How to Determine Whether a LTC / SNF is Well Run

  1. 3
    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.
    gabulldogs, VivaLasViejas, and lindarn like this.

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  2. 45 Comments...

  3. 8
    I think the best assumption is that if you work at a SNF, things are going to suck.

    You do your best to keep from from sucking too bad until you can find a better job.
  4. 5
    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.
    IowaKaren, koi310, NRSKarenRN, and 2 others like this.
  5. 3
    I totally agree with Mazy.
    I have worked in LTC for 25 years; starting in high school working in the laundry department up to being the director of nursing for eight years while I finished my MSN/FNP. My facility is a bit unique, as it is family owned (not my family, but almost by osmosis), but the suggestions Mazy offered are the same things I tell families to do when looking for placement for their loved ones.
    In my state we have to post the staffing ratio. This would be something to ask HR. Also, ask them of the longevity of the staff. As far as your liability, I would ask about the acuity of the residents. If you feel uncomfortable or the atmosphere is not inviting then I would not risk it.
    LTC can be a rewarding environment. Those who do not enjoy it should not be in it. As the baby boomer population ages, LTC is evolving to meet their needs and will be good experience to have.
    Good luck on your endeavors.
    IowaKaren, NRSKarenRN, and LockportRN like this.
  6. 0
    Thank you for your responses. I had such a bad experience at my first full time position-as a CNA. I work on-call in a hospital now and the difference is night and day with regard to the cleanliness and helpfulness of the RN's in providing patient care. In the SNF the LVN's refused to help when the patient has issues that appeared to me to require a more expert opinion, such as bleeding, seeping wounds. In contrast, at the hospital, the RN's assist with more difficult patients.

    However, the SNF smelled good and looked clean and had only 1-2 issues on the state's website, which seemed to be about average. It was only when you really had a chance to observe and take part in patient care that you could see the patient care issues being ignored (bleeding, seeping wounds) and the lack of PPE, etc.

    Some of what I experienced is probably just part of the job of working in LTC / Health care and some of it was probably a fluke and isn't likely to occur again. I will go into my next job in the health care field with my eyes wide open to potential issues and asking more questions.
  7. 4
    Yep. we've had cases of CDiff,MRSA,Scabies..and they've ALL come from the HOSPITAL. We take care of sick people. My facility is well staffed and doesn't smell. I am so tired of people on here condemning an entire industry because of one or two bad facilities....or because they couldn't hack working in LTC.
    nikkibobicky, MedChica, kmarie724, and 1 other like this.
  8. 3
    Quote from CapeCodMermaid
    Yep. we've had cases of CDiff,MRSA,Scabies..and they've ALL come from the HOSPITAL. We take care of sick people. My facility is well staffed and doesn't smell. I am so tired of people on here condemning an entire industry because of one or two bad facilities....or because they couldn't hack working in LTC.
    Amen! I love my SNF! I love my residents and the wonderful aides I work with. Of *course* a SNF won't have the same resources as an acute care hospital. We have to make do with WAY less and we do a darn good job. I, too, am sick and tired of nurses who say they could never do LTC as if it were below them. In most cases the truth is they just couldn't handle it!
    AnnaleaRN, IowaKaren, and kmarie724 like this.
  9. 0
    Dear OP - the reason I don't want to work in LTC is due to not liking seeing the residents decline, then die. I also am not a big fan of warehousing the elderly. I much prefer Pediatrics. I have done my best to stay out of LTC because I know my heart is not in it. I could do it and do it well, but I didn't go into to nursing for just any nursing job - I went into it to work in pediatrics.

    As noted by previous posters, it is important not to judge all nursing homes or all nursing home employees by one experience. I have worked in four - 2 as an aide and 2 in clinicals. I like the rehab side - these are patients who get better and go home. Probably much the same in the hospital - they get better and go home.

    How to tell if a nursing home is good - the above posts were good: does it smell bad? Are the staff rushed? Are the patient's taken care of? What is the ratio?
  10. 3
    Warehousing? My residents all have a private room, breakfast anytime from 7 to 1030 in the morning, activites 10 hours a day...yep....sign me up for that kind of warehouse. Lots of my residents get better and go home. Those who stay with us for the remainder of their lives are very well cared for.
  11. 2
    Quote from MN-Nurse
    I think the best assumption is that if you work at a SNF, things are going to suck.

    You do your best to keep from from sucking too bad until you can find a better job.
    This is my take on the matter. In different geographical locations, at widely different points in time, I have found that every LTC facility I worked in, left much, much to be desired, both in terms of care provided to the residents, and workplace behavior of many employees, impacting on that care. Best to assume the worst and be pleasantly surprised if that assumption is wrong (if ever you find that place).


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