Medicare halls

[wyogypsy, RN]

Does your facility have a 'Medicare' hall where almost all of the Medicare patients are? I have worked facilities where they were spread out throughout the facility; and am now working in a facility that has almost all Medicare residents in one hall.

It is killing us. The number of blood sugars and insulin injections; the high number of meds including pain meds as almost all of them receive therapy; the IVs; the wound care; not to mention that we get more phone calls than the other halls combined; the alert charting; so many new orders as these residents go out to the physicians much more often than long term care residents; and that never-ending Medicare charting. Luckily this facility splits the charting half and half between day shift and night shift, but there is so much of it!

And though I would like to forget it, the constant admits. Now I know that we have to have admissions, and that Medicare admissions are much better for the finances, but geez - let us get one admission finished before getting the next admit!

The other nurses on shift have the long-term halls - one is very busy but nothing compared to the Medicare hall, one is fairly busy, and the other one is pretty much a piece of cake - lol can't wait till someone quits and I can move to that hall!

How is it managed at your facility, and if you work the Medicare hall, how do You survive?

[amoLucia]

Yep - your Medicare hall is your SKILLED hall and that's where you receive your high level of care pts, like those you describe. It's always a SUPER BUSY unit. Facilities had to earn 'Medciare Certified' classification and there were certain criteria that had to be met. So it is at the facility's discretion where their SKILLED beds are. And mgt has its reasons. But many places do scatter them throughout the facilty, thus the acutiy pt load seems better balanced.

You apparently do know that high acuities is where the money is for reimbursement. It's how facilties make their income as we all know Medicaid pays poorly and then there's charity/indigent care. Did you ever wonder why the admissions office is so vigilant about making absolutely sure insurances are up to date? So everything is 'covered'.

As staff/supervisor, I'd groan about being hit with so many admissions too (esp late on Friday evenings). I'd have to keep repeating my mantra to myself and other staff. I want my mantra made into a needlepoint or a painting to hang somewhere for all to see. My mantra = WE DON'T GET PAID FOR EMPTY BEDS!!! And it's the truth. There's even day of discharge vs day of admission pay't issues - only one provider.

A full acute census is what pays the bills for the facility and thus gives us our jobs. Pts are sicker and sicker and sicker. Thus the more tasks, tests & appts, documentation (If it aint' written, it ain't done!) and the unending back & forth communication, ie telephone and faxes.

The fact that you seem to be getting so many in & outs (altho I doubt it is really & truly unnusual) bespeaks 2 facts to me. First, you have a well run facility with a good reputation to get so many referrals; or secondly, you're the only facility nearby. I'd like to think it's the first reason.

You are not unusual. I've worked both kinds of facilities, those with a single dedicated unit and the fully certified Medicare bed facility. Busy is busy is busy. From my point of view, it's 6 of one and 6 of another. No difference to me.

Just FYI - those other units/halls at your place may just LOOK quieter. I've worked them too. They have a different kind of busy and stress. They ARE a bit less noisey. To survive you have to be organized & detail oriented. You have to priortorize. There isn't much room to be the social butterfly, so just stay focused on what YOU have to do, not the other staff. And above all else, DO NOT, I repeat, DO NOT lose your 'cheat sheet'. (That panics and all but immobilizes me!) Hang in there!!!

[BrandonLPN, LPN]

Don't facilities staff thier skilled units with more nurses per resident? At my old job I worked in the LTC hall, but I had like 12 more residents than the nurses in the skilled hall.

[wyogypsy, RN]

I don't complain about admits as I know they pay my salary - but we can't take care of more patients than is humanly possible. After all, there are so many hours in a shift and no matter how fast, how organized, or how focused we are we can only do so much.

No, we do not get more staffing. I have just as many patients as the long term halls. I have worked those halls, and though busy in their own way, they do not have the acuity that I have, the constant turnover of patients, or the amount of charting.

[PankaD89]

The facility I work has the MCR residents spread throughout the facility. That being said, we do have a particular wing that is higher acuity but the same amount of staff to care for it. I'm PRN so I work all over the building & I'm not gonna lie, my stomach turns when I have to work there but I just grin & bare it. Thank God for wonderful coworkers & AWESOME unit managers :)...but every hall has its days!