dying_alone_by_holgahead84People should not die alone. They came into life surrounded by people, shared their life with people, gave life to people.

To die alone in a short-staffed nursing facility is a disgusting epitaph for a sick society.

A society that throws away its human garbage – no passing bells for those who die as cattle.

All dying people should be surrounded by caring people, loved ones, fiends.

As a nurse in charge I insisted on a member of staff being with a dying patient, and if I was accused by other nurses of lessening the care given to others, I said, yes, so be it, but would your attitude be different if it was you left dying in a dimly-lit room or hospital bed, or your spouse, or child?

No reply, usually, and if there was I would let rip. Many were of a like mind to me, of course, the last of a kind.

It should not be necessary, but, because of the reality of much of present-day nursing, American iniatives such as No One Dies Alone should be applauded, and taken up widely in Britain.

In the words of Debra Wood, RN: ‘Ideally, people will pass from life to death surrounded by loved ones or a nurse but, often times, patients lack friends and family willing or able to stay with them. And nurses are often too busy these days to sit with a terminally ill patient. In an effort to ensure that patients make the journey in the presence of a caring person, a number of hospitals around the country have launched No One Dies Alone or compassionate companion programs’.

The volunteers stay three or four hours with the dying person and may play soft music or hold the patient’s hand.

A volunteer said: “Those of us who volunteer have a sense we can assist people and be there during those moments.”

Sandra Clarke is credited with initiating the No One Dies Alone program,after being asked by a a patient who was near death to stay with him. She said she would, but by the time she had seen her other patients, the man had died, and she felt terrible.

She developed a guide and materials that she sent to 900 hospitals.

“This is a win-win,” said Clarke, explaining that staff nurses no long feel guilty about not being able to stay with a dying patient.

Volunteers find the experience changes them and prepares them about what to expect with death.

The volunteers make sure the patient is warm, comfortable and clean.

“Those last hours are not undignified and they are not abandoned,” Clarke said. “The idea is not to abandon them on their last journey.”

Volunteers agree to be contacted four times per month and sit with patients for two to four hour shifts.

The volunteers provide comfort-care measures to imminently dying patients at hospital and nursing homes.

The volunteers receive eight weeks of training, covering all issues of end of life care.

Nurses welcome this program. The volunteers are seen as advocates who can inform the nurse of any pain breakthrough or breathing deterioration.

The volunteers find it fulfilling, receiving immediate feedback that they are making a difference in someone’s life by providing companionship at the end of life.

The volunteers provide emotional, spiritual and social support in the hospital, nursing home, home, or hospice.

They commit to meet with the patient at least weekly through the course of the person’s illness or until family members arrive. The nursing facility offers the volunteers ongoing support and meets with them on a regular basis.

It should not be necessary, but, because it is, I urge compassionate people to step forward and set up local No One Dies Alone programs.

I urge all compassionate people to volunteer.

Do not let nursing become just a compassionless task.
lenin nightingale 2015



517067_630x35430% of American nursing homes have been cited for neglect, abuse, and death.

I very much expect the true situation in the UK is similar.

The Florida Agency of Health Care Administration believe the true figure is higher because families are unaware that abuse has occurred. Many nursing home patients are unable to communicate the abuse to their loved ones due to embarrassment, dementia, or fear of retribution.

Carol Daniel and John Butler, in an article entitled ‘Lawmaker Pushes for Cameras in Nursing Homes to Prevent Abuse’ (, reported on ‘allegations of rape, physical and verbal abuse, and neglect that filled the pages of Missouri nursing home inspections. The investigation that spanned three years was carried out by the U.S. Department of Health and Human services’ Center for Medicare and Medicaid. A state lawmaker contends such abuse is still going on, and he may have a way to combat it. Missouri Rep. Andrew McDaniel has filed a bill to allow the families of nursing home residents to place a video recording device in their room. “You probably hear the horror stories of people following grandma and stuff like that – we don’t want that,” McDaniel says. “We want them people taken care of and hopefully we’ll get rid of them type of people. Other health-care workers, they’re doing their job, they have nothing to worry about.” McDaniel says families have told him of cases of some patients developing bedsores from being left to sit in their own fecal matter.

The Missouri Association of Nursing Home Administrators declined to comment.

Families across America, driven by suspecting abuse or neglect, have turned to hidden cameras, better known as granny cams to identify and record abuse. Not only are elderly patient families resorting to technology to capture evidence, facility managers and law enforcement officials across the country are doing so as well. In addition to recording abuse, the use of video has captured caregivers stealing money, prescription drugs along with violation of appropriate behavior between caregivers.

The laws regarding security cameras vary from state to state. While the public is pushing for legislation that will allow for cameras in a patient’s room, there is strong opposition from the nursing-home industry citing an increase in insurance costs and concerns with resident and employee privacy issues.

Texas, Maryland and New Mexico now have laws that allow nursing home residents or their families to install monitoring cameras in their room. About a dozen state legislatures have granny-cam legislation under consideration. Adopting this legislation will be a positive step towards the prevention of elderly abuse, while providing families access to real time video or recently stored footage.

It is proven that the use of surveillance cameras had deterred crime in public facilities such as shopping malls, hospitals, schools, government buildings, etc. as well as the home.

It is astounding that the same technology is not allowed to protect our most precious asset, our senior citizens.

Daniel and Butler recount the story of a ‘St. Louis-area woman who wishes to remain anonymous says she would have put a camera in her husband’s nursing home room had she known what she knows now – believing it would have saved his life. The woman’s husband died July 28, 2010. “It’s been that long and I still have a problem,” she says. Her husband of 52 years was abused, she says – something she saw first hand during a visit. “A foul odor preceded me opening the door and when I did, there was my husband sitting head down in a room of about 90 degree in temperature because someone had turned off the air,” the woman says, and closed the window. He was hospitalized with bed sores, dehydration, and had to have a blood transfusion.

As to privacy concerns, the woman says cameras are already everywhere in our lives, and anyone who objects to such devices in nursing homes has something to hide‘.

There is strong opposition from the nursing-home industry, who hide the shamless faces behind the mask of ethics. These are the the heavily indebted companies that governments allow to operate private nursing homes, and which cut the number of staff to the bone, and dole out workhouse standard food to their residents.

It is this they have to hide, as well as employing many people who frankly haven’t a caring bone in their body; those devils of care that can not find a job more in keeping with their callous nature, such as feeding Christians to lions.

Make audio-cameras compulsory in UK nursing homes and hospitals.

Nationalise all UK nursing homes.

Manage them from the local district hospital.

The hospital to run a audio-camera monitoring unit, with access by relatives to recordings of their loved ones.

Rotate staff between nursing homes and hospitals.

Instigate draconian punishments for negligent and unkind care.
lenin nightingale 2015


how-to-avoid-the-worst-nursing-homes-in-2015-300x192I remember reading in about a case of neglect of a nursing home resident in Michigan that left an indelible mark on me. I had witnessed much poor and sometimes disgusting care meted out to elderly residents over the years [always robustly intervening; always being disliked by nurses who had become ‘managers’, thus, no longer nurses], but there was something about a patient infested with maggots that left a particular mark.

A nursing assistant found maggots in the genital area of a 66-year-old woman who had a urinary catheter at 5:59 a.m. on Aug. 13, 2011. A nursing home incident report said the patient “was offered a shower, which she refused, so she was ‘immediately’ given a bed bath by staff.”

However, in interviews with a state inspector on Aug. 30 and 31, a nursing assistant and the charge nurse said the woman did not get a shower because the nursing home did not have enough staff. Both the nursing assistant and the charge nurse told the state inspector the nurse used saline solution to rinse the area. But not all of the maggots came off, the assistant said.

Two nursing assistants told state inspectors that they had seen flies in wounds on the woman’s legs about two weeks before the maggots were discovered. One of them reported telling the unit manager and the director of nursing “she’s gonna get maggots.” The aide reported being instructed to document that the woman refused showers. The state report quotes the aide saying, “They let her lay there and they didn’t change her wounds (dressings) and they didn’t want to argue with her.”

A nurse manager came to the facility around noon to give the resident a shower the day the maggots were discovered. She told the inspector she saw “one or two maggots, but I think there were more.” She also said a “clinical corporate person” wanted her to document the discovery on the incident report as debridement. “They wouldn’t let me put maggots down on the incident report,” she said.

Another nursing assistant reported observing a nurse manager removing maggots from the woman’s genital area three days after the discovery of the maggots.

The woman was sent to the hospital on Aug. 28 and diagnosed with septic shock secondary to a urinary tract infection, chronic skin ulcers and kidney stones. Later tests and examinations revealed she had a broken hip likely due to bone thinning and extensive skin changes due to poor hygiene and refusing to be turned.

The woman told the state inspector that she was embarrassed by the maggot incident. She said she had told staff at the nursing home about seeing flies in her room and in the hall but no one did anything. She also said she told staff her catheter needed cleaning, but “they wouldn’t wash my catheter. There were times it was weeks before they cleaned my catheter.”

In its plan of correction, the nursing home stated the resident is now offered daily bed baths and her doctor and a family member will be notified if she refuses. Regular catheter care is also provided.

While the poor care that allowed the maggot infestation is perhaps the most shocking of the violations detailed in the September report, the state regards it as less serious than others cited. Violations are ranked on a scale for severity and scope, providing a measure of how many residents were affected and how many times a violation has occurred. Grades are given, with A being the least serious and L being the worst.

The discovery of maggots in the patient’s genital area ranked as a D, while the failure to provide a sanitary environment and failure to maintain the records were ranked Fs. The failure to monitor the fluid intake and output of a resident and failure to supervise residents in wheelchairs ranked as Gs.

A follow-up visit from the state in October found all problems at the nursing home cited in the September inspection had been corrected, a state official said Thursday. However, another inspection on Oct. 27 found several new violations, although none as serious as several of those in the September report.

Angil Tarach-Ritchey, a registered nurse who runs her own private-duty nursing company in the Ann Arbor area and who has worked in elder care and advocacy for more than 30 years, is not convinced.

“This isn’t a problem that just happened and this isn’t a problem that’s going to go away,” she said. “How the care is provided in a facility stems from the ownership and administration.”





lenin nightingale 2015


Extracted from Workers Vanguard No. 1019, 8 March 2013:

‘These and future cuts in social programs will add enormously to the already crushing burden on families as they try to cope with providing care for aging parents or disabled family members. The Elder Care Study (2010) by the non-profit Families and Work Institute found that during the five years preceding the study, fully 40 percent of the country’s workforce had provided elder care to family members. On average, such care represents the equivalent of a part-time job and typically lasts for over four years. Although family caregivers often perform medical tasks such as administering IVs and injections, caring for wounds and operating dialysis or other specialized equipment, they normally receive no help from anyone except other relatives — no home visits by nurses, medical assistants or other health care professionals.

The percentage of adults providing personal care and/or financial assistance to an aged parent has more than tripled over the past 15 years, reflecting the rapid increase in the country’s elderly population. According to the 2010 census, the number of those 85 years and older increased by 30 percent during the previous decade. Many studies have documented the dramatic toll that the stress and anxiety of caring for aging parents takes on adult children’s health, from higher mortality risks and rates of hospitalization to greater incidence of chronic disease.

Overall, two-thirds of caregivers are women. As they marry and give birth at an increasingly later age, more are becoming part of the “sandwich generation”—adults who are responsible for the care of both young children and elderly parents at the same time. Today, nearly 40 percent of women caring for elderly relatives are still raising children of their own, with many of those women also holding down a full-time job. In this capitalist class society, the enormous costs of providing elder care, which should be borne by society as a whole, fall on individual working-class and poor families and, above all, women.

That cruel calculus makes perfect sense in terms of the functioning of the capitalist system. For the owners of banks and industry, government spending on caring for the aged is an unnecessary overhead expense that ultimately lowers the overall profit rate. As Karl Marx explained, profits derive from the exploitation of labor: Workers, who have to sell their labor power to survive, add value to what they produce, but they only get paid a sum that allows them to continue to toil and to raise a new generation of workers. The difference between the value added by the workers and what they actually get paid ends up in the capitalists’ pockets in the form of surplus value. However, the aged and infirm do not labor and therefore do not generate surplus value. In the interest of maximizing profits, the engine that powers the capitalist system, public spending on the aged and disabled should logically be cut to the bone.

The Nursing Home Pestilence

Providing professional care for elderly people in this country is big business, and it will become even bigger with the baby-boomer generation entering retirement age. At the center of that business are for-profit nursing homes, often run by giant corporations. As is true of all capitalist enterprises, nursing homes must drive down expenses in the pursuit of profits. Many nursing homes avoid admitting elderly patients who are afflicted with dementia or other chronic diseases — precisely those who need care the most — due to the high cost of looking after them.

Likewise, nursing homes minimize the number of registered nurses employed, almost never hire on-staff doctors and pay the direct-care staff (almost always non-unionized) a wage they could earn at McDonald’s. Often, even in the better nursing homes, there is not enough staff to ensure that residents are properly fed. What they do not stint on are tranquilizers and other drugs that allow them to cut corners in attending to residents. As one academic researcher told the New York Times (23 September 2007), nursing home chains “have made a lot of money by cutting nurses, but it’s at the cost of human lives.”

This also exacts a toll on the remaining nurses and other staff. Nursing homes are stress-filled, physically demanding workplaces where non-fatal injury rates are greater than in the construction, meatpacking and mining industries. Inadequate training and equipment, higher patient loads and mandatory overtime feed the problem. Nursing home workers, who are predominantly women, need to be organized into the trade unions that represent nurses and other health care workers. Backed by the industrial unions, whose role in production gives them far greater potential social power, this fight must be part of a broader campaign to organize all the unorganized, a struggle that is crucial to reversing the decades of attacks on labor.

Low-budget nursing homes that cater to impoverished recipients, especially those located in poor (working class) communities, are often simply foul-smelling hellholes … Such conditions often persist despite the best efforts of health care workers, who seek to provide quality care in defiance of the rapacious nursing-home bosses. In the case of Hurricane Sandy, it was the staff, often putting in 36-hour shifts, that carried out the emergency evacuations of dozens of stricken New York City nursing homes. There was no good reason why people could not have been evacuated in an orderly fashion before the storm hit. It was penny-pinching by Mayor Michael Bloomberg that left the elderly in harm’s way.

Under capitalism, nursing homes hardly even begin to address the social need for elder care. Only about one person in eight aged 85 or over is placed in a nursing home. Of course, many prefer staying with their families, especially with what is on offer at most old-age facilities. The whole setup is focused on profiteering. By raking in about $160 billion per year while holding down costs, private nursing homes have been quite successful in maximizing their shareholders’ return on investment. This industry provides an object lesson in how the capitalist system is incompatible with satisfying basic human needs’.





lenin nightingale 2015


kicked-in-the-faceI remember reading what I considered to be a dramatic article about violent nursing home residents, written by Thomas Zambito (The New York Daily News, December 18, 2000).

He wrote of ‘three slayings of nursing home residents by other residents in the past six years, including one in which a Manhattan woman was suffocated by her 90-year-old roommate. In the past year alone, government health inspectors have cited three New York City homes for failing to protect residents from one another’.

This struck a chord with me, as I had begun to witness the admission of patients with violent behaviour into for-profit nursing homes, allowing them to live side by side with the frail and vulnerable. The profit motive (bums on beds) was the reason; with managers of these homes being under pressure to accept almost anyone by avaricious and debt-ridden owners. One manager told me that she had been told to accept Jack the Ripper, if necessary.

It was the legal aspect of such admissions that I questioned. Mr. Zambito’s article stated that: ‘the state Health Department singled out Brooklyn’s Rutland Nursing Home for jeopardizing the safety of elderly residents by allowing them to live side by side with dangerous residents’.

I questioned the legality of admitting patients with violent behaviour, given that nursing homes are places where frail, elderly people live close together, and can not escape from a violent attack, nor be protected from one in an industry where short staffing is endemic. These problems have been compunded over the last two decades or so, as many psychiatric institutions shut their doors, and nursing homes have taken in more mentally ill patients than ever.

I agreed completely with Mr. Zambito’s summary: ‘Resident-on-resident violence and harassment have been getting worse for years, fueled by dramatic shifts in nursing home populations that have created a volatile mix of residents‘.

Where are the special units for the growing numbers of residents with behavioral problems who are being discharged from hospitals and psychiatric facilities?

Moving on a to 2012, data from the Canadian Institute for Health Information (OANHSS), found that 8,400 residents of Ontario long-term-care homes rate high on a scale of aggressive behaviour. The scale looks at whether residents are physically abusive, verbally abusive, physically resistant, require restraints or exhibit inappropriate and disruptive behaviour. Some who not too long ago would have been housed in psychiatric facilities or in complex continuing-care beds are now finding themselves in long-term-care homes, explained Jane Meadus, a lawyer with the Advocacy Centre for the Elderly.

Moving on to May, 2015, ‘the daughter of an elderly man killed in a Winnipeg care home is happy a judge is recommending more special behavioural units be created in Manitoba to deal with patients with violent or aggressive tendencies’ ( news).

There are many types of abuse we heap on the discarded elderly – institutional abuse, which includes cutting back on food, heating, inappropriate care workers being employed, loss of dignity and respect, discrimination, neglect, financial exploitation, emotional abuse, and sexual and physical abuse – but let us add to that list and say that the admission of a patient with violent behaviour into a short-staffed nursing home is a heinous crime of neglect of care, of poor vigilance, driven by the profit motive.

The practice of admitting unstable patients to nursing homes is as prevalent in the UK as anywhere, take  time to read Alzheimer’s Society forum posts, but reports of patient-on-patient violence in nursing homes in the UK do not seem to make news headlines. Are we brushing this issue under the carpet of patient confidentiality, and, by this, protecting care home companies and compliant nurses? Does it help that the CQC does not enforce the requirement for a nursing home to have a qualified nurse as manager, who would be duty bound to protect their residents (and staff) against the inappropriate admission of violent patients?

Drag the executives of nursing home companies who allow an unsafe mix of residents in front of the courts.

Remove any nurse complicit in this abuse from their professional register.

Get rid of the CQC; their penalties are like being hit by a wet lettuce.

Place all reports of serious patient-on-patient violence in the public domain, altering names.
lenin nightingale 2015


There are significant regional variations in the cost of care within the UK, whether that is to provide care with or without a nursing component:

Region/Cost per week   Care home   Care home with nursing

East Midlands                £555            £687
East of England             £604            £788
London                          £625            £825
North East                     £515            £591
North West                    £480            £673
Northern Ireland            £476            £656
Scotland                        £596            £743
South East                    £641            £874
South West                   £592            £791
Wales                           £497            £603
West Midlands              £513            £694
Yorkshire                      £489            £655

Source: Laing & Buisson Care of Older People, UK Market Report 2013/14.

The common factor is the cripplingly high cost of care for the individual of limited means. Whether that cost is born by the government, or by an individual or their family, who have perhaps been forced to sell the family home to meet costs, the question of affordability takes on an increasingly keener edge.

A solution, for some people, is to arrange for themselves or their relative to be nursed overseas. In 2011, when first researching this subject, I came across an article in, which told of the experience of Steve Herzfeld: ‘After three years of caring for his increasingly frail mother and father in their Florida retirement home, Steve Herzfeld was exhausted and faced with spending his family’s last resources to put the couple in a cheap nursing home. So he made what he saw as the only sensible decision: He outsourced his parents to India.

Today his 89-year-old mother, Frances, who suffers from advanced Parkinson’s disease, gets daily massages, physical therapy and 24-hour help getting to the bathroom, all for about $15 a day. His father, Ernest, 93, an Alzheimer’s patient, has a full-time personal assistant and a cook who has won him over to a vegetarian diet healthy enough that he no longer needs his cholesterol medication.

Best of all, the plentiful drugs the couple require cost less than 20 percent of what they do at home, and salaries for their six-person staff are so cheap that the pair now bank $1,000 a month of their $3,000 Social Security payment. They aim to use the savings as an emergency fund, or to pay for airline tickets if family members want to visit.

Every time he looks at the bills — less than $2,000 a month for food, rent, utilities, medications, phones and 24-hour staffing — Herzfeld thinks he’s done the right thing for his parents and himself.

“It can be done,” he said. “This is working.”

These financial savings can be put into perspective: In The United States the cost for assisted living in a community will run about $4000-$5,000 a month to say the least, in some cases depending on the community up to $10,000 month.

Savings on the cost of care can also be gained in the Philippines. Individuals and their families can access to read that: ‘Mabuhaii Nursing Home offers unique and high quality nursing for elderly from America, Europe, Australia and Asia … We offer four different nursing service categories which differ in the level of intensity of healthcare provided. Prices differ depending on the house and room … Board and lodging without healthcare (Assisted Living) can be booked at lower alternate prices for those who don’t need care … Meals, laundry, cleaning and caregiving are of the same quality in all three categories and houses. Special requests such as air conditioning, flat screen TV, refrigerator and telephone can also be arranged.

Intensive Care
House Price per Month (USD)
Riao $2,130 to $2,590
Mandu $2,470 to $2,790
Molo $2,630 to $2,970 (c. £1,900)

Two (2) nurses per day or four (4) nurses per week take care of only one single resident in 12-hour shifts. Four (4) professional nurses are assigned for one single resident per week. Our healthcare team comes in on two (2) alternate shifts per day in a 7-day period taking care for only one resident. Our nurses and caregivers work for 12 hours a day, 3 to 4 days a week, so they can provide their services effectively in their full potential.

The 24-hour professional care includes:
catering, cleaning, laundry and room service.
house accommodation with high quality European standards.
massage and a full range of activities with the elderly.
trips, entertainment, etc.

Compared to the high costs of being in congestive nursing facilities in Western countries, where there is a sad reality of less quality care, you will save for up to 70% by staying with us for a sophisticated and heavenly nursing home service.

The cost of Intensive Care is slightly more than that of Standard Care, but it provides 100% more health care intensity.

Standard Care
House Price per Month (USD)
Riao $1,360 to $1,840
Mandu $ 1,690 to $2,020
Molo $1,870 to $2,190 (c. £1,350).
Two (2) registered nurses per day or four (4) nurses per week take care of two residents in 12-hour shifts. Standard Care includes high quality medical and social care

Cheaper care services are also offered in the Philippines: At it is stated: ‘We are strategically located at higher elevation and cooler part of San Juan, and of the entire Metro Manila. Thus, our home is safe from the rain and flood in Manila. We are very close to Carnidal Santos Medical Center.

Two-Bedroom House, One Patient per Room.

Our family-oriented staff consists of a supervising nurse and one caregiver for every elderly. The … services include 24-hour care, regular meals, and laundry. A doctor is on 24-hour on-call for emergcy cases. Visiting hours is between 6pm to 9pm everyday or by appointment.

(We) provide a 24-hr communication channel between the elderl(y) and their families … a secure web camera of the client’s room will be shown … to the concerned family.

The following are the detailed services we provide:
– one supervising nurse and two nursing assistants per elderly
– regular meals and laundry included
– 24-hr on-call to doctor, nearby hospital, and concerned families
– scheduled daily visits for client families
– telephone, email, and chat are allowed channels of communication
– secure web camera access for care supervision

Total cost per month for one elderly patient is PHP 30,000.00 (around USD 721.59). (c. £470).

In giving details of these services, I am not endorsing them. I can say that I have worked with very caring Philippino and indian care staff, and the possibility of care being monitored by a web-cam is a positive indication of good care being provided.

What I believe to be the main ethical issues surrounding overseas care are as follows:

Outsourcing a parent (or disabled child/adult) is not the same as relocating a call centre, at least not to most people. An individual struggling to meet care costs might face an agonising choice of sending themselves overseas – “it will help my family, I will be able to leave them my house”. Most would move ‘heaven and earth’ not to send their mum , dad, son, or daughter abroad. Some would not make such effort.

Will government eventually insist on overseas care? This is the main question for the future. The weasel-speak of divide and rule can be imagined: “In times of austerity it is wrong for the elderly and disabled to be a burden to hard working, apiring families. This government will provide the transport costs to high quality ‘care in the sun’ for all”.

The logic of ‘market forces’ makes this inevitable.

Those in possession of absolute power can lie and make their lies come true.

lenin nightingale 2015


85Having finished reading a blog entry by a care assistant in a private nursing home, who informs of her and one nurse having to attend to the needs of 25 elderly residents on a night shift, and of her thinking the food given to residents during the day was on par with what would go in the bin of very cheap boarding house (this as the homes’ administrator received a bonus for cutting costs), it occurred to me that all private nursing homes should be open to scrutiny by residents’ friends and relatives.

For this purpose, I have adapted an assessment form used in America, from the National Caregivers Library, by which friends and relatives can give scores on a 1-5 rating scale for a series of nursing home performances that impact on their loved one’s daily routine.

The assessment document, which I have named NURSING HOME ASSESSMENT BY RESIDENTS’ FRIENDS AND FAMILY, assesses the home’s performance in the areas of Quality of Life, Quality of Care, Nutrition, and Safety.

The nursing home is given overall score out of a possible 200 points. It is strongly suggested that any score of below 150 points should be a cause of concern regarding the overall care of a resident. Specific areas of concern can be highlighted, and the assessment form ends with an additional comments section, in which such concerns and more general impressions can be given.

The assessment form is not one so worded by a nursing home as to minimise any criticism, it asks probing questions.

There is a need for friends and relatives to become involved with assessment, in that they are often as isolated within a nursing home as their loved one, feeling that they have no one outside of the home that they can share their concerns with, with the CQC inspection regime only geared to investigate general concerns within a nursing home, effecting all residents, and not individual ones. Yet, if a number of residents’ friends and relatives within a nursing home complete the assessment form, with assessments all pointing to the same areas of concern, and these forms are posted (I advise by registered letter) to the local Contracts Compliance Department of the local council, this department will be legally bound to pass on these widespread concerns to the CQC, triggering an inspection.

Friends and relatives should be encouraged to photocopy the assessment form, and distribute it to others. Nursing staff who feel that the homes’ management are not responding adequately to concerns about residents’ care should be encouraged to inform residents’ friends and relatives about the assessment form. Permission could be given for a homes’ assessment forms to be viewed by those thinking of placing their loved one there.

Too many people believe that their loved one is being cared for as someone from whom a profit can be extracted. They see their concerns not being addressed by the head office of the multinational corporation that owns the nursing home, with concerns being repeatedly referred back to the care home manager, whose main remit is bed occupancy levels/low staff ratios/economical menus, that is, profit. People feel isolated and powerless under such a system, with (mostly announced) inspection visits by the CQC being nothing more than a theatrical production for an invited audience of friendly critics.

Combine as friends and relatives to protect your loved ones. Become militant on their behalf. Keep copies of the assessment form. (Assessments could be used as circumstantial evidence in any ensuing legal action). As groups of the concerned, go to your local M.P. and raise issues that have not been addressed.

The government and taxpayers are paying for what is all too often is a poor service. In America, this is treated as a fraudulent use of funds, a felony that attracts criminal proceedings, with fines of millions of dollars being imposed on nursing home groups, and the threat of imprisonment for owners. The business-friendly approach of the UK offers no more than a slap on the wrist. It is time this changed.

Residents’ friends and relatives – Combine with others to be strong in the protection of your loved one.

Nursing staff – do not stand idly by if your concerns are not met by management, combine with residents’ friends and relatives to distribute assessment forms and to give advise as to where to send them.

The UK approach, backed by the NMC/RCN cartel, of persuing concerns within the offending establishment, stinks. It is like going to a bully to ask for leniency. The form also asks friends and relatives to state whether a nursing home is managed by a qualified nurse. It is a national disgrace that many are not, with the only response of the CQC being to ‘wave their handbag’ at the business owners of nursing homes who do not meet the cost of employing a nurse manager. Would you want your loved one to get into a taxi driven by someone who had not passed their driving test? Then why put them in a nursing home run by an untrained manager?

I urge everyone to distribute this form.

I urge militancy on behalf of nursing home residents.

lenin nightingale and carol dimon 2015


A list of basic questions to ask when you and your loved one visit a nursing home.

Facility Name: ——————————-

Date Visited: ——————————–

Address: ————————————-

Nursing Home Information
1. The person in charge of the home is a registered nurse. YES NO
2. The home conducts background checks on all staff. YES NO
3. The home has Abuse Prevention Training. YES NO


1. Residents can make choices about their daily routine. Examples are when to go to bed or get up, when to bathe, or when to eat. 1 2 3 4 5
2. The interaction between staff and patient is warm and respectful. 1 2 3 4 5
3. The home is easy to visit for friends and family. 1 2 3 4 5
4. Friends and family are made welcome. 1 2 3 4 5
5. Concerns raised by friends and family (including those of potential abuse) are taken seriously. 1 2 3 4 5
6. The nursing home meets you cultural, religious, or language needs. 1 2 3 4 5
7. The nursing home smells and looks clean and is well lighted. 1 2 3 4 5
8. The home maintains comfortable temperatures. 1 2 3 4 5
9. The resident rooms have personal articles and furniture. 1 2 3 4 5
10. The public and resident rooms have comfortable furniture. 1 2 3 4 5
11. The nursing home and its dining room are generally quiet. 1 2 3 4 5
12. Residents may choose from a variety of activities that they like. 1 2 3 4 5
13. The nursing home has outside volunteer groups. 1 2 3 4 5
14. The nursing home has outdoor areas for residents use and help residents to get outside. 1 2 3 4 5

1. The facility corrected any Quality of Care deficiencies that were in the CQC Report. 1 2 3 4 5
2. Residents may continue to see their personal physician. 1 2 3 4 5
3. Residents are clean, appropriately dressed, and well-groomed. 1 2 3 4 5
4. Nursing home staff respond quickly to calls for help. 1 2 3 4 5
5. The administrator and staff seem comfortable with each other and with the residents. 1 2 3 4 5
6. Residents have the same caregivers on a daily basis. 1 2 3 4 5
7. There are enough staff during the day to care for each resident. 1 2 3 4 5
8. There are enough staff at night and on weekends or holidays to care for each resident. 1 2 3 4 5
9. The residents association is independent from the nursing home’s management. 1 2 3 4 5
10. Care plan meetings are held at times that are easy for residents and their family members to attend. 1 2 3 4 5
11. The staffing mix adequately reflects the culture of the local community. 1 2 3 4 5

• A good patient/staff ratio is important to good care, but you should also consider other care factors. Examples are staff training programs and how long staff stay at the home. If staff changes frequently, ask why. If excessive agency staff are used, ask why.

1. The home corrected any deficiencies in these areas that were on the recent CQC inspection report. 1 2 3 4 5
2. There are enough staff to assist each resident who requires help with eating. 1 2 3 4 5
3. The food smells and looks good and is served at proper temperatures. 1 2 3 4 5
4. Residents are offered choices of food at mealtimes. 1 2 3 4 5
5. Residents’ weight is routinely monitored. 1 2 3 4 5
6. There are water jugs and glasses on table in the rooms. 1 2 3 4 5
7. Staff encourage residents to drink if they are not able to do so on their own. 1 2 3 4 5
8. Nutritious snacks are available during the day and evening. 1 2 3 4 5
9. The dining room environment encourages residents to relax, socialize, and enjoy their food. 1 2 3 4 5

• Ask the professional staff how the medicine a resident takes can effect what they eat and how often they may want something to drink.
• Visit at meal time. Are residents rushed through meals or do they have time to finish eating and to use the meal as an opportunity to socialize with each other?
• Sometimes the food a home serves is fine, but a resident still will not eat. Like everyone, nursing home residents like some control over their diet. Can they select their meals from a menu or select their mealtime?
• If residents need help eating, do care plans specify what type of assistance they will receive?

1. There are handrails in the hallways and grab bars in the bathrooms. 1 2 3 4 5
2. Exits are clearly marked. 1 2 3 4 5
3. Spills and other accidents are cleaned up quickly. 1 2 3 4 5
4. Hallways are free of clutter and well-lighted. 1 2 3 4 5
5. There are enough staff to help move residents quickly in an emergency. 1 2 3 4 5
6. The nursing home has smoke detectors and sprinklers. 1 2 3 4 5
FACILITY TOTAL  —-  (out of a possible score of 200)