Observe, Record, and Report

This chapter examines the home health aides' (HHAs) mantra: “observe, record, and report” (O.R.R.). At the end of each shift, Cooperative Home Care Associates (CHCA) aides filed an automated report by telephone, pressing numerals to respond to recorded questions about the tasks they had done that day. Any anomalies in the patient's physical or mental health had to be reported immediately to the client's nurse supervisor. The aides served as the eyes and ears of a patient's care team, and nowhere was O.R.R. more important as a prevention tool than with skin care. The Obama administration issued a rule allowing consumers to sue nursing homes for negligence rather than submit to binding arbitration, as is frequently specified in nursing home contracts with patients and their families. Seven months into his term, Donald Trump moved to eliminate the rule and allow nursing homes once again to insert a binding arbitration clause in their contracts. The chapter then traces the long history of money troubles between care workers and the people for whom they care. Almost all of CHCA's revenue came from clients whose home health care was paid for by federal Medicaid insurance.