ANOTHER new CMS guideline

Specialties LTC Directors

Published

What's with the federal government??? Here we go with another new CMS guideline...went into effect June 1. Tag 248...activities...yes ladies and gentlemen, your facility can now get cited at a G-actual harm level- for lack of activities because that could cause a decline in psychsocial well being. Hello...anyone ever see any actual harm because the resident missed BINGO.

I've been in LTC in Skilled Facilities my entire career and have seen many many changes...more regulations, less reimbursement, sicker patients with no increase in staff, and now we are going to be tagged starting at level 2 for activities?

I think this is it for me. Now I not only have to worry that I will be blamed as management for a mistake a staff nurse made, I have to worry that our activities aren't good enough.

I've spent the last week and a half feeling horrid every time I head for work. I've been at this place for less than 2 months and the DNS left to go on vacation. The administrator is not at all supportive. We have some of the worst nurses I've ever seen and the ED tells me they are nice to the patients so I have to cut them some slack. Nice? On the sub-acute unit they didn't recognize the classic symptoms of CHF...instead of IM lasix they kept giving the poor man nebulizers. The dementia unit is always noisy..half the nurses won't give a PRN unless one of the managers tells them they need to..of course you have to holler at that point to be heard over the screaming resident.

The salary is wonderful but...

Sorry for the long rant...I think I'll go play BINGO.

Yah, can you just see one of those alert residents whining to the state that they got left off the last Wally World outing and now they're depressed--F-tag coming!

I wish I could say hang in there but I can't. I'm going back to acute care myself, and I don't want to come back to LTC. You can never work hard enough or try to anticipate enough. You are always standing on the edge of that cliff LTC isn't about taking care of the elderly any more. It's about paper compliance and an institutionalized need for perfection that no one, even perfectionist me, can ever achieve. You never start out at 100%, you always start out at zero and have to prove yourself every day. You did a good job yesterday, and that means nothing today because you're starting at zero again. I hope you find something that will deserve your talents.

So how is long term care any different from acute in these areas?

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Specializes in acute care and geriatric.
Ask for more staffing??? You might as well ask to be queen of France.

I've worked in several facilities (over 20 years) and I always make it my business to get along and befriend the administative staff (I never criticize and I stay supportive- with a little patience it works in my favor and I am able to get services for my patients and/or staff that we wouldn't have had otherwise) . I have learned that new guidelines that require additional hours of service (such as this ) frequently results in EVENTUALLY increasing staff hours in order to properly fulfill the requirement. Many facilities are already in compliance and they would be wise to let that fact be known, but if your facility has just thrown a new slew of responsibilities your way that will take time and manpower- you put up a brave face to start (be supportive- after all we WANT to be in total compliance) then show administation that it is stealing time from other (important) tasks- leading to an increase in pressure sores, infections, med errors,staff burn-out or fatigue. I usually keep a log of what my nurses are busy with every hour of the day in order to show administation that they are not just lazy (and I warn staff to look busy and not be caught on many long cigarette breaks and never be disrespectful of the administation). When I present it to administation, I explain that we want to give quality care etc but there is just a limit to what we mere humans can be pushed to. I do not criticize and if administation turns me down the first time I keep a smile on my face (never get angry it doesn't help) and ask them to think about it. I also present info on courses that are available to train my staff for this new responsibility. After all activities are not just Bingo- they are supposed to be therapeutic and effective. You wouldn't just blindly pull 5 pills out of the med drawer and give them to a patient and claim that they are receiving excellant medical care!!

I usually get a compromise ( not the queen of England!) and my staff appreciates it, administation appreciates it (beleive me there is more money there than you can imagine) and the patients benefit so the families appreciate it- we all come out a winner.

Lastly document, document, document and show photos of the patient enjoying the new activities on a bulletin board!

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Specializes in ICU/ER/Exec..

Ever think about being a nurse entrepreneur? Why not be a consultant for LTC and work for yourself?

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I truly feel overwhelmed as a new DON in a facility of 100+ residents. My goal as others have been good patient care and our facility "being their home." I am constantly putting out fires and trying to make all staff members feel the compasion I do about our residents.

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;) ;) My resignation went in yesterday and my administrator can't understand why. She thinks it's because I'm new to the facility .... jeezlies peezlies...she tells me she doesn't think about work at all when she goes home and always sleeps like a baby. I always think about work..all the work I didn't get done because I was chasing after the staff nurses and trying to get them to step up and do what they are supposed to do.

I've already put in applications at a few places, but if I don't get another job for a month, Cape Cod is not a bad place to be in the summer

I don't even know you except from here and I am upset by your resignation. It isn't fair that the people who seem to do the best job and care the most are driven out by the rules and regulations and lack of adequate staffing.

I'm really sorry that it came down to this for you...you always seem to be one of those stable people who who are the backbone of LTC. Your facility is losing a valuable member of their team.

:scrying:

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I understand how you feel, but please remember that if all the people whotruly care leave then there will be no one to give example to the people who will be taking care of us one day.

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Specializes in Gerontology, Med surg, Home Health.

Wow---this is an OLD post. I got out of long term care for about 4 months!! I really missed it so I'm back working as the DNS of a non profit organization. I've only been there 2 weeks but so far so good. If those of us who love this niche and are really good at what we do stick with it, perhaps there will be hope for the industry...and for US when we get to be old and in need of care.

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Specializes in acute care and geriatric.

WELCOME BACK!!

Piece of advise? Don't take it too seriously that you burst- find out what turns you on- what will help you relax between crisis to crisis- a spa treatment, good music, a long weekend - it doesn;t matter- you deserve it and it will help you cope with the craziness.

BTW I prefer nonprofit organizations as bosses to private ones whose only concern is their own profit!!!

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Nice to hear others talk about DPH and SNF's.

I've got a question. I just took on a new position as an SDC in a SNF.

I'ld like a list of the 12 competencies that need to be done yearly.

Your help is greatly appreciated.

Vanessa:redpinkhe

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