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Joined Mar 14, '04 - from 'California, USA'. herring_RN is a retired registered nurse. She has '>40 years' year(s) of experience and specializes in 'Critical care, tele, Medical-Surgical'. Posts: 17,180 (73% Liked) Likes: 34,312

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  • Oct 17

    First this law is for long term residential care, NOT an LTAC.

    Long-term acute care hospitals (LTACs) are defined by the Centers for Medicare and Medicaid Services as providing care to patients with medically complex conditions requiring an average length of stay greater than 25 days. LTACs must meet the same requirements as general acute-care hospitals. They often provide care for patients requiring mechanical ventilation, IV medications, and other acute care. The California safe staffing ratios must be met.
    View Document - California Code of Regulations

    The new law, SB 219 protects LGBT seniors from discrimination in long-term care facilities, such as a facility refusing to use a resident's preferred name or pronoun, denying admission to a long-term care facility, transferring a resident within a facility or to another facility based on anti-LGBT attitudes of other residents, or evicting or involuntarily discharging a resident from a facility, on the basis of a person's actual or perceived sexual orientation, gender, gender identity, gender expression, or HIV status. In addition, the bill requires that all long-term care facilities post a notice regarding this form of discrimination where its current non-discrimination policy is posted.

    When LGBTI seniors need skilled nursing care they often go back into the closet. People should know they will be cared for with dignity.
    Senate Passes Senator Wiener’s LGBT Seniors Bill of Rights for Long-Term Care Facilities | Senator Scott Wiener

    Bill Text - SB-219 Long-term care facilities: rights of residents.

  • Oct 13

    The only reason for someone to be admitted to a hospital is for nursing care.

  • Oct 12

    My step-Mom lives in a senior community with a SNF on the property. Twice after hospital discharge she was cared for at the SNF. For many that is their home. They also have a locked dementia unit with nice room and a patio where they can sit outside. When there is music at the SNF or a concert in the section where independent people live a companion HHA takes one or two of them.

    Many of the independent residents use walkers and have medication service. One of the two LVNs on duty brings the medications as ordered by the physician, NP, or PA. That cost $150.00 a month in addition to the homeowners association fees.
    One man, who just turned 80 recently, lost his long time lover after a falling and not ever waking up. When they had dances he would go in drag and dance with his partner. When dressed as a woman he uses a female name.
    On the 28th there will be a Halloween party with grand children and great grandchildren coming. He plans on dressing up and handing out candy to kids. He is really excited. He showed my Step-Mom and I pictures of him in drag when he and his partner were young. He truly looked like a beautiful glamorous woman. Now he looks like a tacky, but nice old lady.

    They have free transportation to doctor appointments, outings to movies, stores, and restaurants. One of the drivers is a youngish trans woman. I don't think most of the staff or residents know she was once a man. Somehow she knew it was OK to discuss it with her.
    Step-Mom was with a woman for years before meeting and marrying my Dad. They loved each other and she was a good wife for my Dad 18 years before he died.
    While I was at their house caring for him that lady called on the phone. She told me, "I used to be *****'s wife. She then describes the very attitudes and behaviors I was dealing with. You she lived with her. Things like being very upset when I was putting stamps on Christmas cards as she asked and ONE STAMP was crooked.
    Anyway, that young driver is personable and helpful.

    I don't notice anyone, staff or resident, being uncomfortable when a gay person or the driver joins in the Wednesday poker games, the mahjong, or backgammon. Some are cheerful and others are grumpy.

  • Oct 12

    By releasing the video she gives an example of patient advocacy. We all must be ready advocate in the best interest of our patients.
    Nurse Wubbels continues to do so.
    She gives an example of why nurses are considered the most ethical and respected occupation.
    From my state's standards for registered nurses:
    [A registered nurse shall be considered to be competent when he/she consistently]

    ... Acts as the client's advocate, as circumstances require by initiating action to improve health care or tochange decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided...
    http://www.rn.ca.gov/pdfs/regulations/npr-i-20.pdf

  • Oct 12

    Quote from jdub6
    I can maybe see a little where OP is coming from (giving benefit of doubt). In the ED at times it can be confusing at times as we resister people by their preferred name/gender and it can be difficult to know when we need an hcg or when to set up for a pelvic for that low abd pain.

    I wonder if there is a sensitive way to note biological status (whether a uterus is present, or testes, ovaries, etc). It's that much harder since people can have different degrees of surgical change. ultimately I guess we need to just ask the patient which parts are there-and there should be a way to alert staff in the medical record that the male patient meets hcg prior to radiology in the ED etc.
    The new law only applies to residents of a skilled nursing facility.
    I think the chart would use the patient/resident's legal name.
    Unless they are a celebrity or well known the legal name if used.

    We nurses and other staff call the persons how they wish to be addressed.

    I cared for a pleasant man in his ninties. He said, "Don't call me Mister *****. That is my father.
    We all fondly remember a patient who wanted to be called, "Big John."
    Often people like to be called, Buddy or Bud, Carrot Top, speedy, or Blondie.
    Then the common Pat, Patty, or Patsy for Patricia, Chuck, Chaz, or Charlie for Charles.

    I think that in general the admitting physician would document their patients conditions ans history.

    I have cared for intersex people whose chart didn't mention it. One example was a married grandmother whose clitoris looked like the penis of a two year old boy.
    It was noticed during her bath.
    When I asked her doctor about it he said. "It is normal for her and not unhealthy."
    I called her Mrs. *****.
    What is intersex? | Intersex Society of North America

  • Oct 12

    Quote from jdub6
    I can maybe see a little where OP is coming from (giving benefit of doubt). In the ED at times it can be confusing at times as we resister people by their preferred name/gender and it can be difficult to know when we need an hcg or when to set up for a pelvic for that low abd pain.

    I wonder if there is a sensitive way to note biological status (whether a uterus is present, or testes, ovaries, etc). It's that much harder since people can have different degrees of surgical change. ultimately I guess we need to just ask the patient which parts are there-and there should be a way to alert staff in the medical record that the male patient meets hcg prior to radiology in the ED etc.
    The new law only applies to residents of a skilled nursing facility.
    I think the chart would use the patient/resident's legal name.
    Unless they are a celebrity or well known the legal name if used.

    We nurses and other staff call the persons how they wish to be addressed.

    I cared for a pleasant man in his ninties. He said, "Don't call me Mister *****. That is my father.
    We all fondly remember a patient who wanted to be called, "Big John."
    Often people like to be called, Buddy or Bud, Carrot Top, speedy, or Blondie.
    Then the common Pat, Patty, or Patsy for Patricia, Chuck, Chaz, or Charlie for Charles.

    I think that in general the admitting physician would document their patients conditions ans history.

    I have cared for intersex people whose chart didn't mention it. One example was a married grandmother whose clitoris looked like the penis of a two year old boy.
    It was noticed during her bath.
    When I asked her doctor about it he said. "It is normal for her and not unhealthy."
    I called her Mrs. *****.
    What is intersex? | Intersex Society of North America

  • Oct 12

    More than 40 years ago I was a CNA when I cared for my first transgender patient. She was in traction for a fractured hip with surgery scheduled for the morning. I helped her with a bedpan before finding out she had been born a boy. (At that time we aides answered call lights while the RNs took report.

    Later in the CNA report the RN told me she was transgender. Her "sister" stayed with her. Her adult children visited.

    The H&P stated she had been a man in the British army during WWII. He was married with two kids.
    When he figured out why he felt so out of place he told his wife. Because they had a successful business he could afford to have treatments and surgery in Sweden.
    The lady with him had once been his wife. When they came to the USA they lived as sisters. He had been his kids father and now was introduced as their aunt. They were very pleasant people thankful for the care she received.
    If not for the chart I wouldn't have known.
    When I first introduced myself I called her "Mrs. *****. She told me she was like Rene Richards and had been a man. She asked me to call her by her first female name.

    This new law is for nursing homes. It was passed because people were discriminated against in their HOME.

    ... According to "Stories from the Field: LGBT Older Adults in Long-Term Care Facilities," a 2011 study published by the National Senior Citizens Law Center, these issues have gone unaddressed.
    In that study, 43 percent of respondents reported personally witnessing or experiencing instances of mistreatment of LGBT seniors in a long-term care facility, including all of the following: being refused admission or readmission, being abruptly discharged, verbal or physical harassment from staff, staff refusal to accept medical power of attorney from the resident's spouse or partner, discriminatory restrictions on visitation, and staff refusal to refer to a transgender resident by his or her preferred name or pronoun.
    Eighty-one percent of respondents believed that other residents would discriminate against an LGBT elder in a long-term care facility, 89 percent of respondents believed that staff would discriminate against an LGBT elder in a long-term care facility, and 53 percent believed that staff discrimination would rise to the level of abuse or neglect. Though this was a national report, it included instances of severe discrimination within California.

    Even more recently, in 2013, the San Francisco LGBT Aging Policy Task Force commissioned a report by Professor Karen Fredriksen-Goldsen of the University of Washington, "Addressing the Needs of LGBT Older Adults in San Francisco: Recommendations for the Future," based on information collected from over 600 LGBT seniors residing in San Francisco, including nearly 140 LGBT seniors of color.
    This report found that nearly 60 percent of the study participants lived alone, and of the 15 percent of the study participants who had children, 60 percent reported that these children would not be available to assist them.
    Many reported poor physical and mental health with nearly one-third of all respondents reported poor general health, close to one-half reported having one or more disabilities, and one-third of male participants reported that they were living with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS).

    These results indicate that, as compared to seniors in San Francisco generally, LGBT seniors have a heightened need for care, but often lack family support networks available to non-LGBT seniors.
    Further, LGBT seniors' fear of accessing services is justified.

    Nearly one-half of the participants in the San Francisco study reported experiencing discrimination in the prior 12 months because of their sexual orientation or gender identity.

    While state and local laws already prohibit discrimination in public accommodations on the basis of actual or perceived sexual orientation, gender identity, gender expression, and HIV status, the promise of these laws has not yet been fully actualized in long-term care facilities.
    The purpose of this act is to accelerate the process of freeing LGBT residents and patients from discrimination, both by specifying prohibited discriminatory acts in the long-term care setting and by providing additional information and remedies to ensure that LGBT residents know their rights and have the means to vindicate them.
    Bill Text - SB-219 Long-term care facilities: rights of residents.

  • Oct 12

    More than 40 years ago I was a CNA when I cared for my first transgender patient. She was in traction for a fractured hip with surgery scheduled for the morning. I helped her with a bedpan before finding out she had been born a boy. (At that time we aides answered call lights while the RNs took report.

    Later in the CNA report the RN told me she was transgender. Her "sister" stayed with her. Her adult children visited.

    The H&P stated she had been a man in the British army during WWII. He was married with two kids.
    When he figured out why he felt so out of place he told his wife. Because they had a successful business he could afford to have treatments and surgery in Sweden.
    The lady with him had once been his wife. When they came to the USA they lived as sisters. He had been his kids father and now was introduced as their aunt. They were very pleasant people thankful for the care she received.
    If not for the chart I wouldn't have known.
    When I first introduced myself I called her "Mrs. *****. She told me she was like Rene Richards and had been a man. She asked me to call her by her first female name.

    This new law is for nursing homes. It was passed because people were discriminated against in their HOME.

    ... According to "Stories from the Field: LGBT Older Adults in Long-Term Care Facilities," a 2011 study published by the National Senior Citizens Law Center, these issues have gone unaddressed.
    In that study, 43 percent of respondents reported personally witnessing or experiencing instances of mistreatment of LGBT seniors in a long-term care facility, including all of the following: being refused admission or readmission, being abruptly discharged, verbal or physical harassment from staff, staff refusal to accept medical power of attorney from the resident's spouse or partner, discriminatory restrictions on visitation, and staff refusal to refer to a transgender resident by his or her preferred name or pronoun.
    Eighty-one percent of respondents believed that other residents would discriminate against an LGBT elder in a long-term care facility, 89 percent of respondents believed that staff would discriminate against an LGBT elder in a long-term care facility, and 53 percent believed that staff discrimination would rise to the level of abuse or neglect. Though this was a national report, it included instances of severe discrimination within California.

    Even more recently, in 2013, the San Francisco LGBT Aging Policy Task Force commissioned a report by Professor Karen Fredriksen-Goldsen of the University of Washington, "Addressing the Needs of LGBT Older Adults in San Francisco: Recommendations for the Future," based on information collected from over 600 LGBT seniors residing in San Francisco, including nearly 140 LGBT seniors of color.
    This report found that nearly 60 percent of the study participants lived alone, and of the 15 percent of the study participants who had children, 60 percent reported that these children would not be available to assist them.
    Many reported poor physical and mental health with nearly one-third of all respondents reported poor general health, close to one-half reported having one or more disabilities, and one-third of male participants reported that they were living with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS).

    These results indicate that, as compared to seniors in San Francisco generally, LGBT seniors have a heightened need for care, but often lack family support networks available to non-LGBT seniors.
    Further, LGBT seniors' fear of accessing services is justified.

    Nearly one-half of the participants in the San Francisco study reported experiencing discrimination in the prior 12 months because of their sexual orientation or gender identity.

    While state and local laws already prohibit discrimination in public accommodations on the basis of actual or perceived sexual orientation, gender identity, gender expression, and HIV status, the promise of these laws has not yet been fully actualized in long-term care facilities.
    The purpose of this act is to accelerate the process of freeing LGBT residents and patients from discrimination, both by specifying prohibited discriminatory acts in the long-term care setting and by providing additional information and remedies to ensure that LGBT residents know their rights and have the means to vindicate them.
    Bill Text - SB-219 Long-term care facilities: rights of residents.

  • Oct 12

    More than 40 years ago I was a CNA when I cared for my first transgender patient. She was in traction for a fractured hip with surgery scheduled for the morning. I helped her with a bedpan before finding out she had been born a boy. (At that time we aides answered call lights while the RNs took report.

    Later in the CNA report the RN told me she was transgender. Her "sister" stayed with her. Her adult children visited.

    The H&P stated she had been a man in the British army during WWII. He was married with two kids.
    When he figured out why he felt so out of place he told his wife. Because they had a successful business he could afford to have treatments and surgery in Sweden.
    The lady with him had once been his wife. When they came to the USA they lived as sisters. He had been his kids father and now was introduced as their aunt. They were very pleasant people thankful for the care she received.
    If not for the chart I wouldn't have known.
    When I first introduced myself I called her "Mrs. *****. She told me she was like Rene Richards and had been a man. She asked me to call her by her first female name.

    This new law is for nursing homes. It was passed because people were discriminated against in their HOME.

    ... According to "Stories from the Field: LGBT Older Adults in Long-Term Care Facilities," a 2011 study published by the National Senior Citizens Law Center, these issues have gone unaddressed.
    In that study, 43 percent of respondents reported personally witnessing or experiencing instances of mistreatment of LGBT seniors in a long-term care facility, including all of the following: being refused admission or readmission, being abruptly discharged, verbal or physical harassment from staff, staff refusal to accept medical power of attorney from the resident's spouse or partner, discriminatory restrictions on visitation, and staff refusal to refer to a transgender resident by his or her preferred name or pronoun.
    Eighty-one percent of respondents believed that other residents would discriminate against an LGBT elder in a long-term care facility, 89 percent of respondents believed that staff would discriminate against an LGBT elder in a long-term care facility, and 53 percent believed that staff discrimination would rise to the level of abuse or neglect. Though this was a national report, it included instances of severe discrimination within California.

    Even more recently, in 2013, the San Francisco LGBT Aging Policy Task Force commissioned a report by Professor Karen Fredriksen-Goldsen of the University of Washington, "Addressing the Needs of LGBT Older Adults in San Francisco: Recommendations for the Future," based on information collected from over 600 LGBT seniors residing in San Francisco, including nearly 140 LGBT seniors of color.
    This report found that nearly 60 percent of the study participants lived alone, and of the 15 percent of the study participants who had children, 60 percent reported that these children would not be available to assist them.
    Many reported poor physical and mental health with nearly one-third of all respondents reported poor general health, close to one-half reported having one or more disabilities, and one-third of male participants reported that they were living with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS).

    These results indicate that, as compared to seniors in San Francisco generally, LGBT seniors have a heightened need for care, but often lack family support networks available to non-LGBT seniors.
    Further, LGBT seniors' fear of accessing services is justified.

    Nearly one-half of the participants in the San Francisco study reported experiencing discrimination in the prior 12 months because of their sexual orientation or gender identity.

    While state and local laws already prohibit discrimination in public accommodations on the basis of actual or perceived sexual orientation, gender identity, gender expression, and HIV status, the promise of these laws has not yet been fully actualized in long-term care facilities.
    The purpose of this act is to accelerate the process of freeing LGBT residents and patients from discrimination, both by specifying prohibited discriminatory acts in the long-term care setting and by providing additional information and remedies to ensure that LGBT residents know their rights and have the means to vindicate them.
    Bill Text - SB-219 Long-term care facilities: rights of residents.

  • Oct 11

    Hurricane Maria’s death toll in Puerto Rico is higher than official count, experts say
    Leovigildo Cotté died after not receiving the oxygen he needed at the only shelter that exists in the town of Lajas on the southern coast of Puerto Rico, which has been without electricity since Hurricane Maria careened through a week ago.
    Not even his connections to the government could save him.
    “The generator never arrived,” said Lajas Mayor Marcos Turín Irizarry, who said he looked for oxygen for Cotté — father of the former mayor of that same town — “turning every stone” but could not find it...

    ... The storm-related fatalities are mounting with each passing day, and official numbers are not counting patients who are not receiving dialysis, oxygen and other essential services.
    Among those at risk are people such as Pedro Fontánez, 79, who is bedridden at the Pavía Hospital in Santurce in San Juan and was due to be released even though he lacks electricity at home to support the oxygen and gastric tube-feeding he needs to keep him alive. His daughter, Nilka Fontánez, went to the government’s Emergency Operations Center desperately seeking help, but was told they were not accepting patients.
    “There’s no information,” said a frustrated Fontánez...

    ... The dead are at the hospital morgues, which are at capacity and in remote places where the government has yet to go. In many cases, families are unaware of the deaths...

    ... CPI sources in half a dozen hospitals said those bodies are piling up at the morgues of the 69 hospitals in Puerto Rico, of which 70 percent are not operating. The majority of the hospital morgues that provided information — including Doctor’s Center in Bayamón and Santurce, Pavía Hospital in Santurce, Manatí Medical Center, Dr. Pila in Ponce, Río Piedras Medical Center, Mayagüez Medical Center and the HIMA hospitals in Caguas and Bayamón — are at full capacity. Those hospitals are among the 18 that are partially operational...
    Hurricane Maria’s death toll in Puerto Rico is higher than official count, experts say | Miami Herald

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  • Oct 11

    Puerto Ricans Call for Aid Amidst Catastrophe: "We're American Citizens. We Can't Be Left to Die"
    Six days after Hurricane Maria slammed into Puerto Rico, 3.4 million U.S. citizens in the territory remain without adequate food, water and fuel....

    ... San Juan Mayor Carmen Yulín Cruz said, quote, "What we’re now seeing is that the aftermath is almost more horrific than the actual passing of the hurricane itself"
    Puerto Rico’s Governor Ricardo Rosselló has asked for more government aid to avert a humanitarian catastrophe, especially in the area—in the interior and areas not reached by relief efforts. This is a resident and mayor of Toa Baja, a city on the northern part of the island.
    TOA BAJA RESIDENT: [translated] We don’t have communications. I have no telephone. We have nothing. We do not have supplies. In my house, we do not have water. There is no gas. The lines are long...
    Puerto Ricans Call for Aid Amidst Catastrophe: "We're American Citizens. We Can't Be Left to Die" | Democracy Now!

  • Oct 11

    First this law is for long term residential care, NOT an LTAC.

    Long-term acute care hospitals (LTACs) are defined by the Centers for Medicare and Medicaid Services as providing care to patients with medically complex conditions requiring an average length of stay greater than 25 days. LTACs must meet the same requirements as general acute-care hospitals. They often provide care for patients requiring mechanical ventilation, IV medications, and other acute care. The California safe staffing ratios must be met.
    View Document - California Code of Regulations

    The new law, SB 219 protects LGBT seniors from discrimination in long-term care facilities, such as a facility refusing to use a resident's preferred name or pronoun, denying admission to a long-term care facility, transferring a resident within a facility or to another facility based on anti-LGBT attitudes of other residents, or evicting or involuntarily discharging a resident from a facility, on the basis of a person's actual or perceived sexual orientation, gender, gender identity, gender expression, or HIV status. In addition, the bill requires that all long-term care facilities post a notice regarding this form of discrimination where its current non-discrimination policy is posted.

    When LGBTI seniors need skilled nursing care they often go back into the closet. People should know they will be cared for with dignity.
    Senate Passes Senator Wiener’s LGBT Seniors Bill of Rights for Long-Term Care Facilities | Senator Scott Wiener

    Bill Text - SB-219 Long-term care facilities: rights of residents.

  • Oct 5

    Quote from hppygr8ful
    Nurses in California formed a powerful lobby back when Arnold Schwarzenegger ran for Governor. They helped him get elected and he in return signed a safe staffing bill into law. It was a big deal back when it happened. Still there are significant exclusions to the law and it only covers acute hospitals.

    Hppy
    Oops. It was not Arnold.
    More info later.
    Pro life people need to watch this video because RATIOS SAVE LIVES!

  • Oct 3

    By releasing the video she gives an example of patient advocacy. We all must be ready advocate in the best interest of our patients.
    Nurse Wubbels continues to do so.
    She gives an example of why nurses are considered the most ethical and respected occupation.
    From my state's standards for registered nurses:
    [A registered nurse shall be considered to be competent when he/she consistently]

    ... Acts as the client's advocate, as circumstances require by initiating action to improve health care or tochange decisions or activities which are against the interests or wishes of the client, and by giving the client the opportunity to make informed decisions about health care before it is provided...
    http://www.rn.ca.gov/pdfs/regulations/npr-i-20.pdf

  • Sep 29

    In the 1990s I worked nine 8 hour shifts as registry in a Navy hospital critical care unit. I was required to have a BSN and CCRN.
    I was given a temporary ID.
    One night I notified the physician of a patient condition ans was told he would insert a Swan-Ganz catheter.
    I told the excellent charge nurse that I wasn't familiar with the equipment and would need help setting up. She told me the corpsman would do the set up and calibration.
    He was professional and competent.

    Back in the 1970s I worked with many former corpsman who had been allowed to challenge LVN boards.
    They had to adjust to the limitations of the LVN role. They had been on the battle field in Viet Nam where they had standardized procedures.
    After stopping bleeding they gave IM morphine through the clothes of injured soldiers before getting them in a helicopter for transport to a hospital.
    They started IVs for hypotension.
    At the time I was an LVN in med-surg working with excellent RNs.


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