more skilled replacing what used to be just ltc- what am i missing?

Lynx25, LPN · Oct 24, 2011

Money money money!

It's not just you, it's everywhere.

Right now I have 30 "residents", of which four have peg tubes, 2 have Trachs, 2 are rehab, 8 are agressive, or have serious care refusal issues, 3 with medium to large wounds... AND!

I just admitted a lovely gentleman who was in restraints and sedated up until the hospital sent him with the EMS. As soon as they dumped him off here, he took a nose dive into the floor.

Hurray LTC!

We don't even have a locked unit... *grump*

martymoose, BSN, RN · Oct 24, 2011

And who gets all the blame for when something goes wrong with these "residents(my azz)" THE NURSES DO.

It's time someone put their foot down- or up someone's ykw if this is a trend. So tired of nurses being scapegoats.

itsmejuli · Oct 25, 2011

$$$$$$$$$$$$$$

Those people are valuable to the bottom line and therefor your paycheck.

I'm glad I left LTC and Florida.

xtxrn, ASN, RN · Oct 25, 2011

I graduated in 1985. Trachs, respiratory therapy (by nursing), g-tubes- those were LTC then, though considered "skilled"- even though there was no expected improvement to be gained.

I moved to TX in late 1985, and they called g-tubes "skilled".... I was amused.

To me, it wasn't how many tubes they had, but how stable/unstable they were; or how time-consuming. It's a lot faster to tube feed someone than hand feed. JMO :)

TheCommuter, BSN, RN · Oct 25, 2011

In the state where I live, your average skilled (Medicare) resident is going to generate anywhere from $300 to $400 per day in reimbursements, while the average long-term (Medicaid) resident is going to generate only $100+/- per day in reimbursements. If the skilled rehab (Medicare) resident is going to result in triple or quadruple the cash flow, then facilities are really seeking these types of 'clients' because they are more profitable.

I have previously said that the healthcare industry is all about the money, and that cash rules everything around you and I.

xtxrn, ASN, RN · Oct 25, 2011

In the state where I live, your average skilled (Medicare) resident is going to generate anywhere from $300 to $400 per day in reimbursements, while the average long-term (Medicaid) resident is going to generate only $100+/- per day in reimbursements. If the skilled rehab (Medicare) resident is going to result in triple or quadruple the cash flow, then facilities are really seeking these types of 'clients' because they are more profitable.
I have previously said that the healthcare industry is all about the money, and that cash rules everything around you and I.

And, unfortunately, the cost of caring for that patient is closer to $550-600/day (figuring in room and board, nursing, supplies, therapy costs, medications, housekeeping, laundry, dietary, light and water bills, etc) ....so the more the merrier...Rehab patients cost the facility money; extensive medical (wound care, IV antibiotics, or things that nursing does- NOT therapies) have the best return for the facility, since the staff is already there. A LOT of SNF facilities contract their PT/ST/OT, so they have to pay THEM for their time, which is nowhere near covered by Medicare's lovely PPS system.

Forever Sunshine, ASN, RN · Oct 25, 2011

A few years back my unit used to just be for ltc separate from the rehab unit. This past 2 years i'm seeing rehab residents coming in once a room empties. I have 6 skilled (rehab) out of 28. Are you seeing this trend in your facility? I'm sure it's related to the cutbacks they're trying to get more$ in. I'm getting burnt over here- what am i missing?

I'm seeing it loud and clear like a freaking foghorn. I used to have maybe 4 rehab patients.. my dear little old ladies passed away.. and now I have at least 8(soon to be 9) rehab patients on my hallway.

You aren't missing anything. Just your dinner break lol

CoffeeRTC, BSN, RN · Oct 25, 2011

Yep...it has changed big time...15 yrs ago when I started...no one was really discharged unless they were going to the funeral homes!

Even over the last 2 yrs or so, the acuity has changed. We are getting residents 2 days after knee and hip surgery for rehab. We are getting trach, G tubes, central lines, picc, TPN complex wounds with wound vacs, wounds with drains, behavioral issues.....you name it we take it.

Staffing hasn't changed from the LTC to the rehab/ short term stays either. That is the big problem.

Lets talk about the no return to hospital push too. See all of those sick people that get discharged early from the hospitals.....we need to make sure we don't send them back to the hospital.

It is crazy.