Abstract
Nursing assistants provide more than 80% of direct care to residents. However, it is unknown whether or not they clearly understand the purpose of nursing home regulation and incorporate regulatory standards in their care delivery process. This study uses qualitative methods to explore their experiences with nursing home inspection. Findings suggest that the subtle nuances of human interaction between nursing assistants and residents tend to be overlooked in the midst of enforcing highly strict and detailed regulatory standards that mainly focus on visible outcomes of care. In addition, the state survey might deepen the chasm between nursing assistants and nursing home administration so that the hierarchical culture of mistrust and ritualism continues in nursing homes. To resolve such problems, it is critical to rethink the impact of nursing home regulation at the level of direct interactions between nursing assistants and residents and to consider increasing nursing assistant involvement in the inspection process.
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