I know they're not all like this, but whats up with Nursing Homes?!?

Specialties Geriatric

Published

Specializes in ICU.

I work in ICU. Time and time again I have gotten an admission from a NH were the patient looks as though they've been left to rot in a corner until someone finds them in such an awful state that they call EMS.

Now please dont think I'm saying ALL nursing homes are like this. I'm sure they aren't. I simply need to vent a little.

90% of the NH pts I get need a complete bath at the time of admission. This includes scraping off old stool and providing oral care for 10 minutes because there is so much gunk in their mouths, among other things.

What topped it off was Wednesday, when I admitted a patient who had been in our ICU for months with multiple problems, VRE, MRSA, and had finally gotten out of the hospital just recently. She had been placed in a local NH. I admitted her, intubated...foley in "place"... lactate 7.5 and in septic shock. No urine in foley tubing or bag. Not a CRF patient. We turn her to do the usual complete bedbath for NH pts and we see urine coming out. Ok no biggie, we figure the foley is leaking. Well turns out it's not even in the right spot. We inserted a new foley in the CORRECT orifice and out came about A LITER of PURULENT OPAQUE "URINE".

Now I'm not going to point fingers, but isn't it a common nursing practice to check for URINE when inserting a foley??? I wonder where her septic shock came from! :banghead:

Such a shame.

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Sue...I work in a nursing home as a CNA and while this is the only one I've ever worked at I have seriously debated whether or not I should stay.

The ONLY reason I do is frankly because I'm scared to leave the residents. I am, and I quote "too slow". Maybe that's because I wiped ALL of the poo off of them...WITH SOAP! or maybe it's because I brushed their teeth... oh no, wait, maybe it's because I talked to them! who knows? but I am A.O.K. with being "slow". If they are 15 minutes late for breakfast, ya' know what...I'm ok with that, because the reason they were late is because I was TAKING CARE OF THEM! So, sadly, I must say that you have hit the nail on the head!...and I, too, hope that not all NH's are like that, but frankly I'll bet that 95% are, how sad is that???

As far as bedbaths go, I have never given one. The reason...I haven't found anyone yet that is in too bad of shape that I can't get them on the shower bed where they can actually have running water on them. (I'm not saying that there aren't people too sick to give them too, I just don't resort to them if a shower is possible)

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Specializes in LTC, Subacute Rehab.

Some places will hire just about anybody... of course this equates to bad care!

I've worked as a CNA for just over two years (waiting to take LVN boards), and it can be hard with the high patient-to-staff ratios. It's no excuse, however, for leaving incontinent patients sitting up in chairs for hours on end, oral care being skipped, baths not getting done... My facility is excellent as far as care goes, but before the current company took over (right before I was hired), horror stories abounded.

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Specializes in LTC , SDC and MDS certified (3.0).

you are right that you ARE not referring to all nursing homes....

I wish I had a dime for all the times we've sent them to the hospital and they come back with break down from not being turned...

my favorite is when we got an admission that was dx dementia because she was speaking "in tounges" HELLO she was raised in GREECE!!

There we both vented for today!!!

My first lesson as a nurse was i can give the best care for the 8 hours i'm there and I can teach but when I walk out the door it's by the grace of god the good care continues..(from CNA-LPN-RN a daily reminder to myself )

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The NH that I work at isn't that bad but I have seen some that are horrible.

It's all about staffing.

On the floor that I work it's hard to provide good care because there are 3 or 4 CNAs and 1 LPN to take care of 40 residents. I do treatments and pass meds and with all of the paperwork involved that's all that I can do. The CNAs are responsible for everything else. We don't even have a dining room on the floor so the CNAs are also responsible for transporting residents to the dining room, serving in the dining room, and one has to stay on the floor to pass out trays and feed the ones who can't go downstairs. The CNAs where I work also have their accountability sheets to fill out before their shift is over or they get written up for that.

Now like I already wrote where I work it isn't so bad. I acknowledge that the care we provide isn't always the best and yes there are lazy CNAs and lazy nurses out there just trying to collect a pay check but for the most part we really do try to take care of our residents.

I am one nurse with 40 residents to manage and it's dam* hard to do a good job. I can only imagine what goes on at these facilities with 60-70 residents with one nurse and 3 or 4 aides on the floor. NH work is a thankless and dang near impossible job but no one cares about what we go through. All we get is more work to do and endless complaints that we don't do our jobs.

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I do agree with all of you. The fact that there are 3 CNA's (4 on a good day) to care for 42 residents is nearly impossible.

I put it to some people this way...think about if you have a baby...

how many times do you change their diaper a day? 4-5

how many times did you feed the baby? 4

how many times did you re-dress the baby? 1

how many times did you clear the kitchen table? 3

baby baths? 1, maybe 2

how worn out were you by the end of the day???? VERY

Now, that's just one 10 pound baby!

A CNA...

diapers changed? at least 30

feeds? 3, 2x a day= 6 (but add in prep for food and it jumps to around 20)

dress and redress? lets say 25

tables cleared? 5, 2x a day= 10

showers? 7

And that is on people who weigh on avg 200 pounds and don't stand well, if at all!!!

so are we working hard, are we doing all we can? yes

is it enough??? no, but how much more is humanly possible?

and don't say that the mom of that baby also has to do the housework, laundry and everything else, because I still have to come home to do that and take care of 2 kids!

That is how it is where I work. I am not saying that the CNA's where I work are lazy (with a couple exceptions) in fact some of them are down right mind-bogglingly fast.

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Specializes in School Nursing.

so sad that we even need to have this conversation :crying2:

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Specializes in ER/ICU, CCL, EP.

It IS sad that we have to have this conversation.

Sue, I see the same stuff all the time. Unfortunately, I never see the patients that come from NICE nursing homes, because they don't die of septic shock. It gives me a bad impression of nursing homes. I should go work in one for a little while so I can see great care, instead of the 'usual'.

There is a certain nursing home in the area that we have gotten SEVERAL patients from. They look just as Sue said, like someone left them in a corner to rot. A DARK corner. Filthy, stinking, obviously no bath in WEEKS. Skin breakdown, sepsis, etc. It is a real shame that when I think of nursing home care, that kind of thing comes to mind first, because those are the incidents that stick in my mind.

And I am aware that most nursing homes are not like that. :) No flaming....lol :flmngmd:

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Not all nursing homes are bad, but the ones that are need to be reported to the state. Maybe they got that bad because they weren't reported, and that's a shame. As for the owners that let this happen for the profits-----may they end up in the Devil's nursing home.

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Specializes in CNA.

I too worked in a nursing home as a CNA. Little pay. I have worked in 3 the first 2 I quit after 1 month. Have you ever been to a nursing home where it just plain stinks? Like someone said you feel horrible when you leave becaus some people don't do complete care. The last place I worked for 2 years. It was a fairly clean place. You always had yourr slackers. The main problem I say is understaffing. Most days there would be 3 CNA's for 40+ patients leaving each of us with 15 or more patients. I also did the calculations after being called slow:argue:. Do you want us to give proper care or not. And they had the nerve to cut our hours with the same patient load.Check this out, it does not add up. I love caring for people when it is reasonable.

8 hours minus 30 min lunch/10 min break

gives us 7 hrs and 20 min to care for 10-15 patients

1. fully clean/shower all 15 pts

2. feed 7-9 of them breakfast and pass/put away trays

3. change every 2 hrs or sooner if they need it

4. take 5 to toilet

5. feed 7-9 of them lunch and pass/put away trays

6. put 7-9 back to bed!!!

7. do what the family wants

8. Doing what nurse tells you

9. Cleaning

10. I know I'm missing at least 5 other things

vitals

taking them to dialysis

beauty shop

activities

etc..

all while 60% are fighting you, undressing, or spreading feces around which requires another shower.

There is just not enough time

it takes 30-40 min per pt to properly clean and dress, at that place we really did our best with what we had, sometimes buying our own supplies

mind you I worked with Alzheimer's, compative, heavy, bed bound, mental, and other pts. Not mention family members who expect their family to be changed every 30min-1hr as if you are private duty. They see you hauling *** with the other 14 pts. It was so bad you just expected to only have 3 CNA's on your floor everyday. Too cheap too higher more help. They expect you to be super****woman/man

But on the days when inspectors were there you better believe everyone was helping so, feeding transporting, and everything else fully staffed for 1 week. I finally quit from going home with head, back, and foot aches almost every day. Now I do home health. A lot more money!! And at least my patients get completely taken care of. :nuke:

I will be a nurse in 2 years thank GOD

Sorry to vent, but very interesting topic.

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Specializes in Community Health, Med-Surg, Home Health.

I used to also bring my own supplies; lotion, deodarant, etc...because the ones with no family (and that was many of them) did not have the custom supplies that the nursing home is supposed to provide. Most of the nurses were appreciative, but then, one nurse stated that we should be careful doing that, because the outside supplies may cause allergies. Now, that I am a nurse myself, I can understand that better, but my heart still goes out to those poor patients living under those conditions.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I'm really frightened sometimes the way human beings are treated in some nursing facilities, and this includes hospitals.

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