Please help me respond to this disturbing article - page 2

While I certainly believe that alot of nursing homes don't do as good as a job as they should, their are certain things about this article that I would like to educate the public on: 1) the... Read More

  1. by   cargal
    Here is the article, ktwlpn. It is also found on the front page of alnurse.com. Boy you guys make some great points, I am glad I posted. I will write a reply to the paper soon.

    http://www.allnurses.com/news/jump.cgi?ID=1178




    A View from the Experts: Former prof hopes overuse of medication is waning

    Sunday, October 20, 2002

    By Lynda Guydon Taylor, Post-Gazette Staff Writer


    It's no secret to nursing homes that an overmedicated patient means less work for staff members, said Estella Hyde, a retired nursing professor at Edinboro University of Pennsylvania.

    A drugged patient is one who is not going to make demands on the staff, said Hyde, an AARP executive council volunteer. An overmedicated patient also is one for whom staff members do not have to provide activities.

    When Hyde was a professor of nursing, she said she had students in nursing homes who told her of what was going on in the facilities. This was something nurses talked about all the time, she said. It's easy for these types of abuses to occur when doctors visit only about once a month.

    Although unaware of what the situation is now, Hyde said, she'd like to think it's changed in the past five to 10 years. She hopes that what the staff does has changed and has resulted in more activities planned for patients today.

    Asked how many deaths might be attributed to overmedication, Hyde said she wasn't sure that could be determined. When a patient dies in a nursing home, that death is generally considered routine. A nursing home patient is someone whose health already is compromised, she said, so there's no inclination to question it.

    If this kind of abuse occurs, Hyde said, it's more likely to happen in a personal care home than in a hospital, where even in the case of serious ailments, the stay is usually short term. She acknowledged that inadequate staffing in personal care homes could be a problem leading to overmedication.

    Adding to the problem is the fact that elderly patients tend to revere a doctor's exalted status. They're not likely to question a doctor's authority because they were raised during a time when the doctor was considered almost a god. She sees people in their 60s and 50s taking a different stance, however. Those younger than 50 question their doctors all the time and consider them more as collaborators in their health care.

    While the Pennsylvania Chapter of the AARP has not received any complaints of overmedication in the past year, the organization does what it can to alert members to the dangers of another problem: harmful drug interactions. In television ads and brochures, consumers are urged to report to their physician all the drugs they are taking, including over-the-counter varieties. AARP encourages consumers to discuss their medication with their health-care providers, Hyde said.

    If a family suspects a loved one is being abused, no matter the method -- whether it's overmedication, improper feeding or whatever -- those suspicions should be reported to the facility's administrator or director of nursing. If they don't get a satisfactory response from the facility, they can report their concerns to the state's Protective Services hot line at 1-800-537-2424 or the Department of Health at 1-800-254-5164.

    According to the Department of Aging, which operates Protective Services, in the 1999-2000 reporting period, the state's area aging agencies received 10,991 reports of physical, sexual or other forms of abuse. Of those, 2,703 were substantiated. Those cases included health, safety or welfare complaints involving the elderly.

    Lynda Guydon Taylor can be reached at ltaylor@post-gazette.com or 724-746-8813.




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  2. by   ktwlpn
    [QUOTE]Originally posted by cargal
    [B]Here is the article, ktwlpn. It is also found on the front page of alnurse.com. Boy you guys make some great points, I am glad I posted. I will write a reply to the paper soon.

    http://www.allnurses.com/news/jump.cgi?ID=1178




    A View from the Experts: Former prof hopes overuse of medication is waning

    Sunday, October 20, 2002

    By Lynda Guydon Taylor, Post-Gazette Staff Writer


    It's no secret to nursing homes that an overmedicated patient means less work for staff members, said Estella Hyde, a retired nursing professor at Edinboro University of Pennsylvania.

    A drugged patient is one who is not going to make demands on the staff, said Hyde, an AARP executive council volunteer. An overmedicated patient also is one for whom staff members do not have to provide activities.

    When Hyde was a professor of nursing, she said she had students in nursing homes who told her of what was going on in the facilities. This was something nurses talked about all the time, she said. It's easy for these types of abuses to occur when doctors visit only about once a month.

    Although unaware of what the situation is now, Hyde said, she'd like to think it's changed in the past five to 10 years. She hopes that what the staff does has changed and has resulted in more activities planned for patients today.

    Asked how many deaths might be attributed to overmedication, Hyde said she wasn't sure that could be determined. When a patient dies in a nursing home, that death is generally considered routine. A nursing home patient is someone whose health already is compromised, she said, so there's no inclination to question it.

    If this kind of abuse occurs, Hyde said, it's more likely to happen in a personal care home than in a hospital, where even in the case of serious ailments, the stay is usually short term. She acknowledged that inadequate staffing in personal care homes could be a problem leading to overmedication.

    Adding to the problem is the fact that elderly patients tend to revere a doctor's exalted status. They're not likely to question a doctor's authority because they were raised during a time when the doctor was considered almost a god. She sees people in their 60s and 50s taking a different stance, however. Those younger than 50 question their doctors all the time and consider them more as collaborators in their health care.

    While the Pennsylvania Chapter of the AARP has not received any complaints of overmedication in the past year, the organization does what it can to alert members to the dangers of another problem: harmful drug interactions. In television ads and brochures, consumers are urged to report to their physician all the drugs they are taking, including over-the-counter varieties. AARP encourages consumers to discuss their medication with their health-care providers, Hyde said.

    If a family suspects a loved one is being abused, no matter the method -- whether it's overmedication, improper feeding or whatever -- those suspicions should be reported to the facility's administrator or director of nursing. If they don't get a satisfactory response from the facility, they can report their concerns to the state's Protective Services hot line at 1-800-537-2424 or the Department of Health at 1-800-254-5164.

    According to the Department of Aging, which operates Protective Services, in the 1999-2000 reporting period, the state's area aging agencies received 10,991 reports of physical, sexual or other forms of abuse. Of those, 2,703 were substantiated. Those cases included health, safety or welfare complaints involving the elderly.

    QUOTE] OH good Lord! I wonder which of these articles appeared first? Such an infammatory collection of erroneous information....argh! I will e-mail the writer again....In my experience-medicating a pt with any kind of tranquilizers or anti-psychotic causes MORE work-NOT LESS...Along with monitoring the residents condition-especially their intake and gait we also have to monitor and document any side effects each shift........God forbid they stand up and fall over---paperwork then abounds...How long ago was this person a professor of nursing? At least 10 years? So she has NO current info of the regs in LTC...none...And we all know that students can be as misinformed as anyone else-and are very likely to misinterpret a situation in clinicals.As far as activities go-the state regulates how many hours of activities must be offered each day...of course-we can not MAKE anyone attend.We know that LTC's are much more closely regulated then personal care or assisted living homes in Pa...On my unit of 44 I have maybe 10 getting risperdal or remeron...maybe 5 taking zyrexa......1 takes xanax regularly,2 take ativan regularly(since long before admission to our facility-and we are attempting to taper them down)..No sleepers...1 on depakote .....No prn's at this time...We have discovered that the most affective treatments with our dementia residents are a snack and a drink and a bit of hand holding-and some tylenol once in a awhile...If they want to sleep during the day and be awake at night we don't fight that-it is a common behavior in Alzheimers and someone just walking through the unit may not know that....Some of the attitudes we see concerning LTC just frost my butt-many of us work so hard to learn how to care for our residents-especially the challenging dementia residents...."So long as Americans maintain the fantasy that somehow Americans should never be inconvenienced by the predictable outcomes of their everyday behaviors (diet, exercise, drinking, automobile use, air and water pollution, crime, etc.), and if they are inconvenienced, somebody ELSE should both fix it (right now!) and pay for it, there will be no improvement. So long as Americans fantasize that they and their loved ones somehow should never die, and that death is always such a tragedy that we should spend about 1/3 of our healthcare budget on the final few weeks of people's lives, there will be no improvement. " Sjoe-that says it all!
  3. by   shabookitty
    You said it deespoohbear. I have never worked "in" an LTC but merely visit to draw blood for a few hours a day. And yes it has been an eye opener. You want to believe it is like the movies portray...Old folks sitting around playing pea-knuckle and rummie and talking about the old times. God bless those elderly ppl that wake just to go another day...and God bless those that muster up the energy and emotion to care for them. LTC is my weakness...I just want to squeeze and love 'em all. I honor those that put in 100% there all day b/c my heart just can't take it.
    I put the blame on the Government. There is just no excuse. They do not prioritize money for LTC...for the reason they nor their family will not have to encounter it! Or if they do, it will be the top LTC in US. I honestly believe that if the President visited a home in my town and KNEW he was going to placed there...the walls would be painted warm , cozy slippers would be provided and fireplaces installed...and the staff would be paid immensley.
    The second party I blame is the familys that are too busy to give a rats butt to give "quality" time. Not just a stop-in once a month to give a calendar. And ask Questions about "why mom is so combative, or sad...or drugged!" Duh! Just my opinion.
    And why is it okay to live and contribute 80-90 yrs of life in this rich country...and be dumped in some homes that are not much better than third world countries? Why are skyrises built to show beauty and business...hospitals too...and LTC homes still look like disaster shelters. It makes no sense to me. And i don't even work in one.
    Last edit by shabookitty on Nov 1, '02
  4. by   cargal
    I was reamed a new one today because I politely told the administrator that the new staffing was not adequate. Staff was reduced and the census was increased. She told me we were in intermediate care and not acute and we were staffed more than adequately. She told me I was not experienced enough to know that we were staffed adequately. I do know that it takes me three hours to do a med pass and check on my residents on my end of the hall, then I am expected to function as charge and call the MD's with labs, problems, and take orders, not to mention direct the staff, who are ill equipped and trained to handle the older, less stable resident , most who have dementia. This article is right, but for the wrong reasons. We don't drug the residents to make it easier for staff. But I can't attend to this population any more in LTC. This facility is losing this nurse. This facility is losing a patient advocate. Perhaps we should let the author of this article know what the problems really are!


    Blessings,
  5. by   whipping girl in 07
    I wish I knew what the answer was to long term care. I know that when we get nursing home patients into the ICU I work in, they tend to be much better cared for than the patients who need that kind of care who are taken care of at home. (Does that sentence make sense?) Anyway, I think government involvement in our health care has made the system worse, not better. I see doctors every day who do EVERYTHING possible to save a patient who cannot be saved so that the family will not sue them. Americans are afraid of death, and doctors are afraid of lawsuits, and as long as Medicare pays *this much* and the hospital has to write off the rest, one-third (or more) of our healthcare expenditure will be consumed by people in the last days of their life. How much better could that money be spent?!

    I, for one, don't want to be anywhere near a hospital when I get old and decrepit. I've kept too many people "alive" who aren't living to want to have that done to me.

    I applaud you Carrie for having the courage to stand up for your convictions. I completely understand why you are leaving the facility you work for and I hope that you can find a place to work that is not an old people warehouse; a place that will pay you decently and provide enough employees to care for the patients decently. Sadly, these are becoming few and far between.
  6. by   cargal
    Konni,
    Many of you here at allnurses.com have helped me be the nurse I am today.... and given me the courage to continue to fight. If I don't work in LTC ..... I may write that book some day! Thanks for being there.



    Carrie
  7. by   jemb
    I haven't worked LTC in ages, and then only did it rarely -- per diem, but would like to make a few comments that might be apropriately included in the content of a response to either article. 1) People who are placed in nursing homes are there because of multiple problems for which multiple medications are prescribed. Even those who are there only for a short period of time may require meds in addition to the everyday pills they take simply to treat the condition that required the change of residence from home to LTC. 2) Yes, LTC residents may sleep longer periods of time than you are used to their sleeping at home. Boredom and depression both may contribute to this. Those who are not "pemanent residents", but who are there because of a temporary although long-term condition probably don't feel well either. Don't we all tend to want more sleep when we're not well? 3) I would respectfully suggest to anyone who is concerned about the amount of personal attention available to each resident to volunteer their services to help feed, accompany a resident to the outdoor patio for a change of scenery, and provide some company to someone who has no family or friends to visit. This could not only be of benefit to the residents, but has the potential of helping change the future of LTC care by giving the public more of an insider's view of what the problems are.
  8. by   Teshiee
    I have worked in LTC facilities and I am sicken how we treat our elderly. With the youth worshipping society we live in it is no wonder our facilities are nothing more than dumps for the elderly. I loved working with my residents but the lack of care and greedy grubbing hands of the administrators were too much. They only cared for their money and the poor families assume that their loved ones are in good hands. If they only knew. I know all LTC aren't bad unfortunately there are too many that are. I have tried to make the most of it but when saftey issues were being neglected not to mention setting up my licensure to be jepordized I had to go. The whole system itself needs to be revamped big time. I truly feel for families who have to put their loved ones there. I know I couldn't put my mom or dad in one of those mills they call hospitals. Because knowing my personality the state would have to pitch a tent there......... just my 2 cents.
  9. by   nightingale
    Way back, 5 years or so ago.. before I was a GN, I thought I could "maybe do LTC"... I really did not get that oppourtunity till last year when I lived in a very small community. The local hospital was most dishonest and controlling of scheduling and yadda yadda... they said to me, "What are you going to do? Work in the Nursing Home"? well.. given that challenge the way I did.. that is exactly what I did....

    I really thought I could do it... it was too hard.. too depressing... too sad....

    I was physically beat up twice; one of those times it was with a steal brace kicking me while I was backed up to a wall. The other time the poor dear lady was so frail I was afraid she would hurt herself when she kept slapping me. Had I had a shot of something I would have gladly injected it to both of my patients.

    What are the answers? I do not know.

    I just know it is too hard and unrewarding for me to do that kind of work. I applaud and am in awe of nurses who do that sort of thing.

    I can sometimes still hear and remember the screaming and moaning of those individuals. Some were lucky and did have family coming regularly. Most were there because no one else could care for them or some simply had family who did not care.

    I for one, pray to God, that I go nice and quick and do not have to end up that way... sad but true...

    Oh and the "Administrator" would tell us we obviously were not utilizing "interventions" to control negative or inappropriate behavior.. the dog....

    I could go on and on.. but I will not...

    Thank you for letting me vent....
    Last edit by nightingale on Nov 2, '02
  10. by   deespoohbear
    Another thing that gripes me about the state and LTC is the way they look down on anti-depressants in the elderly.. For crying out loud, why wouldn't most elderly people be depressed? My 84 y/o grandmother (who is still at home) has every reason in the world to be depressed. Let's see, in the past 10 years my grandma has endured: the death of a grandson, the stillborn death of a great-grandchild, the death of a son-in-law, the deaths of 2 of her siblings, been diagnosed with CHF, afib, and had a pacemaker placed, suffered a cardiac arrest post pacemaker placement, lost her ability to drive, has been told that she has macular degeneration, glaucoma, went from taking zero drugs to 7 or 8 daily including Coumadin, and last but not least has been told in the last month that her oldest daughter has cancer, and probably is terminal.......

    That is enough to depress anyone....but no, according to our wonderful government people (who don't have a freaking clue!!) accuses health care of giving unnecessary mood altering medications. If I had been through HALF of what my grandma has been through the last decade, I would be depressed too. A lot of elderly folk have been through hell and back the last few years, why not give them medication to help lift their spirits? Hell, I would need the drugs and the key to the liquor cabinet if I had been through all that......
  11. by   CraftyLPN
    I had worked in LTC for a short time...When the families came in and the client happened to be in my hall..it was total chaos...I would love to spend more 1 on 1 time with these folks...but it is virtually impossible.. but that doesn't stop me for trying my best..maybe I am too ambitious...but I tell the families exactly this..."I treat everyone in here as if they were my own."
  12. by   rncountry
    Carrie, You bet I am going to write this reporter. I worked in LTC for 5 years from floor nurse to DON. The prof. quoted in this article appears to not have been a floor nurse since the 1970's.

    Think this, given the average patient load for a CNA in LTC and the average length of time to get patient's up and in the dining room for breakfast, it gives CNA's just over 8 minutes per patient. I can't manage to get myself ready in 8 minutes. Do the same thing given the average patient load for nurses and divide that into the allowable time span for meds and nurses have just over 2 minutes to see each patient to pass all the meds. The inability of staff to truly interact with patients beyond the most mundane things will lead to great depression among the elderly, studies show that one of the biggest issues for elderly is depression, in and out of nursing homes. And many of the hallmarks of major depression are sleeping, not interacting or participating with outside stimuli, etc...
    Then of course there is the idea that LTC is equipped to deal with mentally ill elder citizens. Behavior modification can never work as long as there is not enough staff to do it. On too many occasions I have seen residents who were violent sent to a mental health facility, back in 3 weeks on a variety of meds, just for us to have to wean them off so as to not get a citation and then we have the violent resident who attacks both staff and other residents. A vicious cycle. All patients who are on pyschotropic meds have to be tracked with behavior sheets, as well as being flagged on med sheets. It is my opinion that we are denying useful medications to our elders at this point for fear of being cited for overuse of medications. In not one area of nursing have I worked in have I been physically abused by patients as often as I was as when I worked in LTC, including when I worked in a Neuro ICU unit.
    To me the majority of activities in a nursing home are a joke. We expect elderly people to play games as if they were children. In the Eden Alternative there are several things going on at the same time allowing the resident to pick and choose what they would like to do, the vast majority of homes that say they have gone to the Eden Alternative most certainly have not. Putting a couple birds or dogs in a facility with some plants is not the Eden Alternative.
    For every problem there is in LTC the solution could be found in appropriate staffing. In Michigan the minimum staffing guidelines are 2.25 hours of direct care per patient in a 24 hour period. There are many states that are even less. Most homes, for want of a better word, staff so close to the minimum's that one call in can then put staffing below minimum's. There is no way to meet the needs of the multiple issues the elderly in LTC have with that type of staffing.
    In LTC the inability to medicate appropriately with physcotropic medications has led to deaths of residents. In Michigan a couple years ago there was an elderly woman who strangled her roommate to death. There was all sorts of hoopla over that, with the media questioning how a woman who had a known violent history was not appropriately watched. I think my husband got tired of me talking to the TV when this happened. Let me think, this happened because there was not enough staff to watch her, this happened because the appropriate medications were withheld from her, something that would not have happened had she been much younger. The ability to restrain a patient has basicly been taken away from us, regardless of whether the patient is violent, will fall repeatedly out of their wheelchair or bed, or if they are harming themselves. With long term mental health facilities basicly none existant anymore there will be more and more mentally ill, and often plain deranged elderly being placed in nursing homes that are ill equipped to deal with them, who can not medicate them. The idea that the elderly in nursing homes are sedated or overmedicated makes my blood boil, because unfortunately the opposite is true. The patients who are asleep in their chairs are likely depressed, for which I may not be able to medicate them for, they may simply be tired because their bodies are old, and as we get older we do not sleep in the same rhythms as when we are younger, instead older people tend to cat nap through the day and often through the night. That can be found in any textbook and the good prof. should know that.
    Then of course the demented, wandering patient has to be thought of. The ones who constantly are out the doors so that the already thin staff is running 50 times a day to get them back into the building. Wish I had a dollar for every time I chased a resident down the block trying to convince them to come back inside, could go on a great vacation. Some will become physically violent towards you, so you are ducking and diving to avoid being a punching bag while convincing the resident who is determined they are going home or to work, that really they have to come with you. Most of the time this is done alone, because other staff are too busy doing other things.
    The family member who wants to know why mom is allowed to keep falling and injuring herself. Well, the state says she has the right to fall. By state regulations we are not allowed to give any chemical restraints, nor physical retraints. Then of course the family member looks at you like you have three heads. Did I mention the family members who scare the bejesus out of you? But you can't bar them from the facility either.
    After the 5 years I spent in LTC I am so burned out in that area that the only way I would go back to it is if that were the only way I had to feed my kids. The inability to provide appropriate care to the people who built this nation to what it is now became too much for me. The paperwork requirements are so heavy that if we were able to put the nurses on the floor that are now engaged in only paperwork then there would be at least 4 more nurses available to do direct care, and that is based on a middle sized nursing home. Across Michigan, at least, the use of mandatory overtime is more frequent in nursing homes than in hospitals because staffing is already so low that a call in or a scheduling error drops you below minimums. This of course leads to more staff turnover. It amazes me that the industry is allowed to continue to function in the manner it does. The guidelines for nursing homes are not bad per se, they are simply enforced at the whim of the inspectors. What was ok one year may get you a citation the following year. It is a guessing game, and because of that facilities come up with new and improved, read more, forms to try to appease the inspectors.
    They all cry proverty, that is simply not true. What is true is that if they staffed based on the actual care and acuity of the patients it would cut into profits. Read the Newsweek article under activism. It only solidified what I believed. Ultimately I believe it is much cheaper to staff appropriately than it is to pay fines, or get an inspection that is so poor that the facility closes to admission and readmission of patients. Then in Michigan if a facility have citations of actual harm, then the state can send in a state administrator and however many consultants it feels is necessary, they can order any equipment they feel is needed etc... and the cost of this is paid for by the facility itself. I know of one facility that paid over half a million for 30 days for this. The real interesting part of this is that the consultants are actually a private group hired by the state, and most of those consultants used to be state inspectors. Talk about croynism. There are a whole lot of people benefiting from the system as it stands, but it sure as hell is not the frail elderly that is supposed to benefit. And as Carrie found out, the nurse who speaks up is told they don't know anything, even though they are the ones who are actually doing the work and knowing they are not providing what is needed. If they opt not to quit, they will likely be pushed out one way or another.
    Carrie, I say write this journalist. I plan to.
    Helen
  13. by   cargal
    Thanks for being there for us. I plan on speaking of this to my adminstrator, too. The words "you will go into the community and speak of this place bad" came from her mouth when I brought this up. Patient care is not the concern, only the census. She said we are not making money. Where can I find out what there profit margin is. I am burning mad, but with all your support, I have just begun to fight.

    Blessings,
    Last edit by cargal on Nov 3, '02

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