Barriers to SNF and ALF improvements

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I think the title speaks for itself...but I'll try to elaborate.

It would be difficult to find any nurse who would argue against the notion that the status quo of doing business in SNF/ALF facilities needs a huge overhaul. That being said, what are the issues that need addressed?

Staff burnout, poor regulation, and care models that prioritize profit are a few that come to mind. If you work in one of these facilities what would you change?

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Specializes in Dialysis.

Ratios and percent of profit allowed to be earned

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2 hours ago, Hoosier_RN said:

Ratios and percent of profit allowed to be earned

Can you explain the "percent of profit allowed to be earned?" Does this mean that nurses, CNA, etcs don't receive fair compensation based on the amount of money brought in?

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Specializes in Dialysis.
40 minutes ago, IKnowYouRider said:

Can you explain the "percent of profit allowed to be earned?" Does this mean that nurses, CNA, etcs don't receive fair compensation based on the amount of money brought in?

No, that the corporate owners can only keep so much profit- they get max x percent, the rest would need to be reinvested. Then they would hopefully quit screwing staff in the effort to make crazy profit. The rest of earnings by company could go to pay and more staff

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Specializes in retired LTC.

Hoosier - what!?!

Does this mean tampering with the incentive bonus for the admissions coordinators (who approve inappropriate residents for entry)!?!?

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Specializes in Dialysis.
1 hour ago, amoLucia said:

Hoosier - what!?!

Does this mean tampering with the incentive bonus for the admissions coordinators (who approve inappropriate residents for entry)!?!?

No. I said the percentage of profit that the owners may keep. At this time, it's unlimited. They can pay staff so little and run out of supplies while owners/shareholders get millions. As for as inappropriate admissions, there's a special place in Hell for those who do that to their fellow nurses in the name of a bonus. But that's a different ball of wax, if the owners allow. There are some facilities that absolutely don't allow that craziness

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Specializes in retired LTC.

Hoosier - not sure if you caught it, but I was being sarcastic.

I THINK you got it. Right?

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Specializes in Dialysis.

After I posted LOL. It was a 16 hr day and I got off at 11p. Brain cells not processing ?

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Specializes in Geriatrics, Dialysis.

I left LTC after 25 years. Mostly because despite any promises made things just never got better and I actually worked for a decent company.

It's all about the money. I'd hate to be on a budget committee making the decisions what to cut to meet whatever the owners decide they are willing to give.

Of course since I didn't sit in on those meetings I have no idea what the process is but I can tell you from being on the front line the first things to go were supplies, followed by staff. Yet that somehow never seemed to effect the management staff. Despite having more hourly paid middle management than nurses that actually did patient care the floor nurses and the CNA's saw cuts to the bare minimum to keep the place staffed while not a single management position saw hours reduced at all.

The place I worked in was 85 beds max, usually 75-80 residents on census. There were building wide on day shift 7-8 CNA's with 8 being full staff and depending on census they would run with 7, even occasionally 6. There were 4 nurses, occasionally three with promises by management to help which meant they might pass meds between meetings but otherwise we were on our own.

There was also between the DON, ADON, Unit managers and MDS Coordinators 7 management nurses! Let that sink in a second, 4 floor nurses on a good day to 7 management nurses. What's wrong with that picture? What's wrong with LTC that requires almost double the number of nurses working in a management role compared to the number of nurses working in direct patient care?

Figuring out what requires that and trimming the fat at the top would free up a decent size chunk of the budget. But then, who am I kidding? That money if reallocated would never go the direct care staff anyway. It's not enough to make a significant difference to wages for direct care staff or additional supplies so any money saved there would just go right back to profits for the owners anyway.

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Specializes in retired LTC.

kbrn - Did we work at the same place? You forgot to add the SDC/Inf Prev, Restorative Nurse and Admissions Nurse. And we had 2 for MDS.

I kid you, NOT. We were 240 beds.

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Specializes in Geriatrics, Dialysis.
19 minutes ago, amoLucia said:

kbrn - Did we work at the same place? You forgot to add the SDC/Inf Prev, Restorative Nurse and Admissions Nurse. And we had 2 for MDS.

I kid you, NOT. We were 240 beds.

We had 2 MDS nurses also, for 85 beds. Really? Why on earth is that necessary?

Though one of the MDS nurses did oversee restorative nursing. You're right, I forgot to mention them, there's also 2 restorative CNA's. I left right before the COVID isolation started so I am not sure if they are still working in that capacity. Come to think of it I have no idea how they handling therapy at all, they must be doing what they can in resident rooms I imagine.

We didn't have an admissions nurse but there was an Admissions director who was not a nurse. Always bugged me that the person responsible for accepting admissions had not a clue how much nursing care might be involved. I do know that his position was cut after COVID started but I have no idea if he was called back after admissions started again or not. I'll have to ask somebody I used to work with if he's back or not.

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Specializes in retired LTC.

IKnowYouRider - any thoughts from you? Or was this to provide some basis for a class paper/research project?

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