Culture Change In LTC? - page 4

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   mercy1975
    Quote from CapeCodMermaid
    I have to disagree with the whole bath thing. While your idea of soft music, salts, ambient lighting and the like sounds wonderful to ME, you are talking about a generation who didn't bathe as often as we do. They had functional bathrooms not spas...no double sinks , no granite countertops.
    Until Medicaid reimbursements go up we won't be able to afford their idea of culture change. The increase in staff alone is prohibitive. And until we will further have to segregate the relatively healthy elders in our care from the subacute population who NEED the medical model we have now because they are quite ill.
    I think even though the residents did not grow up with certain "luxuries,I'm sure we all feel that they deserve all we can give them now. Most residents would love the idea once they had the bathing experience.
    I realize that there is never enough money to care for our residents, and homes are always understaffed.
    But cultural change happens a step at a time. It seems everyone thinks it needs to happen now and all at once. It will take time and small steps.

    Another example is starting to offer residents a selection of meals.
    One of our facilities has done this and it is working very well. The residents are given a menu for the next day and can pick from two selections of each food group. This allows them some control and has saved food wastage. The dietary knows how much of each item to cook. The residents love this. They still don't have open hours, but it is a step in cultural change.
  2. by   Hospice Nurse LPN
    It all sounds wonderful, but in reality who isn't short staffed? Every evening when I go to work I pray we have enough CNA's show up to work. Our residents are fed dinner at 4:30 and are offered a snack at 6:00 p.m. It's sad to see folks having to get up at 5:00 to shower....again it's due to staffing. There are 54 (half the facility) people to shower before breakfast. There are very few geri pts in our facility (mostly psych), but even still, it's as if they are "warehoused". I worked in the MR/DD field before going to nursing school and there is much more respect and dignity there. I wish more people would keep in mind that we'll all be old someday. Oh well, I know I can't change much, but I can make life a little bit better for the folks I do care for.
  3. by   mercy1975
    Quote from Hospice Nurse LPN
    It all sounds wonderful, but in reality who isn't short staffed? Every evening when I go to work I pray we have enough CNA's show up to work. Our residents are fed dinner at 4:30 and are offered a snack at 6:00 p.m. It's sad to see folks having to get up at 5:00 to shower....again it's due to staffing. There are 54 (half the facility) people to shower before breakfast. There are very few geri pts in our facility (mostly psych), but even still, it's as if they are "warehoused". I worked in the MR/DD field before going to nursing school and there is much more respect and dignity there. I wish more people would keep in mind that we'll all be old someday. Oh well, I know I can't change much, but I can make life a little bit better for the folks I do care for.
    State surveyours would have a big problem with residents being gotten up an 5:00 to shower (unless the resident was up or restless, etc and care planned.) They shoud not be awaken before 6 AM just to get cares done. Administration will figure it out once they get tagged. Never hurts for someone to "mention it" to a surveyor while they are asking you questions.
    Sorry to hear management wants it that way. You sound like a very caring person. Thank goodness the residents have you!!
  4. by   CapeCodMermaid
    Quote from mercy1975
    State surveyours would have a big problem with residents being gotten up an 5:00 to shower (unless the resident was up or restless, etc and care planned.) They shoud not be awaken before 6 AM just to get cares done. Administration will figure it out once they get tagged. Never hurts for someone to "mention it" to a surveyor while they are asking you questions.
    Sorry to hear management wants it that way. You sound like a very caring person. Thank goodness the residents have you!!
    Oh please ! "Mention it to the surveyor"....You should be working WITH management not whispering to the surveyors behind their back. Don't you realize that ANY care issues reflect on YOU.
  5. by   mercy1975
    Quote from CapeCodMermaid
    Oh please ! "Mention it to the surveyor"....You should be working WITH management not whispering to the surveyors behind their back. Don't you realize that ANY care issues reflect on YOU.
    I was responding to the quote that stated management did not respond to staff's concern regarding getting residents up at 5am. I agree you should be working with management. But when management fails you and you have tried all other avenues, there is still another opportunity to help the residents. If the facility received a tag they may change their ways so the poor residents do not have to suffer.
  6. by   Dixiecup
    We are implementing some of the changes now.

    The way we did the "get up when you want to" thing is we interviewed each resident (the ones who were cognitively impaired, we interviewed family members to see what their routine was like earlier in their life) and asked what time they would like to get up in the morning. Then we made a list of all the times and that is when they were assited with getting up.(in other words, they just couldn't choose a different time each day but they could pick a later time than they were getting up now.)

    We are trying open dining for breakfast only right now. From 7am-9am. There are menus on the table and we take their order every day and they can pick from virtually anything on the breakfast menu. The residents seem to really like this.

    We just ripped out our old nursing station that was, as someone put it, right in the middle of their living room. We still have a nurses station but it was moved to an office room out of the way.

    Haven't tackled the shower issue yet.

    We are taking it little steps at a time and it hasn't been to bad.
  7. by   Hellllllo Nurse
    If these changes are to be successful, LTC facilities need to markedly increase staffing, and spend a lot more money. But we know they won't.
    The culture change will fail. More nurses will leave. The suits will spend millions of dollars on consultants and studies trying to figure out why.

    Sorry to be so negative, but this is what I think will happen.

    (BTW- I am not talking about any one specific unit. Some individual units do provide good care. I'm speaking of the LTC industry in general).
    Last edit by Hellllllo Nurse on Oct 29, '07
  8. by   Hellllllo Nurse
    Quote from mercy1975
    State surveyours would have a big problem with residents being gotten up an 5:00 to shower (unless the resident was up or restless, etc and care planned.) They shoud not be awaken before 6 AM just to get cares done. Administration will figure it out once they get tagged. Never hurts for someone to "mention it" to a surveyor while they are asking you questions.
    Sorry to hear management wants it that way. You sound like a very caring person. Thank goodness the residents have you!!

    I have worked at facilities where residents are gotten up @0400 for showers. This is with a "fully staffed" unit. What mgmt considers fully staffed, and the number of staff required to actually provide good care are two totally different numbers.
  9. by   Hellllllo Nurse
    Quote from Suesquatch
    I tried. I got fired.
    I have eight years in LTC- as a CNA, then LPN, and finally RN.
    In my experience, any nurse who voices her concerns about residents, talks about things that need to be improved, or tries to be proactively involved in improving care in LTC, is labled a trouble maker, is seen as a threat by mgmt, and will be forced out.
    Last edit by Hellllllo Nurse on Oct 29, '07
  10. by   Dixiecup
    I am very fortunate to work in a facility that when they say the resident comes first, they really mean it. I've never worked anywhere like this place.

    We are slowly implementing changes, it does take money and my company is spending it!

    Residents come first, employees second and believe it or not, the budget comes in about third place!:spin:
  11. by   dream'n
    Culture Change sounds just great, AFTER all the more important, basic issues have been addressed; low staffing and morale, high staff workloads and turn-over (both decrease the quality of care), lack of needed supplies, etc.
  12. by   IowaKaren
    Quote from ingelein
    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.
    Oh so very true! This norm is only getting worse and with gas prices, low cost of living pay wages, so very difficult to get 1/2 shifts covered which really should be a full time positions, heaven forbid one extra person working and if you can't find a replacement of a call-in, a full time person can not have overtime, period, so you work short Even those so called "not for prophet" NH's have an agenda to make money to "build and expand for the community needs" which is for the upper class with the money available. Say they won't turn anyone away but they are selective since they usually only offer private rooms which medicaid folk's can't afford. The all inclusive not for profit retirement, religion based complexes are sooooooooo expensive but you wouldn't know it by the wage or the staffing. It's so frustrating and sad but I will admit, the families are usually involved with the residents and they advocate often if they see neglect. Some problems are petty/minor, but some are well founded. In all cases, we are reprimended but nothing changes with staffing. I think staffing correctly, above and beyond the state's bare minimum should be mandated for all NH's and wish I knew how to advocate that legislatively in my state.
  13. by   Simplepleasures
    Quote from CapeCodMermaid
    Oh please ! "Mention it to the surveyor"....You should be working WITH management not whispering to the surveyors behind their back. Don't you realize that ANY care issues reflect on YOU.
    You dont owe anything to the nursing home, you owe it to the patients and your self respect to tell the ugly truth, hopefully the "state" will do the right thing and correct the situation. Management is NOT there to work with you, dont be fooled. If they are the rare breed who does have some ethics, they dont last too long and are soon gotton rid of. THAT is the ugly truth also.
    Last edit by sirI on Jan 16, '08

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