Loyalty to the nursing home or the patients?

"Loyalty" to your employer should never include breaking the law to cover for them, endangering people or acting immorally.

Does your employer have an employee manual in which it explains any sort of protocol for reporting broken equipment? If not, then I would request a protocol in writing from your manager that is distributed to all the staff. Any communications you have with with manager or admin should be through email so that you have a record of what was said and when. Then, after a "reasonable" period of time, i would send a follow-up email stating that the equipment has not been fixed and a dangerous and illegal situation is being created. Don't be accusatory or emotional or threatening, just informative. But you should also state that you will need to seek further action outside of the facility if the the unsafe situation for both the staff and residents is not cleared up asap. There may also be some sort of ombudsman organization that this can be reported to but I'm not familiar with it, This will protect the residents and your job. Good luck and God bless for having a moral compass.

You follow the chain of command and the procedures laid out by your employer, the only reason to go outside the facility is if you have exhausted all the in house options available and there is still no resolution.

Who owns the wheelchair? If it belongs to the family then it is their responsibility to keep it in good repair, if it belongs to the facility then there should be a process in place to report maintenance needs. You should have refused the unsafe transfer due to equipment failure. After speaking to his wife you should have assisted the family with how to properly report a problem - talking to you and other aides isn't it.

I'm coming back to add - My answer is based on the assumption that you are a new employee and have no reason to assume that your concerns would go unaddressed. I did a lot of stupid things when I was a young worker that I never should have attempted, it is a sign of maturity that you can admit you can't do something and you ask for help.

There are no written procedures in place for anything as far as I know. This is a small 36 bed facility.

According to the manager of the nursing nursing home the appropriate thing to do is to report problems to him and if after six months I see no action is taken, then resign.

What made me go straight to the department of health is that I was told by another patient’s wife that her complaints went unanswered and I know the staff is much more afraid of relatives than they are of me.

Additionally I felt that this was a life threatening issue which had to dealt with immediately. These are PEOPLE not bottles of soda in which case if a few get broken, who cares.

The chairs belong to the nursing home.

One of the responsibilities of one of the staff members is repairing equipment. These brakes have been this way for months if not years. Where is he? Someone has to be hospitalized until he does something? How about looking around and seeing what’s broken?

By the way probably this woman made the complaint to the guy in charge of maintaining the equipment and he just forgot about it. Maybe if she went right to the facility manager it would have been different? Maybe but I’m skeptical. And how and why should I play games with people’s lives at stake?

If I was a surgical nurse and noticed a certain surgeon arrived to surgery somewhat intoxicated and complaints by relatives had gone nowhere should I go to management and hope no one gets killed?

I agree with your employer that the first order of action was to go to him. To sit down and say
"I understand I am new here, and am sorry others didn't bring this to your attention, but we have a dangerous problem with our wheelchairs. Some of them are broken and we have had a few mishaps. I am hearing from families they have experienced problems with W/Cs. I would be more than happy to check all our chairs if you give me the day for it, or if I can do that overtime; I would put a small sticker on those I found to be functioning well. I know you may have your own remedy, could you just give me a heads up when this is addressed, because I am afraid for our staff and patients."
He can fire you after that if he wants, but he could also be happy to remedy something he may never have been told about.
After THAT (and of course you keep a work diary, right? Anyone working in such a job should) you will be free and clear to report this. Licensing is big, and you can lose one quite easily. You need your boss to see you as HELP and as PREVENTATIVE to problems. Not as a threat. Right now you are new on the job. You cannot know if you are working for a jerk who doesn't care, or for someone great. Keep gossip out of it. If you discuss with other workers all these things it is problematic.
Were I your boss I would expect you to come to me. The ASL place my brother is all the folks have moved up from within, and because of their SKILL. If I were your boss and you came to me with that idea you would have my heart and my eye and you would be on the fast track up. Just sayin..............

“After THAT (and of course you keep a work diary, right? Anyone working in such a job should) you will be free and clear to report this.”

How long would you wait?

I would have done it that way, however I had heard that complaints by relatives didn’t produce results.

And just by the way I AM a very serious threat to anyone who I see is putting innocent lives needlessly in danger.

The nursing home is understaffed. However I realize so is almost everywhere else. More staffing may be financially impossible.

But what’s the excuse for letting equipment dangerously go to pieces? This isn’t something which is difficult to notice and it’s been like this for months presumably.

I think someone here needs to get on the ball or get a new job.

Unfortunately many nursing homes both there and in the UK have abysmal track records despite the hype they put out to encourage folk to leave their loved ones in their “care”

If moving a resident is dangerous, both to you and the resident, you are entitled to have the correct number of staff to assist in moving the resident safely. Your manager should have that policy in action. Which should include enough staff on hand to cater for care needs.

Broken chairs, whether brake, footrest .. if unsuitable for use- should have a designated place they are taken to for repairs and should not be used. Your manager should have that policy in action. There should be a report log which details what the problem is when it occurred/ was noticed and whether fixed or replaced. There should be adequate wheel chairs available to cater for one or two with defects- though as you’ve found- this rarely happens.

I got a Red Cross wheelchair and walker due to the poor standards of the ones at the home, they were more interested in celebrating an occasion than dealing with the fact dad’s walker was damaged so he couldn’t mobilise.

i have met a number of nursing home workers who left due to standards they disagreed with. It includes one who contacted me in tears after walking out because, according to her manager, the paperwork was more important than a resident who had fallen.

I’ve witnessed many shocking things in my role as a carer over the years including refusal to elevate a fractured ankle as “their doctor” had not seen and recommended it. Resulting in a pulmonary embolism where clot travelled from leg to lung and it was only the dedication by A&E doctors who resuscitated him twice before stabilising him.

Taking medication from those capable of managing - and by the time due to release they had become institutionalised and reliant on others to do things for them making it more dangerous for their safe return back home.

Whlst most nursing homes expect the bulk the bulk of their residents to be permanent here are occasions they are not and the above should be catered for.

You might make life life hard for yourself by ensuring your manager is kept duly informed even if others aren’t doing their job correctly and doing the same, but at least you have a strong morale and are fighting for what’s right

The coroner had to rebuke the nursing home re falls and inaction over a broken hip despite my repeated demands for medical aid.

My best in your efforts

“Broken chairs, whether brake, footrest .. if unsuitable for use- should have a designated place they are taken to for repairs and should not be used.”

AMEN to that.

Even after being raided by the health department at 8:00 am last Wednesday, the specific wheelchairs which I included in my complaint are still in use as before, unrepaired.

Do I need to take hostages or something to get through to these people?

If I was complaining about understaffing, I get it, there’s no money. But a wheelchair? If they cannot afford to provide each patient with a safe properly functioning chair then shut the place down.

Actually I’m living in Israel. Israel was founded by socialists (if not communists) and although times have changed and May Day parades with red flags are in the past there are pretty strong protections for workers rights. There are special labor courts. Were I to be fired the burden of proof would fall on the employer to prove that it was not in retribution for my complaint.

Having said that, I’ll work as a janitor before I stand by and watch innocent helpless people be endangered. I would not have said anything unless I was angry enough to quit.

There is a difference between a shoddy work ethic and deliberate negligence, one can be improved while the other will lead to push back and cover up. In any small business workers often have to step outside their assigned roles to help out as needed - the break system on most wheelchairs is an easy fix unless parts are needed, and if a task such as the transfer you describe is too much for one worker a team system can be implemented. Quitting in disgust won't help any of those vulnerable residents but, if you are willing, encouraging your coworkers to seek change might.

I would encourage every single person to put there complaints in writing and copy whatever organization licenses these homes or over sees that they are being ran according to law.

It is easy to get into a he said she said if everything is verbal.

Where I live you provide your own durable medical equipment for mobility, so not sure if your patients can provide their own so they're not in such danger.

Your boss is full of it. It’s not your job to cover up violations. If there are illegal things going on or conditions that are putting people in danger, the authorities have to be told.
The alternative is to go to him each and every time you see an unsafe condition or illegal practice, and it seems as if they don’t want to spend the money required to operate a safe, clean facility. Honestly, I would look for another job on the QT. Eventually that facility is going to get some bad publicity and when it does, you don’t want to be associated with it.
I know some jurisdictions have laws that protect whistleblowers, but I don’t know if that applies to your situation.
Mister, get outta there!

I wonder if this is part of the general lack of value which we give to older people. Today we seem to view people like cars. The older it is the less it’s worth. This starts from age 40 and keeps going from there. Someone 80 is practically garbage. 

(Full disclosure: my 59th birthday is this month so I’m a little bit personally biased on this subject. I’ve recently seen advertised youth hostels in Tel Aviv which will not accommodate guests over age 40. Doesn’t anyone realize that the rate of violent crime of every type is so much lower after age 50? If they are worried about rape or something, then lock out the really risky 20 year olds.)

Well, My mom was dropped on her head from the same scenario. She died a week later. So, if you do not feel it is safe for the patient or you, you decline to move patient, tell the head of the class, to get someone to do it for you. You really do not want to kill someone. Accidents happen, I understand, but they can be prevented. She suffered, I suffered. It has been over a year, and to see my mom in that much pain, head injury, . WE all have to go sometime, but seriously, not that way. To top it off, hospice, not my gals, came in one night, and said mom was ok, no need to stick around.. If you feel she is in pain, here crush the morphine in a spoon, rub it in her cheeks every hour. By morning, mom was spewing out brain fluids or something, The hospice gal forgot to tell me to add ativan to the mix... It was not the way I wanted mom to go. No need to drop anyone. The caretaker, is a wonderful older man, and he should not have been placed in that position to do that. He got hurt too. He is a very nice man. But come on. USE YOUR BRAIN, USE THE HOYER LIFT. Broken Hip? Really, that is a death sentence to an elder person. PERIOD. An apparently head injuries. dead weight, dropped on her face.. and someone wants question the reasons to use a lifting device? At least two people should carry that burden. One to lift, and the other to serve as a cushion when elder flips and falls on their face. :(

Just tell the manager, killing someone was not in your job description. Potentially, you are putting an elder person in jeopardy and yourself. "Sounds harsh, but I have know four other older people who have died, because they were dropped on their heads. They told me, as I came in the next day, your mom fell last night. BS. She can't fall, she cannot stand/walk. ALZ, etc. I said: SHE WAS DROPPED. AND THEY DID NOT CALL ME!!! I called hospice as soon as I found out, they didn't get a call either. Oh this subject just irks me.
And if I could show you the pictures, you would cry too....She had huge bumps on her head, face, arms, and bruised from head to toe...
You always hope they will die in peace... She is an angel. she did not deserve to die like that.

I really believe the age factor has a lot to do with elder neglect.

Young people, even chronically ill, aren’t treated like this. I’ve worked in a facility for very severely brain damaged children and young adults and they were well funded and everything was done the right way.

The elderly, in modern Western society, simply have little value.

The usage of VSED  “voluntary stop eating and drinking” or even lethal injection is becoming gradually more common.

https://www.firstthings.com/web-exclusives/2017/09/euthanasia-for-alzheimers-patients

It may not be long before nursing homes are replaced by pet food factories.

Maybe we should count our blessings :(

Once we start murdering the elderly, which unfortunately is virtually going on already, the next step will be the murder of any incurablly ill. It’s not a new idea.

https://en.wikipedia.org/wiki/Aktion_T4

I'm impressed and heartened you had the integrity and care to report this situation. Your loyalty has to be to the vulnerable and helpless people you are serving, even while you get paid by the institution/facility. Sadly, this does create a conflict with potential repercussions (as you found!), but personally I'd rather be able to sleep at night knowing I might very well have prevented somebody from being seriously hurt or even killed. I'm coming from a personal position here? My Mom died because a CNA in a NH dropped her (let her drop...) while transferring her from a wheelchair to a shower chair... Mom told her she was slipping, and then fell - breaking both bones (tibia and fibula) below her left knee. She died in the hospital 10 days later, and endured - literally - days of screaming in pain (until the last 3 days when she went on hospice and an IV narcotic drip, the hospital insisted they couldn't give her enough to cover her pain because "it could kill her"...) By that time they thought she'd had a mild heart attack, her kidneys were shutting down, she would never get up from bed again, or have any quality of life if she survived... "We" had just gone through 2 1/2 years of Hell - multiple facilities/surgeries/etc. and damage caused by neglect and abuse from the first "skilled nursing/rehab" center she was in after transfer there from hospital and repair of a broken hip & wrist. She was in the last NH for a little over a year, and while there were definitely issues I at least felt they tried, or cared to a degree... When this happened, I was so burned out - my life was hers for all that time, because I advocated for her tooth & nail, visited every day, took her to all appointments, etc. - even gave away my dog because I was never home - and what was the use anyway? I went to the owners and told them I was sure there were safety procedures that weren't followed, I was sure they would take measures to see that those procedures were followed in the future so no one else died, and I wasn't going to pursue anything any further... Mom had just completed 3 months of (outside) physical therapy - worked her fanny off - and was able to get out of the wheelchair and walk with a wheeled walker! I didn't need to use the "companion wheelchair" when we went somewhere, because she was walking into her doctors' appointments, into restaurants for lunch with me, etc. In the NH, though, she was in the wheelchair because she wasn't stable enough if she was bumped by someone/something, so... I was on my own taking care of her - no kids, no partner, no siblings - but was actually starting to think we might actually be able to get Mom home again? Would I want an aide to report a safety issue she knew about to someone who would actually take steps to correct it? You'd better believe it! Mom fought so hard to get better, and my heart remains broken...

You might be interested in reading a book called "Wilful Blindness" by Margaret Heffernan. It explains how it comes about that egregious malpractices of all sorts are sustained by groups' cultures and mindsets.

All the same you are an employee of an organisation, and it would be reasonable of that organisation to expect you first of all to follow the procedure it lays down for reporting concerns and complaints. Did you?

Talking to co-workers and service users isn't it. You should first of all have taken this to your line manager. If nothing happened, then you go either further up the reporting chain, or to external regulators.

But to say you must "never" make a complaint to the health department is disingenuous and nonsensical. There are all kinds of situations that might arise when you would be morally, and arguably professionally, obliged to.

Asking your manager on what basis he claims to know that you made a formal complaint to the department of health is a fair question, certainly one I'd want answered if I were you. Did the person you spoke to agree that your report would be treated in confidence?

Anyway - so what's the outcome of this conversation with your line manager so far? Will the wheelchair(s) be repaired? What will be done to address the various manual handling problems?

First of all, imageimp, wow. I can understand EXACTLY what happened to your mother. Every day in my nursing home I believe that patients come within an inch of that type of fall.

And it almost happened to me when a broken wheelchair flew out from under a very elderly woman during a transfer. I was furious. I don’t know if I can print here my exact reaction.

countrymouse, I don’t think there’s any kind of rules in place. Frankly I don’t think it’s ever entered a worker’s mind to complain about something relevant to the patients’ treatment.

That be as it may, shouldn’t a legitimate nursing home be happy if the health department visits? Wouldn’t they be proud of their top notch facility? What would they be worried about?

Bottom line, the health department showed up last Wednesday at 8:00 am. Now it’s Monday night. Nothing has been repaired. Nothing.

It’s a small place. Maybe no one in house can really handle this. So how about this: Google “wheelchair fixing guy”. Pick up the phone. He comes. He fixes it. You pay him.

Am I going to have to call the health department AGAIN? I don’t understand this.

I am wondering: are families of nursing home patients afraid to contact the department of health? I get that impression a little bit. Maybe they don’t want to anger the management?

People don't speak up for all sorts of reasons. Not wanting to rock the boat is one of them, not knowing who to call is another, assuming that it won't make any difference another - there are loads.

You say this is a small home - how many beds? Who owns it?

I'm in the UK and our regulations are different in detail (the apathy when it comes to dealing with problems isn't, though) but by and large the role of regulators and inspectors is more or less the same. All residential care facilities, large or small, must display information about how to make a complaint and ensure that residents and/or their representatives have this explained to them. I would be surprised if there isn't the equivalent in your workplace. What did the DoH advise you when you spoke to them?

I'm at a loss as to why a NA would even need someone else's opinion. Your first obligation is to the persons in your care. You are a mandated reporter of abuse, and abuse is defined to include neglect and emotional abuse as well as physical abuse. Your manager would of course love to keep the state auditors out of the nursing home. Call your state ombudsman and tell them just what you've said here. ASAP.

Jacob - sorry, you're working in Israel? Your profile says New York. It makes a very, very substantial difference when we're trying to help figure out where you can turn for advice and support.

What an awful position to be in! This is not about loyalty however, it’s about professional responsibility and ethics, and then of course it’s about plain old caring about another person’s welfare, a vulnerable person at that.
If you are a licensed or registered professional, your regulating body would surely discipline you if they knew of the unsafe and illegal practices you engaged in. They can assist you in dealing with situation-they will have good advice and recommendations. They have likely dealt with it before.
The facility itself or your boss part of some professional associations that would be a great resource.
For all you know, your boss’s procedures and policy may not accurately reflect those of the facilities’ owners. Had you dropped the patient and the patient died in hospital from complications, the nursing home would likely face a law suit. That’s not in their best interests.
Your state or province will likely also have workplace safety regulations that you can look up, or a department you can call.
If you are part of a union, your union representatives are a good resource too.

I am worried about your job, and I’m worried about patient safety. Your situation is serious. I would consider documenting the unsafe practices and the dates of any preventable accidents, in case you need to take them to court.

You might also see if there is an employment lawyer you could consult (some lawyer will meet with you for a free initial consultation).

To me, this is just as bad as if a hospital administrator tried to save money by having doctors reuse their gloves. The doctors would never go along with that. Neither should you.

You are likely not the only worker to be concerned with the safety issues where you work. There is strength in numbers. If you all work together on this issue, you will get the situation resolved, one way or another.

Be brave, protect yourself, and good luck.

You should always allow them to fix the problem. Note the date of all conversations. Put a formal complaint in writing to your supervisor. There should be a forum, methodology,or form to address all safety issues. If not, suggest one.
Then, if the problem isn't resolved, you have all the need paperwork to address with the health department.

This may not be what you were looking for, but based on your post I was a little surprised at your user name? Look over the names from responses, people don’t use or only use part of their names. This is a very public and popular forum and easily found by anyone.

Your first oblgation is to the patient. Follow your conscience.

If you have complaints, you have the legal right and obligation to report issues to authorities. Also, make your complaints in WRITING, sign it, and authorize the authority to share your complaint with the nursing home. If you are going to complain, then make your identity known. When I complained against VITAS hospice with The Agency for Healtchare Administration (ACHA), I did so in writing, signed the document and asked them to share my complaint with VITAS hospice.

I did some research about my nursing home on the health department website, comparing it to others in Jerusalem.

Actually my nursing home compares quite favorably to most. It’s a small private nursing home (36 beds) and possibly fairly pricey. It may be almost a model facility.

Which is nice on the one hand, I’m not collaborating in a slaughterhouse. 

But then on the other hand, what are the bad places like???

I will say that it’s neat, clean and smells good (thank you cleaning staff Shireen and Monera!)

However the brakes are defective on 25% of the wheelchairs which is really being ridiculously cheap and stupid. And in the few weeks I’ve been there one demented man wandered out the door and fell. Thankfully he spent a day in hospital and seems OK. But that’s neglect. The staff is responsible to prevent escapes. (This happened an hour before I came on shift.)

https://ilerlawfirm.net/elopement-wandering-nursing-homes/