what is an acceptable response time to call bell in ltc?

[jrbl77, RN]

:confused:My mom is a resident of a ltc for approx 3 yrs. This problem arises every so often and I don't know the answer. I thought maybe some of you could be of help. What is an acceptable or appropriate time to wait for a responce to a call bell in LTC. I received a call from the LTC today that my mom has been getting out of bed by herself. She is of sound mind, but doesn't move very well. Upon further disscussion with family members, I find that she has been waiting a half an hour to get help to the bathroom. Tonight she needed help getting up to her w/c for supper and a CNA came by and told her she would be right back. Meanwhile a 1/2 hr later she hasn't retunred. My sister helped my mom to the w/c, but my sister doesn't feel that she is trained to do this. I can move my mom, but it has been getting more difficult and I don't want to hurt my already old nurses back moving my mom. I am planning on talking to the DON, but in the past has not been helpful. My family doesn't want to move my mom. Tonight my mom told me that staff tells her that they are so short of staff when they do come to help her. Maybe I'm from the old school, but I never felt it was right to tell the pts that the staff was not adequate. As an RN, I have alwasys worked in the acute setting, but have helped more than my share of pts to the bathroom and been informed by familes when it has not been done quickly enough. This is a double edge sword for me, I have been on both sides of the fence. How long should residents have to wait to get help with toileting and other cares and concerns?

[Nascar nurse, ASN, RN]

I appreciate your acknowledgement of the difficulties of LTC & as well as understand your concerns. It's always nice to have a family member that will speak up if there is a problem without being overly quick to point fingers and place blame.

However, 30 minutes is to long to wait, period (although I'm reluctant to say that it does happen at times everywhere I've ever been in LTC). The other side of the coin tho, is I have often witnessed residents telling their family "I've waited FOREVER for them to answer my light" when the reality is it's only been 5-10 minutes. And it really can seem like "FOREVER" when you are the one that's gotta pee!

In your shoes, I would go right up the chain of command with this. Speak to the charge nurse on duty, then to the DON, then to the administrator. A good facility is going to want to make it right with you. They should be trying very hard to resolve this problem and offer to get back with them in a couple of days to see where their plan of action is. If they continue to ignore the problem you can always call their compliance hotline or even the department of health.

If it continues to happen you may have no choice but to seek alternative placement.

PS: The staff should NOT be telling family they are short of help! Egads!

[kool-aide, RN]

You might check to see if your mother's LTCF has a call light system that keeps track of calls and how long it takes a caregiver to shut the call light off in the pt's room. In my hospital, call light wait times can be reviewed. I know how difficult this position can be; you want the best care for your mom, but you also know how hectic it can be and how a caregiver can have trouble answering call lights in an appropriate amount of time, especially near shift change! Good luck to you.

[noctanol]

I feel your pain, to be quite frank, there is no acceptable wait time. When our facility is staffed correctly 5 aides to 80 pts, the average wait is about 5 mins. Then there are those days that we work with 2 aides, and God knows they dont want to be there, wait times can be anywhere from 20 to an hour depending on what the pt needs.

[NamasteNurse, BSN, RN]

What is reasonable and what is reality are not the same unfortunately. On my floor if we have 4 aides, there should be no more than a 5 minute wait, but we often have only three and then who knows. Three aides with 40 pts means they each have 14 pts and chances are they are always with someone. We nurses pitch in of course, but you can never be everywhere at once. Sad but true.

[Forever Sunshine, ASN, RN]

We nurses pitch in but keep in mind.. we have to draw the line or else we would never finish our assignment.

It mostly depends on staffing. If the CNAs are short, no doubt theres going to be a longer wait time. I answer the call light to let them know of the situation., and if its something quick like water or tissues or a blanket I take care of it myself. and Yes I do tell the residents "I apologize but we are short staffed tonight, your CNA Katie is with another resident right now, I will let her know you would like to get ready for bed and she will be in here as soon as she can."

[gentlegiver, ASN, LPN, RN]

I never could figure out why it's wrong to tell a resident that we are short staffed. Why lie to them or leave them wondering why they are waiting so long? Granted we do have those pts who think 5 seconds is to long to wait, but the majority of our patients are more understanding when told the truth.

[CoffeeRTC, BSN, RN]

Its wrong to tell the residents when they use is as an excuse for everything. Why do the residents need to get upset or feel like they don't count? I know it is obvious to most of the residents we are short staffed. If they ask, I normally tell them "yes, but we are all working together to get everyone covered and taken care of" (and that is the truth).

As far as the wait...I'd say a few minutes until it is answered for the first time and at least assessed as to what you want/ need. Might be something that might need to wait, but at least she is being checked on. Letting a bell go unanwered is just wrong.

[ktwlpn, LPN]

Call bell response times vary shift to shirt. As a way to get around this why not request your mother be put on a toileting program? They are supposed to be tailored to the specfific resident's needs. One of our ladies complained that she had to wait 30 to 45 mins in the evening when she rang for toileting. She truly did because she always rang the second she was finished eating- never mind the rest of the folks and their needs. Now she is on a q 2 hour while awake and OOB program and she goes at 4pm and then again at 6p-that gives everyone on the unit a chance to eat a hot meal.

You can also request she but up for every meal. But toileting (someone else's )trumps that in LTC. We do not encourage family to assist with transfers.Not a good idea. Unless her butt was on fire she should have stayed where she was.

[Leelee2]

Most policies state call bells should be answered in five minutes or less.

The average wait time I have seen is 5 to 10 minutes, depending on time of day. After supper always seemed to be an incredibly busy time. If you are unhappy with the results, then you should contact the DON of the facility. If still unhappy after speaking with DON, wait a few days see if there is any improvements, if not, contact facility administrator.

[flashpoint]

When I did LTC, our policy was that the wait should never be more than ten minutes. But, for many of the reasons already mentioned, that was sometimes not possible. No matter how many CNAs or nurses are working, there are always times that every one is busy. We encouraged our residents to ring as soon as they felt the urge to use the bathroom instead of waiting until the urge was strong. We implemented B & B programs that attempted to keep track of when people usually needed to go and we did our best to accomoate that. People who insisted on being helped to bed immediately after supper generally were served their meals last so that the other reisdents were closer to being done when they were ready for bed. There is no perfect system...even with optimal staffing. Most of the time the residents don't need to be told they are short staffed...they can tell.

[jrbl77, RN]

thanks for all the responses. I suppose there is no one answer. My mom is already supposed to be on a q 2hr bathroom routine and I am 99% sure that doesn't happen. She is also supposed to be walked in the hall daily and that doesn't happen either. Talking to the DON and administrator are like talking to the wall. The DON is always right and the administrator backs her up. I did talk to the LPN that cares for my mom the most and explained our concerns. She told me they are trying to make adjustments to the schedule for tolieting etc. I really hate being put in the middle of this, because as a nurse I understand, you can't be every where at once, but what makes one person more important than another espically when that person is your mom. The LTC is very convient for our family and moving mom would probably open another can of worms. I really think that you have to pick your battles. I just try to be as opened minded as possible. :redpinkhe