Who Does What in a Nursing Home? Part 1

Who Does What in a Nursing Home? Part 1

nursing home expert witnessAttorneys who handle nursing home cases need to understand the roles of the personnel. Some of you may recall a game show of the 1950s entitled “What’s My Line”, where celebrity contestants would try to determine a guest’s occupation through several rounds of questions requiring only a yes or no answer. As a child, a very young child I might add, I enjoyed the celebrities working as a team. They tried to come up with discerning questions that would eliminate non-related lines of questioning and bring one of them to the point where they could make a confident guess of the contestant’s occupation. This was great fun to pass the time on a Tuesday night.

But it is not what families want to do in a nursing home when they are seeking someone who can take care of their loved one’s pain, or clean up an incontinence episode. Yet, by appearance, you can’t always know what a nursing home or rehab facility’s employee job description includes.
Today, nursing homes across the country work diligently to achieve security protocols of name tags and/or specific uniform or style of dress to differentiate the appearance of the employees by their job descriptions. This blog post is the first of two which will attempt to provide the reader with several methods of job distinction and identification in a nursing home.

Some but not all nursing homes use picture IDs for identification and security. The facility where I currently work requires all staff to wear a picture ID above the waist at all times. It is bar-coded to only permit access to locked areas as their job description entitles them and also gives access to the elevators. For example, a housekeeper’s badge will not allow her access to a medication room or a charge nurse cannot enter the records office. Staff using a time clock must swipe their badge to “clock in and out”. Employees must swipe a badge to enter from the employees’ entrance, and if they enter from the main entrance, security will not pass an employee who does not have a badge unless a supervisor comes to the door to confirm ID and current employment. All visitors must sign a guest book and wear a visitor badge received at the entrance.

Almost all facilities require staff to wear some type of uniform. In my facility, the dietary staff wears black pants, a white knit golf shirt with the facility’s logo on it, and special non-skid black shoes. You may observe the dietary employees delivering trucks with meal trays, standing behind a steam table taking orders from nursing staff to prepare plates with meal choices for residents, or cleaning up the dining room after a meal. They also deliver snack trays to each nurse’s station twice a day. They may not feed a resident or take a food request from a resident. These tasks can only be done by nursing staff. Dietary employees may not help transfer a resident, assist one to walk, or even help them get to a standing position. They do not deliver food items to a resident’s room; they are strictly no hands-on employees as far as residents are concerned.

Our laundry and housekeeping department employees wear black pants with a gray golf shirt with the facility’s logo on it and sneakers. The laundry employees deliver incontinence and linen supplies to each unit at the end of a shift for the next shift. The female housekeepers keep the lobby, offices, resident rooms, nursing units, and bath/shower rooms clean. The male housekeeping employees maintain the floors throughout the buildings and empty the large trash and soiled linen containers on each unit. The laundry and housekeeping staff also are not permitted to transfer a resident, assist one to walk, or even help them to a standing position. They are encouraged to speak cordially with our residents as they move throughout the building performing their tasks but they, also, are no hands-on employees as far as the residents are concerned. Before entering a resident’s room, they must knock, identify themselves and the reason for being there, and wait for a reply of permission before entering the room.

The maintenance department staff members wear dark blue work pants or jumpsuit for painting, repairing, and replacing equipment. They must knock on the door identifying themselves, and await a permission reply before entering a resident’s room. They also do not perform any hands-on care for our residents.

The administrator, assistant administrator, admission department, business office, payroll, social service and human resource staff wear office attire. They are encouraged to verbally interact with the residents as they move throughout the building during work but have no hands-on credentials to physically assist residents. They may not feed a resident unless they have participated in a feeding training course given at the facility.

In my next post, I will share more about the medical and rehab staff who perform the daily care needs and provide medications and treatments for residents at a nursing home or rehabilitation center.

Our Nursing Expert earned a master’s degree in nursing from Thomas Jefferson University with emphasis on education and has been certified in gerontology for over 13 years. Our expert has also worked for four years as a geriatric nursing expert witness with Med League reading and evaluating medical records for attorneys related to potential litigation.

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