How to Determine Whether a LTC / SNF is Well Run - page 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)... Read More
Aug 15, '12 by Laurab14My 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.
Aug 15, '12 by CapeCodMermaid, RNYou 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.
Aug 21, '12 by Laurab14I 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.
Quote from CapeCodMermaidYou 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.
Aug 21, '12 by CT Pixie, BSN, RNI, too, have often thought I should cross the border from CT into MA and seek out CapeCodMermaid and her facility.
Aug 24, '12 by KashiaJust 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 malpractice insurance 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:-)
Last edit by Kashia on Aug 24, '12 : Reason: added
Aug 25, '12 by resalcedoThank 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.
Dec 3, '12 by 369PelhamThere 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.Quote from vintagemotherHello 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.
Dec 5, '12 by bbuerkeI 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.
Dec 8, '12 by vintagemother, CNA, LVN, RNThanks 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).
Jan 12, '13 by brown eyed girl, LPNQuote from mazyIn 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! 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.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.
Jan 12, '13 by BrandonLPN, LPNThis is why I'm so glad I don't work in a for-profit nursing home. I find it hard to believe that any nursing home, anywhere, can't afford to provide the CNAs with bottles of body wash or with plastic linen bags. Really? Really??
Jan 12, '13 by LadyFree28, BSN, RNThe best SNF/LTC I worked in my area was a government-run veterans home and a privately run facility. I enjoyed both places because how the treated staff and agency staff equally, and they had a culture of "resident first" mentality.
I remember when I was finishing my upper level courses in my BSN program in my management classes where we discussed the issues of staffing, ratio and the effects of the quality care from hospitals as well as nursing homes we looked a study where the largest FOR Profits were WORSE than government ran (state and federal). I don't have the study anymore, however I found the article from Advance for nurses:
One of my friends works at one of the for profits, but the place is wonderfully ran...I worked there as an agency nurse (I told her to take the job, and she loves it) and have done chart reviews at a few if their facilities for Medicare...at least IMO for this non-profit, they may have ones that follow a "gold standard" while some may not. I have rotated at another fir profit when I was in LPN school and we would smell urine when we came in the door, but the floor we worked on did their work and really seemed committed to working for the pt...and the usual "stolen clothes" incident would happen as well. In my senior rotation, I rotated in a city ran nursing home that was transitioning into state-privately run...kind of like purgatory I guess. The nurses were mostly ran by travel nurses...but the staff overall tried their best. They had WOCN services, respiratory therapists, coordinated care, NP's and MDs for every unit and the did daily visits and would visit if the nurses called the providers. They all worked as a team. The clientele were lower income...one our clients assigned was a registered sex offender on the Megan's Law Website...they took everybody that needed nursing, and at least did the best they could. I learned the most from this nursing home as far as how you can still give your clients the best nursing care, against all odds and situations.
Although I no longer work in LTC, I commend the nurses who are truly serving in this area!
Jan 12, '13 by vintagemother, CNA, LVN, RNI started this thread nearly a year ago and am still working as a CNA, albeit super part time. I am currently in an LVN program and know I am likely to land a job in a SNF.
I appreciate these comments, as I still see things in some SNFs that don't seem quite right, but may be a matter of course. I am sensitive, maybe overly so, to the needs of others and perhaps am bothered by things I shouldn't be.
Thank you all for posting your varied input.