new nurses that come aboard, and intentionally sabotage them to get them to leave. If management gives someone praise, someone get jealous and starts a campaign to destroy their character, or frustrate them enough to make them want to quit. Some workers do not help others when help is needed in order to get them to fail. Taking care of a human being who is incapacitated is a very challenging task, but at times, some patients require a 2 person assist. I’ve seen some CNAs intentionally hide and avoid helping others all in hopes they fail. You (or your loved one) may get a few hot meals each day, but there is verbal sparring over who gets to pour the coffee and drinks. Yes, CNAs actually fight over this! If you’re not standing by the food cart when trays have to be passed out right them, then you’ll be snitched on for “not being partaking of resident assistance.”
5. Robbing the time-clock. Some members of the staff rob the time clock by leaving the facility (with no prior appointment or emergency), and come back when they want to. Some lie and say they have not had a lunch, when they actually took a 2 hour break! A resident/patient could have been ringing their call light for an hour, while a staff member is outside smoking a cigarette or on the phone.
6. Staff members hate agency workers. Ah, yes. There is a disdain for those who work for healthcare agencies. Most healthcare agency workers make a lot more money than the hired staff. This is not a faulted issue for the healthcare agency workers, but a personal issue for those working staff. I’ve seen nurses and CNAs literally and yell at the top of their lungs that they don’t want agency there because they are eating up all the “overtime” and the company pay them (agency workers) too much. How does this affect the company? There will be a high turn over rate when someone feels harassed in this nature. Typically staff give agency healthcare workers the rooms and patients no-one else wants. By verbalizing your concern to management, they would see you as a threat or a complainer. The goal of the staff is to make an agency healthcare worker feel as uncomfortable as possible so they can leave an never some back. No matter how well an agency healthcare worker does, some staff will find something “wrong” with their work performance.

Those are just a few scenarios that I have experienced while working as a CNA both hired as a team member and working for agency. Now let’s get into the types of residents and patients we deal with behind the scenes.

Types of residents and patients

Photo by Sharon McCutcheon on Unsplash

1. The call lighter. Anytime there is an emergency or need, a patient/resident has every right to ring the call light. Whether it be assistance to the rest room, medication needed, help with opening or closing something, bed pan or diaper change, to be fed, etc. this is what the call light is for. Unfortunately, there are people (of all ages) who misuse and abuse the call light system! I have had patients who would literally ring the call light again, as soon as I would step a few feet out of the room! There are people who get a kick out of doing this. Some are lonely, depressed, or want someone to talk to. Others have an obsession to control others but constantly being on the call light asking for “help”. At least 60% of the time, most patients do not need help with anything serious. They just want someone to talk to because they are lonely. The reason why this is maddening and harmful is because if a CNA or nurse is taking care of other patients or residents, and the call lighter stays on the call light, it drastically affects the quality of care for others. Think about it. If some is constantly ringing the call light, and an aide is in their room all constantly, how would that be fair to other patients who need care as well?
2. Master manipulators. These situations are quite uncomfortable. I’ve encountered many patients like this who manipulate the system to get what they want. Every state have mandated laws and rights that every healthcare worker has to abide by. There are some who know the laws but try to see how far they can bend and stretch to get what they want. For instance. The call light situation. Legally, healthcare workers have to answer call lights. Some patients and residents know this, and use this to their advantage. I have seen with my own eyes residents stay on their call light. Staff can go into their room, literally, every 15 minutes! If you don’t come quick enough, they call the front desk, management, or call their loved ones and cry abuse or neglect. Some residents or patients complain that they didn’t get a shower or bed bath, even after specifically telling a CNA they didn’t want one. I do not agree with this behavior, but look at this way. For some, being in a nursing home or ASL facility is their final home before they leave this Earth. By keeping a little drama going, it gives them a sense of power and control, that they may have had when they were out in the world. Many of the patients and residents lie or exaggerate stories to their family members in hopes of getting what they want or to seek revenge on someone. These types of people like to work on your emotions.
3. Unrealistic Expectations. This has to be the most difficult situations I’ve seen. These are family members and loved ones who have POA (power of attorney). They do not want to see their loved one pass away or become incapacitated, so they ask for over the top demands that the staff is unable to meet. Some patients never bounce back from whatever it was they became afflicted with, and they decline dramatically. Their decline may have nothing to do with the quality of care they receive, but the medical situation they are enduring. For example, “Patient A” may be 95 years old, bed bound, a feeder, and has atrophy. But the family has that person full code (meaning resuscitate and attempt to keep that person alive by all means necessary). It is very difficult, but by law, healthcare workers have to do what they are told to do. Even in some situations, I’ve seen patients who were in these facilities temporarily for rehabilitation and therapy and request that the CNAs to only wash them with Dove soap, wash their feet, pamper them as if they were in a spa, and sit and talk with them for hours. It’s just not possible. Some family members (especially those of a higher class), want their loved one to have one on one care by a staff member. The majority of the time, it is not possible. Some feel as if they are the only one that needs care while other patients get put on the back burner. Some patients and residents do require one on one care and that is under the discretion of the facility in which services are rendered.
4. It’s all about the Benjamins. Indeed I have seen this as well. Many residents and patients create scenarios or situations that lead to a lawsuit. Again, this is not all situations. I am not referring to neglect, abuse, wrongful death, etc. I have actually seen situations where families and patients look for things to complain about, all in hopes of suing for a particular amount of money.

Photo by Jake Thacker on Unsplash

These are just a few things that happens behind closed doors. Often times, residents and patients who have poor character, manipulate, and have abusive behaviors often time have difficulty with getting adequate care because most staff don’t want to deal with their drama. This does in no way shape or form condone neglect, abuse, or mistreatment. If that happens to any resident or patient, it should be reported immediately. The fact is that many family members and loved one never see the extent of what happens behind the scenes, and this can be very stressful. Most of them do not care about the hard work that is provided.

I am not making excuses for anyone’s behaviors, but just understand that taking care of someone is a lot of work. You have to bathe them, change their diapers, come in contact with bodily fluids and communicable diseases, and so much more. Some people may ask: “Why not just be a nurse then?”, or “Why not just quit?”. It is easier said than done. Many times I have bonded with a lot of the patients and we became great companions while I worked there. I has hurt my heart to see so many of them so alone and lonely. Unfortunately there are some CNAs and nurses who are lazy. That’s a given. But not everyone who works in this industry has poor character and lack of morals. The world has no idea how hard we work and how much of a challenge it is taking care of someone.

The silver lining.

I have asked God time and time again why I am back in the industry I am in, and the answer is quite simple. It is to pray for others who are in need and to show the compassion of Jesus Christ, even to those who may not deserve it (and that includes my co-laborers).

“ Be kind to one another, tenderhearted, forgiving one another, as God in Christ forgave you.” — Ephesians 4:32

Although I know I’m in this industry for only a season, I make it every effort to ensure that people feel loved before they leave this Earth. It may not have turned out this way with every person, but the response you give to someone before they are discharged, or pass away will have eternal effects on their soul and their spirit. I had become very close with many patients along the way, and knowing that they felt love and compassion, means so much to me.

To those of you out there who work in the healthcare industry and genuinely care for people, keep up the good work. You are loved. You are valued. You are needed.