Venting...Hosp pts coming from skilled nursing facilities - page 6

Before I begin.........I want to say this....I am NOT saying that all SNFs are like this.... I cared for a pt this weekend. 97 yr old black female. Admission dx: sepsis, UTI, fever. s/p right... Read More

  1. by   tiskathleenherself
    I have reviewed the initial post and all of your responses and understand how you can believe that this type of thing is an atrocity. It is and you are right.
    I have done years of research regarding the situation. There are many reasons that the atrocities that you mention occur. None are acceptable.

    The large chains have been notorius for looking pretty, marketing the heck out of the community and making false promises to residents and their families. And they are being sued like crazy. The facilities blame the lawsuits on lack of tort reform, too many plaintiff's attorneys and lack of federal and state funding to allow them to provide good care. (Yet one of the most successful plaintiff's strategies is a "profit over care theme, when suing large chains.) The plaintiff's bar's motto is "regulation through litigation." They believe that if they sue these facilities enough, someone's going to wake up and figure out that they better provide good care or else!

    As you probably are aware, many of the large chains are filing for bankrupcty and are downsizing. One former large chain couldn't sell their facilities and actually paid another chain $13 million to take them off their hands!

    Staffing is horrendous. It's worse in assisted living. Some states don't even mandate a minimum staffing level. Skill set of care staff is marginal, at best.

    As a nurse, you are obligated to report blatant abuse and neglect. Call the Ombudsman or the state agency. They will investigate. The state surveys all facilities, but frequently, things are 'cleaned' up in anticipation of their visit, including increased staff and making things look nicer than usual. Having the state come in unannounced on a compliant investigation allows them the opportunity to see what's really going on.

    Lack of risk management (It's not required, so it isn't done.) and true quality assurance are a big part of the problem. Facilities are required to have a quality assurance program, but the only true requirement as far as what this means is that they must have a QA committee meeting on a quarterly basis. There's no guidance as to what should occur during a meeting or how to make it work. My crusade is to educate and teach risk management practices in an attempt to improve quality of care.
  2. by   stidget99
    Quote from tiskathleenherself
    My crusade is to educate and teach risk management practices in an attempt to improve quality of care.
    What a great crusade! If only more would join in, stand up and be heard! And if they are not heard the first time........stand up and scream until you are heard!!!
  3. by   tiskathleenherself
    Quote from stidget99
    What a great crusade! If only more would join in, stand up and be heard! And if they are not heard the first time........stand up and scream until you are heard!!!
    Thanks for the support. I travel the country, doing my sales pitch to facilities and healthcare associations. It is astounding how hostile a lot of these providers are to the concept of risk management. There is a great deal of denial that they are doing things wrong. Usually I can't get their attention until they've felt the pain of a monetary loss from a lawsuit, which is a shame. I spoke before one state's healthcare association and it was actually said to me, "We don't need risk management. Nobody sues anybody here in this state." (!) A statement like that says a lot. (Unless it hurts "me", I don't need to make a change to improve the quality of care.) It's been a very frustrating uphill climb, but we are not going to give up. I've had a great deal of positive response from organizations and facilities in Florida, which has been extremely encouraging. However, it took a LOT of financial pain in the Florida long term care environment with litigation, before anyone would pay attention. Hopefully, other states will follow suit.
  4. by   lisamilgrim
    I worked in a nursing home here in Arkansas and we have state inspections yearly and anytime something is reported as being wrong. Someone should definatly report this to someone so something can be done. This could be our family someday and I wouldnt want anyone treating my family this way.
  5. by   stidget99
    Quote from lisamilgrim
    I worked in a nursing home here in Arkansas and we have state inspections yearly and anytime something is reported as being wrong. Someone should definatly report this to someone so something can be done. This could be our family someday and I wouldnt want anyone treating my family this way.
    As per my previous post....I did report it to the ombudsman and they in turn reported it to the state. But not that nite (i.e. I did not call the police). I am ashamed to admit this but I was afraid of retaliation. Shame on me! I have kicked myself over and over on this and will be sure to be one of those things that will haunt me forever. I still haven't heard anything at all about this whole issue. I sure do hope that the family took pics and sues the crap out of them!!!
  6. by   mwaldon
    [QUOTE=stidget99]As per my previous post....I did report it to the ombudsman and they in turn reported it to the state. But not that nite (i.e. I did not call the police). I am ashamed to admit this but I was afraid of retaliation. Shame on me! I have kicked myself over and over on this and will be sure to be one of those things that will haunt me forever. I still haven't heard anything at all about this whole issue. I sure do hope that the family took pics and sues the crap out of them!!![/QUO




    Do not kick yourself for what could have been done. Life is about learning, take that experience and turn it into a learning experience. You will no how to handle things like this in the future. We are all human and make mistakes. But truly the only mistake you can make, is one you don't learn from. Keep taking care of the people with love and care and you will make a difference.
  7. by   lost_as_an_easteregg
    Quote from SmilingBluEyes
    I agree. this is elder abuse.
    I'm a cna and I work in a nursing home. Someone asked the question if maybe this happens to this woman because she was black. Honestly, where I work, it's the ones who don't have family or friends visiting regularly, are the ones who are least taken care of. It's sad but true. We owe it all to the cna's and nurses who don't really enjoy their jobs and are not really there to help people. There are only a couple of bad seeds in our facility, and the rest of us have to take up their slack, which is so unfair. But they switch us from hall to hall and when I work on a hall the week after those two, you can tell there are certain ones that aren't taken care of, and it's the ones who have no family. I suppose they think if a daughter or neice doesn't come to check on them and complain, they're ok. We've never had anyone in as bad shape as this poor little lady, but I honestly believe if they didn't rotate the workers on the halls we would have several. It's bad that you have to take care of problems that should never exist anyway, I commend you for caring enough to call the ombudsman. I have seen nurses blow it off and walk away.
  8. by   Figo
    Hope this is the ltc's problem. We frequently get these pts from home and send straight to the hospital to be stabilized. The family members are usually not aware they are abusing or neglecting their loved one. Or sometimes are not aware these people arent caring for themselves at home. Its easy to blame the ltc sometimes even if they just got the pt in. We send pts out to the hospital or home from our facility with no skin issues and if to the hospital they always come back with four things. A decubitus, a foley, c-diff, and a uti. I know probably some ltc facilities are bad but most love their pts and know them like family. I have worked in a hospital and ltc and can assure you ltc facilities know and love their pt s for the most part. Its easy to judge and this pt DOES need attention quick. Just be sure you are jud ging the right source. We sent a pt to hospital with no skin issues . She returned with a stage IV and sepsis. We sent her right back to the hospital . She went to a different floor and the hotlined us. It was a real embarrassment for them to find out the truth.
    Quote from LPN1974
    I also believe there are many conditions that have to be taken into consideration.
    I had a patient once, in a SNF, got a stage 4 decube on her heel.
    We got her up in a chair everyday, and put that foot in this little whirlpool foot tub, with betadine and water, let that solution run around on her foot a couple times/day. {That foot tub was the neatest thing, I've never seen one like it anywhere else.}
    We made do-nuts to put on her foot to keep the pressure off. We had her foot healed up in no time flat.
    So if conditions are right, some decubes can be healed.
    But what about when conditions are NOT right?

    Another patient I took care of, had decubes on her backside. She had no appetite for months prior to getting the decubes, and would eat very little, and the family REFUSED a G-tube until just a few months there on the last, just before she died. And this lady was a full code. They finally got that changed and made her a DNR.
    People who no longer can get up and take care of themselves, won't eat, are incontinent, they're going to start breaking down no matter what you do.
    You can put in foleys, and G-tubes all day long, but when the body is tired and worn out, keeping it alive is just prolonging the agony and the inevitable.
  9. by   NRSKarenRN

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