Culture Change In LTC? - page 2

I personally think it is wonderful plan, but understand the fear and concerns direct care staff face while implementing these changes? Is anyone implementing this in there facility?If so what are... Read More

  1. by   SitcomNurse
    I work in LTC, and I have to say that, I think a more "Poconos" type approach would be very beneficial. A more hotel type enviornmant, so persons feel like they are on an extended vacation, instead of in an institution. Things couled be more computerized this way too. Structured meals are between this hour and that.. and the residents have their pass key/wristband swiped so we know who ate and who didnt.
    Where I work reisdents have the right(as do all res.) to decide if they want to get out bed on any given day, but deciding on your own shower day..everyone wants their bath on sunday AM so they are fresh for Church, or the day before the holiday... lotsa variables there...
    Therpay appts. kept like doctors appts, where you wait an hour or longer to be seen because you decided on your own time to come...oops, more vairables.. cuz if you decide not to attend therapy becasue the wait is too long, and we are in our collection period.....
    Hmmm... ok, so there are negatives that need to be worked out, even in my own theroy.
    But the documentation of the whole thing is going to be a challenge. Id love to be in the foreground of this type of enviornment, looking toward the future when my parents will need care(assisted or LTC)I can see that a more....'cruise line' atmosphere would greatly bebefit them, and their mood and behavior.


    I work on a more acute wing, Trachs, immobility, O2 dependence, IV/PICC etc. these people arent making theor own decisions. And that one guy who hasnt showered in 6 weeks is killing me.
    So, with increased independence for the resident, is there decreased accountablility for the staff, whereas we only have to encourage, and not require a shower? We have a cafe here in our building, and the residents eat whatever they want, when the cafe is open. We mark in our books, ate off unit, and only intervene if there is wt loss. Its the diabetics eating 4 black and white cookies that get us going.....
    I'd still ike to try it, even for all of the poetntial drawbacks. Need lotsa staff to have them feel like they are in this 'hotel' setting, and of course, more private pay.

    After all that, I think it would only happen in my place, if the state were to mandate it.
  2. by   CapeCodMermaid
    If this kind of culture change is going to take place, then we will have to further segregate our residents. On a subacute unit where many of the residents are quite ill, some things HAVE to be done on a certain schedule. Perhaps it would work on a long term wing. Most of these proposals are made by people in the periphery of the business....the theories they have don't often work in the world WE all work in. I read an article in the American Gerontological Nurse magazine once on how to give a bed bath in LTC. Are you ready for this: warm towels, ambient lighting, soothing music.....we do NOT work in a spa with hot rocks and pool attendants....
    It's a nice idea but I am not holding my breath that it'll work in my professional lifetime.
  3. by   TammyArkansas
    So on ALF, the State regs don't apply re: there must not be more than _______ hours between meals?
  4. by   CapeCodMermaid
    In Massachusetts the regulation only applies to the hours between dinner and breakfast...I think it's 13 hours. BUT, if the residents want to vote and the majority says they will go longer than 13 hours, it's okay to do. We are in the process of changing meal times around and have been researching the regs.
  5. by   banditrn
    The last facility I worked in was one of those without a nurses station - most mucked up mess I ever saw, IMHO!

    We had a 'med room', but there was no where to write in there - didn't matter, because all the charts and meds were 'decentralized' - locked up in a med-server at each patient room.

    If we had several charts to chart on, we could gather them up, and sit in the break room, dining room (if no one was in there) or a counter that was outside one of the patient rooms.

    If a doctor happened to call, we would have to put him on hold while we ran down to the room to get the chart.

    And, heaven forbid, once you put all the charts away, if you remembered something else, then you had to run back down and get the chart again. And when the doc's came in - someone would have to stop what they were doing (the nurse) run all over, and gather up all the charts he wanted - the doc's didn't have keys to the med servers.

    I so appreciate the nurses' station where I work now - all the charts are in one place, so I can go back and forth between them. And the residents know where to find me - even if I'm not there, they know I'll be back shortly - they don't have to wander all over looking for me.
  6. by   Simplepleasures
    Ive been on duty when the administrator or DON is showing around a family of a potential patient. The sales pitch is amazing, "our alzheimer unit is state of the art", "we have family style dining", the staff are here to meet every need your loved one has. BUT never have the family been told the real story, that despite the wonderful new furniture or the great new "concept" in living, it is NOT their home, it is a nursing home full of strangers,taking care of their loved ones to the best of their ability, despite CRITICAL short staffing and overwork, PLUS underappreciation.The LTC of the future cannot ever improve the lives of the patients in them until there are ENOUGH staff to be able to take care of them PROPERLY , the way the family is led to believe.
  7. by   withasmilelpn
    I think I would just like to see more activities and trips offered to my residents, especially the evening hours. Absolutely more CNAs too. As far as keeping their own schedule, after dinner, there is always a mad rush to go to bed. Everyone wants to go to bed RIGHT NOW! Families come and tell you that their loved one wants to go to bed RIGHT NOW! And act like they can't leave until you put them to bed, even though they haven't been there all day when you took care of the rest of their care and don't appear to notice that there are 56 residents and 4 CNAs.
    I get that they've lost a lot of independence and that's how they get their control back. But we all had to wait at times throughout our life, didn't we?
    Just one example: When I went to college, I had to go when the cafeteria was open if I wanted to eat. I slept through breakfast plenty. And no, I didn't have any $ to get anything anywhere else either. Or how about waiting in line to go to the bathroom or at the grocery store...
    I just think that there are alot of unrealistic expectations.
    Restaurant style dining would only work for capable individuals,not those that require supervision and assistance,but I do think its a great idea.
    As far as showers, I think it would be hard to find CNAs that are that flexible. Some are wonderful, but I think even the most wonderful would have a hard time giving 6 showers with 14-16 residents to care for.
    Frankly, I think these changes would probably only work for (truly) ALF people.
    Don't get me wrong, change is desperately needed. Start with adequate staff!
  8. by   CoffeeRTC
    More staff. Period.
  9. by   RN 4 Life
    Wow, it is clear that most nurses work in facilities that struggle with staffing issues. I am just going to push the envelope a little by asking the question:
    What have we as nurses done to be proactive in pushing staffing mandates in LTC?
    Have we called the state to notify them of unsafe staffing issues?
    Have written letters to our local councelman or woman?
    Have we went public [wrote letters or emails to the news stations] with our concerns?

    I am just asking the question because many of us will in the future [50-70 years] be in a situation where we may be faced with long term care as our living place and I truly want the culture change initiative to be apart of my life. Will it be?
  10. by   RN 4 Life
    Is there any nurse who has begun initiating Culture Change in there Long Term Care facility? I know it is a new initiative but there has got to be some one with some feed back on how it is going? Anybody out there.....
  11. by   SuesquatchRN
    Quote from RN 4 Life
    Is there any nurse who has begun initiating Culture Change in there Long Term Care facility? I know it is a new initiative but there has got to be some one with some feed back on how it is going? Anybody out there.....
    I tried. I got fired.
  12. by   Simplepleasures
    Quote from RN 4 Life
    Wow, it is clear that most nurses work in facilities that struggle with staffing issues. I am just going to push the envelope a little by asking the question:
    What have we as nurses done to be proactive in pushing staffing mandates in LTC?
    Have we called the state to notify them of unsafe staffing issues?
    Have written letters to our local councelman or woman?
    Have we went public [wrote letters or emails to the news stations] with our concerns?

    I am just asking the question because many of us will in the future [50-70 years] be in a situation where we may be faced with long term care as our living place and I truly want the culture change initiative to be apart of my life. Will it be?
    I reported to state, not staffing, but something as serious and pervasive in LTC, PROMPTLY got fired, now involved in lawsuit. Thank goodness for the WI Healthcare Whistleblower Retaliation Act and my excellent lawyers who have not taken a penny from me. Also I am very disapointed in the lackluster investigation by the state into this matter. How can things improve if the agencies we depend on to enforce the healthcare laws are not doing it? Yet the DOJ seems to be going after individual nurses when something goes wrong. The facilities still seem to be getting their hands slapped by puny cursory fines, very few criminal investigations.

    I wrote the DOJ. I wrote a newspaper and a national columnist at his blog site, have been in contact with many nursing home reform groups across the country, have contacted several legal nursing home abuse lawyers blogs, letting them know that the poor care that are bringing forth these lawsuits are caused by corporate greed, causing critically short staffing and that nurses work their tails off trying to give decent care in abysmal circumstances.Have talked to many people about this sick system we have and the general concensus is that because the LTC industry is worth mutibillions of dollars a year and continues to have such a strong lobby in this Administration, things are not going to improve until a strong congress gets into power and has the clout to change the laws. There are some initiatives in government already , but it will not happen overnight. Too bad , its been way too long already.
    Last edit by Simplepleasures on Jan 23, '07
  13. by   Simplepleasures
    Quote from Suesquatch
    I tried. I got fired.
    This is what usually happens when individual nurses try to make a difference and go against the accepted culture of their facility.
    Last edit by Simplepleasures on Jan 24, '07

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