Nursing Home Administrators Map Effort to Upgrade Temporary Help

Nursing home administrators in San Diego, frustrated by high turnover among their employees, have banded together in a plan to improve the quality of the temporary help available to them.

In an experiment the California Assn. of Health Facilities describes as unique in the state, the San Diego Health Care Assn. has specified a long list of criteria for nursing-referral agencies. These agencies provide about $500,000 worth of temporary workers annually to the more than 80 nursing homes and other long-term care facilities in the county.

The association asked the agencies to “bid” to be certified as meeting the criteria. Certification would give the agencies’ workers preference for temporary nursing jobs at the homes.

The hope is that the arrangement will both improve the quality of the temporary workers and cut down on state citations that have plagued the homes the last two years.

“Many times a temporary who’s been in your building one, two, three days is not accountable when the licensing and certification division comes in,” said Joe Diaz, regional director for the California Assn. of Health Facilities, a nursing home group.

Stringent Annual Inspections

Because of a federal crackdown on licensing violations, the homes face stringent annual inspections that can shut them down within 30 days if serious problems with patient care are found. Typically, such violations involve understaffing or undertrained staff members, patients whose needs are ignored, incomplete medical charts for patients, or problems with administering medications.

Nursing home administrators say the problems result not from lack of dedication but from high staff turnover--and a resulting need for hiring temporary replacements--caused by low wages. The temporary-help agencies sometimes have not trained the workers or checked out their backgrounds, the administrators said at a press conference Tuesday.

“They can send us somebody who collected garbage yesterday,” said Wayne Grigsby, a board member of the Health Care Assn.

Furthermore, even a qualified worker cannot do the best job if she or he isn’t familiar with an institution’s routines, the administrators said.

Association’s Plan

The Health Care Assn.’s plan sets minimum educational and experience standards for temporary nursing assistants and other workers; asks that the agencies show proof of workers’ compensation and liability insurance coverage for the workers and asks the agencies to share in training so temporaries won’t be sent into unfamiliar institutions.

It asks agencies to submit certification proposals within 30 days and hopes to have screened the agencies within 30 days after that.

The response Tuesday from about 70 nursing registries who were invited to hear about the plan was lukewarm at best. Only about 20 showed up for a briefing, Diaz said.

But the administrators saw the turnout as part of the process of identifying agencies that are likeliest to provide the best workers. “The good ones showed up,” said Charles Bloom, vice president of the Health Care Assn.

The administrators acknowledged that the plan, even though it is voluntary among the nursing homes, might make it harder for some of the temporary-help agencies.

Goal Is to Get Quality Care

“Our whole goal is not to drive anyone out of business,” Diaz said. “Our goal is to get quality, accountable care.”

Wages at the nursing homes average about $4.50 an hour for starting licensed vocational nurses, who, along with nursing assistants, provide most of the nursing care in the homes, Diaz said. Registered nurses earn about $12 an hour, but can earn $15 or more if they work as temporaries through an agency, he said.