How to Determine Whether a LTC / SNF is Well Run

[vintagemother]

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.

[merlee]

My grandmother spent the last few years of her life in an LTC, and our biggest complaint was the amount of her clothing that 'disappeared'. Despite having her last name printed in large letters across the back of most items. Her care was adequate, but she was verbal until the end.

My mother-in-law had to be placed 6 1/2 years ago due to dementia. She has been in 3 facilities. They have all been extremely well-run. The most recent was family-owned until just a few week ago, and the staff was there since forever. Many people who worked there were related - mother/dau, some sisters, cousins, etc. No one on the staff ever looks sad, stressed, or angry. The place doesn't smell bad. My MIL is always in clean clothes, hair usually combed, etc. She is still ambulatory but is nonverbal.

I am happy that she is being well-cared for.

LTC facilities vary widely and it is no easy task to care for many of these patients. Many years ago I worked at one, and I truly appreciate those who can.

My sincerest best wishes to ALL of those who work at these types of places!!

[Mom of Diskids]

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.

Not true at all........ I LOVE my job! I have a Masters degree in Nursing and choose to work in LTC.

[kids]

I went back and found a long post I made about this a few months ago: https://allnurses.com/general-nursing-discussion/how-do-you-593503.html#post5400513

[txredheadnurse, BSN, RN]

I am in different facilities every day due to the nature of my work. They do vary dramatically but the good ones are out there and they are not as scarce as some would have you believe. Don't be fooled by a nice entry way and reception area; disregard the decor. Look at the residents and the staff as you walk around the facility. Are residents stacked knee deep around the nursing station and staring off into space? Are the staff all rushing about and not speaking or interacting with residents? Does the staff refuse to make eye contact? Are the residents in clean, appropriate clothing? Does the facility smell or is the noise level equivalent to a nightclub on Saturday night?

To me these are signs of a poorly run facility that doesn't treat residents or staff with dignity, respect and professionalism. Running out of supplies happens everywhere occasionally, being run off your feet by a challenging day happens in every working environment on the planet but all of these things are bearable if, overall, the facility is well run. Please don't let 1 bad experience convince you that LTC is a hellhole or the worse job in nursing. It is not and I see the proof every day in facilities run by caring, dedicated people who do the best they can with the resources at hand.

[writed]

A good source of information about facilities in your area might be the Long Term Care Ombudsman program. In many states, the Ombudsman program is operated through local area agencies on aging.

[nguyency77, CNA]

I think one of the best ways to figure this out-- that I wish someone had told me before I had taken this job-- was to estimate how much it costs a resident to stay at that particular LTC/SNF and compare it to how well-staffed it is. My facility is extremely expensive to stay at; it is outrageous, and we don't have enough CNA to compensate for how much they pay to live here. I always feel really guilty when I can't provide complete care to residents the way I used to in school. I try to keep the place super clean, but I'm not always working. Some shifts leave it sparkling, while others leave a garbage dump.

The truth is, the LTC corporate only cares about making more and more money. The blame for poor satisfaction always falls on us staff, although in reality the problem lies in poor staffing procedures. We don't have enough staff to care for the patients/residents the way corporate would like us to-- we can't fulfill their lies with inadequate staffing. I would not mind a pay cut-- take away my shift differential for all I care; just hire a few more CNA.

It's not that people don't wanna work in LTC because they think they're too good for it; it's because there are too many that are BADLY run. It's a shame, because these places have the potential to be good for patients. Corporate just refuses to sacrifice a small profit for quality.

[ChicRN, MSN]

Omg after reading this I have realized this is me! I started orientation at a "fancy looking" snf & the office staff directors were soo warm, etc. I never really paid attention to the staff on the floor until orientation, but now yes..i notice they just run around the best they can to finish their work, they're burnt out, they do try to smile...but who can w/soo much to do! They don't even have a desk nurse or secretary on their stations and do all of that too. Not sure how to get out myself since its been so hard to find a job as a new grad, but this place seems unhealthy for my well being. The directors don't listen to staff & worry about how to make they're facility look better! I obviously got tricked from the appearance of the place! The comp charting, cna smart charts, & updated facility. i'm hoping everyday i find a job asap because i am getting depressed and this much anxiety is overwhelming..

[BrandonLPN, LPN]

Yes, that's the problem with most (not all) private sector SNF facilities. They care more about putting on a glitzy facade to impress family of prospective admits. This is why I think ALL SNF in the country would be better off being government owned and ran by the feds or the state. Government homes ARE more institutional and less "homey" than private places, but I think having a nursing home be driven by a profit motive is inherently cruel to the residents.

[student forever]

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.

What a warehouse! Just the other day one of my male Residents complained about "having to get up and have supper" . . . I proceded to tell him that he lives like a king. One percent of the world's population gets to have three squares cooked for them, served to them, taken away and cleaned up for them... bed made daily, weekly housekeeping of the entire efficiency apartment, and at his beck and call someone will come running!

I would that the whole elderly population of the world had such a clean and safe way to grow old!

[Havin' A Party!, ASN, RN]

... 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...

After working in three national LTCs, this has also been my experience.

Staff is overworked, poor staffing (especially nurses) based on needs (acuity), no supplies, equipment that doesn't function, and management that really doesn't care -- while verbalizing how much they're concerned for the welfare of "their" residents and staff.

Now when auditors or corporate people are visiting... my what a change! Then, after these "visitors" depart, everything goes back to the status quo.

Another "sad, but true" example in this industry.

[Havin' A Party!, ASN, RN]

I think one of the best ways to figure this out-- that I wish someone had told me before I had taken this job-- was to estimate how much it costs a resident to stay at that particular LTC/SNF and compare it to how well-staffed it is. My facility is extremely expensive to stay at; it is outrageous, and we don't have enough CNA to compensate for how much they pay to live here. I always feel really guilty when I can't provide complete care to residents the way I used to in school. I try to keep the place super clean, but I'm not always working. Some shifts leave it sparkling, while others leave a garbage dump.

The truth is, the LTC corporate only cares about making more and more money. The blame for poor satisfaction always falls on us staff, although in reality the problem lies in poor staffing procedures. We don't have enough staff to care for the patients/residents the way corporate would like us to-- we can't fulfill their lies with inadequate staffing. I would not mind a pay cut-- take away my shift differential for all I care; just hire a few more CNA.

It's not that people don't wanna work in LTC because they think they're too good for it; it's because there are too many that are BADLY run. It's a shame, because these places have the potential to be good for patients. Corporate just refuses to sacrifice a small profit for quality.

"I always feel really guilty when I can't provide complete care to residents the way I used to in school."

This is a very typical feeling among staff nurses in LTCs.

"The truth is, the LTC corporate only cares about making more and more money."

So very, very, very true.

[CapeCodMermaid, RN]

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.