How to Determine Whether a LTC / SNF is Well Run

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Hello Nurses!

I am taking the prereqs to apply to nursing school and recently became a CNA. I'd read and heard that working in a SNF / LTC facility was not desirable to most nurses and I (wrongly) assumed that people who didn't want to work in LTC / SNF didn't care for caring for the elderly or thought the work was unfulfilling.

After my first experience landing a FT job in an SNF went horribly awry (scabies + MRSA, C-diff + no gloves, no PPE and no real training) I learned that these types of issues are at the root of the reason why many chose not to work in SN / LTC facilities.

The reality of it is that many of the available jobs that exist are in these facilities.

How can a new (RN) nurse (or CNA) tactfully determine whether a particular facility follows proper procedures prior to becoming employed?

Are there certain questions that can be asked or things to observe for?

eg Is it appropriate to ask about the ratios? What would good ratios be? Is is appropriate to ask about the policy for supplies being replenished during the interview process? How much /what type of training is appropriate to receive?

I am most concerned with protecting my own liability and keeping myself (and my family at home) safe from communicable diseases.

Specializes in long term care Alzheimers Patients.
I feel sorry for all you people who have worked in bad nursing facilities. Maybe I've been lucky...maybe it's because I live in Massachusetts, maybe it's because I am the proverbial squeaky wheel. I've worked in many facilities. Some were old and needed a fresh look, some were brand new and upscale, some were modest. What I found in most if not all of them....caring staff AND caring administration. Do I get everything I want for the residents? No, but I do get everything they need. The people who own the facility I work for now had several choices when the medicare and medicaid funding was cut. They could lay people off or talk to the staff and see what worked for the majority. So they went building to building, got a concensus of opinions from the line staff--not the managers---and worked it out. The staff is treated well and respected for what they do. The owner and CEO come on a regular basis just to walk around and say hello. The CEO came in on July 4th. Most of YOU were probably at a cook out. My managers and I were all at work throwing a party for the residents and staff who had to work.

Find a good place to work. They do exist.

If you think LTC is so horrible...take a look and read what the hospital nurses are saying. They don't think they can give good care either.

Capecod I have always said if I lived in your area I would love to work at your facility. I have also worked at many ltc over the years and found most of them well run

Indeed not all LTC facilities are awful.My facility I would have to say is somewhere in the middle. There are a lot of people where I work that describe how it was to work where they used to be. It seems the ones that miss their old jobs and now hate where we are were the ones that worked for the non profit facilities, mostly faith based around here.

We have a "county home" that is supposedly "not for profit" but the employees that came from there said they still prefer it here. Government run doesn't seem to be the "best option" either. They have anywhere from 16-20 patients per 1 aid ratio and 50-60 patient to 1 nurse ratio for second shift there more nights than not. I was told there is SUPPOSE to be a second nurse with you for at least the first half of the shift but it is rare for that to really happen. That is why they left there and came where we are. I can't even comprehend how 1 nurse can give meds to 60 patients on time much less do all the treatments and paperwork etc on all of them in 8 hours! No wonder they ran away from the county home!

My best advice is to observe during feeding hours. You can tell alot about the care based on how they feed their dependent residents. Are they shoveling it in? Do they leave it running down their faces? Feeding takes alot of patience as well as compassion, and to me, also shows indicators about staffing as so many aides are rushing through to cover their halls.

Specializes in Gerontology, Med surg, Home Health.

You can tell alot about the care given if the home calls it 'feeding hours'. I don't know about you, but in MY house we call it lunch or dinner.

I guess that is exactly my point. When the staff IS shoveling in food and not interacting with the residents it no longer becomes a meal, it becomes "feeding time." These are the things I look for when observing a nursing home. I do a lot of clinicals in nursing home and I have found this mindset to be a pretty reliable indicator of the type of overall care they receive.

You can tell alot about the care given if the home calls it 'feeding hours'. I don't know about you, but in MY house we call it lunch or dinner.

I, too, have often thought I should cross the border from CT into MA and seek out CapeCodMermaid and her facility. :)

Specializes in Med-Surg, Home Health, LTC.

Just a short comment on what is where:

I do agency work and work a lot of different places. There are wonderful long term, assisted living and acute care hospitals and there are the "others."

I find federal and state survey ratings are fairly accurate and are posted online in your state...and it is public information. There are also online secondary organizations that post these same survey results and have added information. all of that will be helpful for you to know and help you decide.

Liability is a reality and there is through private companies not very expensive.

but it seemed your main concern was your family and you bringing something home to them.

Infections bacteria like MRSA and viruses are nearly everywhere, in acute care hospitals and LTC and

probably the local grocery store:-)

Scabies are not caused by dirt, they are a mite and could just as well be contacted directly to your skin in public hotels motels or a bus or airline seat or in a school. ekk!

I have heard bed bugs are epidemic in some places and are found in some acute care hospitals, 5 star hotels, . and probably elsewhere.

We live in a buggy world:-)

I think your best protection is personal, hand washing and wearing gloves.

When you get home, or before you get in your car, take off your shoes.

scrubs off at the door or outside the door, and take a shower before hugging your family or babies:-)

Thank You! Yes there are staffing issues in many facilities, but my friends working in hospitals are dealing with exactly the same issues. The staff in my facility really do care. They pick up extra shifts, work on holidays and truly love their residents. We all have residents who are not our favorites, but they get good care too. The issues in the industry are not just issues experienced by LTC's but throughout the entire industry. The Medicare/Medicaide cuts really impacted our business leaving us to provide better care with fewer resources. The thing is, if you are a nurse and you aren't up to staying up with the changes, maybe its time for a job change. LTC is a very rewarding area to work, but as with everything else in life, you get out what you put in. Make a difference and work towards making better changes.

Specializes in Long Term Care.

There are good & bad SNF, just like anything else. You have to be careful. I recently got fired from a one, unfairly I believe. But I believe in defining my failures & not letting my failures define me. My former SNF almost closed b/c of mulitple bad surveys with loads of deficiencies. After a few months I applied to another SNF. What a difference, a deficiency free facility is! The patients are well cared for. Supplies for the most part are available. The CNA's are awesome in letting you know when they see a problem. I can actually get everything done that needs to get done on my shift. So sad their aren't better quality controls because some SNF are run like warehouses, while others treat our elderly with the respect and dignity they deserve. I have been a charge nurse for over 5 years in LTC and to set the record straight if a CNA ever asked me to look at something, no matter how big or small, I WOULD EYEBALL IT, call the doctor if I had to & get something going if needed. Some places are overstaffed with underpaid & overwehelmed people. Currently I am working at a place that I can be proud of the work that we are doing. Rarely do they work short staffed, they care careful at who they take in. Not everyone fits well into a SNF environment, so admissions must be careful at who is admitted. Unfortunatley, Medicare & Medicaid & insurance companies do not re-imburse well, and consequently, some of the SNF will take anyone with any dx to fill a bed. And ultimately the patient suffers. If people just remember that someday, they could end up being in these beds. I seen workers come back to the facility as patients and it is an eye opening experience for some people.

Hello Nurses!

I am taking the prereqs to apply to nursing school and recently became a CNA. I'd read and heard that working in a SNF / LTC facility was not desirable to most nurses and I (wrongly) assumed that people who didn't want to work in LTC / SNF didn't care for caring for the elderly or thought the work was unfulfilling.

After my first experience landing a FT job in an SNF went horribly awry (scabies + MRSA, C-diff + no gloves, no PPE and no real training) I learned that these types of issues are at the root of the reason why many chose not to work in SN / LTC facilities.

The reality of it is that many of the available jobs that exist are in these facilities.

How can a new (RN) nurse (or CNA) tactfully determine whether a particular facility follows proper procedures prior to becoming employed?

Are there certain questions that can be asked or things to observe for?

eg Is it appropriate to ask about the ratios? What would good ratios be? Is is appropriate to ask about the policy for supplies being replenished during the interview process? How much /what type of training is appropriate to receive?

I am most concerned with protecting my own liability and keeping myself (and my family at home) safe from communicable diseases.

Specializes in Oncology.

I think the biggest endorsement for any facility comes from the customers. I will never forget when my sister joined the Little Sisters of the Poor. They run nursing homes for impoverished elderly, and they do it with precious few resources (yes, they still go out and "beg"). When we were visiting my sister at one of the facilities a little old lady walked up to me and said "I'm 106. There are several centenarians living here and do you know why? It's because they love us..." Still brings a tear to my eye to this day.

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Thanks for the added input, ladies! I am now in an LVN program. We will do clinicals at SNFs and I will probably look for work at a SNF when I graduate. Since the time I posted, I've had the opportunity to work in different settings as a CNA.

I do think that a lack of funding is at the root of some of the inherent challenged LTC faces (as compared with well funded hospital).

Specializes in LTC/Sub Acute Rehab.
You can go to the Medicare site for their ratings:

Medicare.gov - Nursing Home Compare

When I am job hunting I usually look at this site. Unfortunately, sometimes when I go to the nursing home that looks like it has good ratings, I find it is a pit of despair. You do have to go in person and check it out. Also, some states on their Department of Health sites have all the State survey results from their inspections. You can also do a search for JHACO or State survey results.

You want to look at the type of complaints, are there real quality of care concerns, numerous medication errors, wound issues, infectious issues, abuse or neglect issues, and how do those compare with other facilities. All facilities have their glitches, but a facility with a large number of quality of care deficits obviously has some serious issues.

Also, the type of tags -- are they A, B, C.....which range from isolated incidents, to potential for harm, to actual harm. The higher the letter, the worse the level of care.

Of course the best thing is to walk in the door. Does it smell like urine? Not good. What do the patients look like? Are they clean, is there lots of activity going on, or are they all confined to their rooms? Is the floor buckling with decay? How do the employees look? Do they look happy? Sour? Stressed?

The other thing is how HR treats you. Do they offer you a job the minute you walk in the door? Probably they can't hold onto staff and are desperate.

You really have to be careful. Especially with the for-profit facilities, because they are all about the profit margins, and will skimp on care to get the biggest profits.

In my opinion, the Medicare rating is MISLEADING and the Admissions and Social Service Directors are all to happy to continue misleading potential patients and families. The facility that I work at (and currently trying to get away from) has a 5 star Medicare rating yet, gloves are posted in compartments on the wall in common hallways but NOT PLACED IN ROOMS; they are passed out daily by a designated person and when she's gone, they're locked up. The facility DOESN'T PROVIDE SOAP for the resident's to bathe; the CNA'S use the antibacterial/antimicrobial soap used to wash your hands prior to and after administering care.....that is unless the family provides personal soap for the resident, the CNA'S more often than not care for at max 20 people on their assignment, plastic bags are NOT PROVIDED to the CNA'S to dispose of dirty/soiled linen; they have to carry it out UNCOVERED BY HAND INTO THE HALLWAY wearing gloves and place it in a double side barrel (one for linen, one for trash). I could go on and on unfortunately. When I first saw this, I was mortified!:nailbiting: It is not a secret (unless the state walks in) and is daily common practice on all shifts. So, to me, that Medicare rating means crap to me. Its just another tool the facilities use to market the place to make more money and not pay their staff adequately.
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