[tex]

From a recent association meeting this week, much discussion and focus of the meeting was on the medicaid resident in long term care r/t the budget and that dental, vision, podiatry will not be covered by medicaid anymore. I know..........the pressure sores, the weight loss, impaired vision, falls etc......plus using med techs to pass medications to the residents, but must have a nurse on duty. Then the old rumor to me, new to others, is to d/c the LPN/LVN programs, and grandfather the lpn's and lvn's. Due to these proposed changes, unless we have good lobbyist on our side is a cut in good certified staff, espically our CNA's. Instead of the aides handling more than they can do now, their work load will triple. And the biggest statement made by some of the top people who are in the know, was that the government is looking into d/c the MDS all together? ANd MDS cordinators will no longer be..........They feel like it is to much work/trouble to deal with. tex

[catlady]

That sounds like b.s. to me, particularly as the government is now touting the release to the public of the quality indicators in several states--soon to be all states. Can't do that without the MDS. The public is already learning about the shortage in nursing; they'd scream if there were cuts. I could see them trying to squeeze in med techs, but the rest of it doesn't sound legitimate.

[Fran-RN]

In Indiana, we already have med techs- QMAs- Qualified medication Aide- Tehy are CNAs that take a special course that qualifies them to pass meds. We work with them a lot of times with only one nurse in building of 80 people. I know of other facilities that have even higher ratios. Can't see the government getting rid of the MDS after all the money and effort they have put into its implementation. and as Catlady said, they are using the data to "better" educate the public. What easier way for them to get it than have the facilities send it to them all packaged in a neat little form. Indiana has also greatly restricted the use of medicaid to pay for " extra" services. When a resident need this type of care and has no other pay source, the facility, family and resident have to jump through hoops to get it paid for. When my Husband was ill and living in a home, we had to wait 6 months for him to get dental care. One company offered inhouse care, but I found out later that they didn't use any anesthetic for their procedures. My husband had a tooth pulled with no numbing!!!. I tell every one I know not to use these people, but it is very convenient for the facility and the families to have the dentist come to the facility. AH but I digress. later

[kdhnursern]

In Kansas, CMAs (certified Medication Aides) pass meds under the license of a nurse. I am on call this weekend and last night worked the 11-7 shift. I was the only nurse in the building, one CMA, and 4 CNAs. I work in a 120 bed facility. Now that was a bit scary!!

MDSs are going to be how Medicaid is funded, just like Medicare is now. Besides, if they dc MDSs, how are the surveyors going to know who to target before they even get in the building!!!

I think MDSs are here to stay.

[RNIAM]

You mean to tell me that there were only four cna's? That has to be illegal. That is a 30-1 ratio here? Were you not terribly afraid for your licence? I would never take report knowing that was the staffing,job or no job. This tuff has to stop somewhere, don't you agree?
I am so fed up and scared for all the residents in these facilities.

"I was the only nurse in the building, one CMA, and 4 CNAs. I work in a 120 bed facility"

[Fran-RN]

rhona, I think that ratio is pretty standard based on the facilities I have worked in. I worked one facility that I was resposible for 70 residents on 11-7 with 1 CNA and 1 QMA. Not ideal to say the least. Medicaid in IN is already determined by MDS. fun fun fun.

[VZ/res0ncqx]

I have been out of nursing for 12 years and am now in a facility of 40 beds...geriatric, and rehab. we have 3 aides on days, 2 on eves, and 1 on nights. I work the Baylor weekends. When we have an emergency, there is usually one aide and one nurse, and the charge nurse has to handle the floor and call others in case of call-ins, mop floors in case of boiler room fiascoes, keep residents off the floor then, manage incidents, pass meds....it's a disaster. Plus I am the annoying sort that insists on ethical treatment of patients. Us "idealists" are always touted as "unrealistic", but then are sued when residents related to the "higher-ups" are "mistreated". What's the deal???? I am a crusader who insists on kind patient care, the Golden Rule, and correct procedure. Why don't these things mesh legally???

[Fran-RN]

Ok I'm dumb? What's a Baylor Weekend? Janitors, secretaries, staffing coordinator. when is there time for nursing?

[RhondaRNConsult]

Quality Initiatives are being trialed at the present time.... I think your information source quite possibly gave you some inaccurate info! LTC is going in the direction of MDS's. Deeper & deeper.... Med Tech's are coming in to assist with the nursing shortages, Feeding Assistants (not sure if the ruling has passed as of yet) are also being looked at... in attempt to assist with the nursing shortages.

[Fran-RN]

Exactly what will these med techs duties entail? Who's training them? How will they be different from the current QMAs? I think feeding assistants is a great idea. I hope that gets passed, but I wonder how it will work in the real world. I've worked at 4 different homes in the last 9 years and none of them were able to hire enough help. Esp CNAs. The previous home I worked in , all the managment nurses took turns working the floor as CNAs. Sometimes not even getting applications except from people that you would trust to sweep your floor, much less care for dependent people. If these homes are typical of others in the country then we have a problem that new job classifications are not going to solve.