Quality of Care in LTC

  1. I was thinking about taking a CNA class and giving this another shot. A few years ago, I worked in two different nursing homes (one on 1st shift and one on 2nd shift). Both were terribly under-staffed and, for the life of me, I couldn't figure out how to take care of 10-15 patients in 2-3 hours and still manage to give them the quality of care that they deserve. I didn't want to do what the other CNAs did, taking shortcuts and such. Needless to say, I didn't last.
    I really want to go to NS and nursing homes/hospitals tend to work with your school schedule and usually offer some kind of tuition assistance (right now, I work an extremely inflexible position, where I'll have NO choice but to leave in order to chase my dreams...), but I also don't want to put myself back into this kind of environment.
    So, for all the CNAs, here are my questions...

    1. How do you finish your am/pm care w/o taking shortcuts when you have 10-15 residents/patients to take care of in 2-3 hours. Is it possible? Everyone used to tell me no more than 15 minutes per room... How do you manage that one when you're doing total care?

    2. Has anyone worked for the UPMC system in PA? How are they with CNA:resident ratios?

    3. Are there any "branches" of healthcare for CNAs that allow you more time for your residents/patients OR that have residents/patients that are slightly more self-sufficient? I was thinking, maybe, home health or rehab...

    Any advice/input would be greatly appreciated. Thanks.
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    About crisann

    Joined: Apr '09; Posts: 8; Likes: 2
    Manager; from US

    8 Comments

  3. by   SuesquatchRN
    Honey, you have a good heart and I am sure you are a wonderful aide. However, it is not possible to do an adequate job in 15 minutes on a person who requires total care. To work in LTC you must come to terms with giving the minimal care required, not to actually have the time to nurture the person.

    It's heartbreaking.
  4. by   fuzzywuzzy
    ^yeah, that.

    You need to move quickly, be very organized, multitask like crazy, and work with like-minded people, and you'll still miss a lot of things.

    It helps to get as much as you can out of the way early on.

    I work in one section where everyone is total care or needs extensive assistance, and they're all pretty confused. Most of them are 2-assist so the aides have to spend time helping each other with that too. I have 10 residents (a light load compared to some places), they're all incontinent, and I still rush around as fast as I can and I can barely keep up with my rounds and HS care at the same time. I feel guilty about it but I do my best.

    Before I started working over there the other girls got in trouble for getting people washed up and in their nightclothes before supper. We're not supposed to give showers before supper either (I guess because it's they get into nightclothes but I'm not sure), but we do that anyway. I think the DON cracked down on doing HS care early because she thought it was lazy/looked bad to visitors but I'm always tempted to do it anyway because it would make it so much easier to just pop someone in bed after oral care and go change all the wet people instead of letting them lie there in urine because you're too busy washing up/lotioning/transferring other people into bed (who are also wet).
    Last edit by fuzzywuzzy on May 9, '09
  5. by   asun21ta
    I am so sorry to say that most nursing homes understaff. The quality of life for these residents is horrible. Comapanies are always trying to save a buck by understaffing. Consequently, the only way to get your job done, is to do short cuts. Does that make you a bad CNA? No. As long as you are still doing your job. I was always the last to finish during my morning runs. Too utilize my time wisely, I would set up a minumal assist person to wash themselves. While they were washing up in the bathroom, I would take care of the resident next to them who maybe needed a bedbath because were unable to wash independently. I figured I was helping to keep the independent person independent, yet they could still call on me because I was still in the room with them. I hated having to group them like that, but when you have 15 residents and 4-5 showers, you get creative. The residents didn't seem to mind.


    Home health is less demanding, and depending on the amount of cases you have, you can take time with each resident. It is a lot less stressful. Thats what I ended up doing while I was pregnant with my daughter. My body couldn't handle that kind of stress of that Nursing Home any longer. You could even try assisted living facilities. They may pay less, but MOST time the work is a lot lighter because they are mostly independent residents who just need help with medication or dressing in the morning. Be aware though, there are assisted living facilities out there working the CNA's to death. This is because some residents who are in declining health end up staying instead of transferring the residents to a nursing home where they are better staffed to deal with it. This is where the problem begins.

    You may be able to find a job that has a better cna/patient ratio, but they are few and far in between. I call and ask as If I were inquiring for a new patient. Then ask what is your patient/staff ratio. They have to be truthful. That does not mean that they will be.

    Yes, it's very sad. Something needs to be done.
  6. by   SuesquatchRN
    Quote from asun21ta
    I am so sorry to say that most nursing homes understaff. The quality of life for these residents is horrible. Comapanies are always trying to save a buck by understaffing.
    I really can't blame nursing homes for the short-staffing. Even the county home here, which is filled with caring people, operates at a tremendous deficit beecause reminbursement rates don't reflect what is actually necessary. But then, a lot of people in nursing homes should be allowed to die. Not helped along, but certainly permitted to go when they get sick. That doesn't, though, fit our medical care paradigm.
  7. by   care_baer
    This thread makes me really sad. I couldn't work somewhere if I didn't think I could give the residents adequate care.

    but there is hope out there. I work at a non-profit facility. So all the money that is made goes into the facility. There is a hefty buy in and monthly fee, but if you run out of money they will never kick you out. They have funds to pay for the residents that run out of money. The CNA ratios are 1:7-8 during the day and evening, and 1:15 at night. I love working at this facility, and I know that my residents get the best care around the clock.
  8. by   asun21ta
    Quote from care_baer
    This thread makes me really sad. I couldn't work somewhere if I didn't think I could give the residents adequate care.

    I agree. I actually quite a job I once had at a nursing home for this very reason. The care was horrible. They accepted residents they were not equipped to handle. Short on supplies to the point that you could NOT give proper care no matter how hard you tried. Upset family members. I couldn't deal with it on my conscience and I didn't want to endanger my certificate, so I quite. About a year later, the place was shut down. I agree. The weight of guilt isn't worth it all.
  9. by   mncna08
    Quote from fuzzywuzzy
    ^yeah, that.

    You need to move quickly, be very organized, multitask like crazy, and work with like-minded people, and you'll still miss a lot of things.

    It helps to get as much as you can out of the way early on.

    I work in one section where everyone is total care or needs extensive assistance, and they're all pretty confused. Most of them are 2-assist so the aides have to spend time helping each other with that too. I have 10 residents (a light load compared to some places), they're all incontinent, and I still rush around as fast as I can and I can barely keep up with my rounds and HS care at the same time. I feel guilty about it but I do my best.

    Before I started working over there the other girls got in trouble for getting people washed up and in their nightclothes before supper. We're not supposed to give showers before supper either (I guess because it's they get into nightclothes but I'm not sure), but we do that anyway. I think the DON cracked down on doing HS care early because she thought it was lazy/looked bad to visitors but I'm always tempted to do it anyway because it would make it so much easier to just pop someone in bed after oral care and go change all the wet people instead of letting them lie there in urine because you're too busy washing up/lotioning/transferring other people into bed (who are also wet).
    do we work in the same place? lol i also work where i have 8 total cares( which in comparison is a light load) a lot of them are two person transfers etc and it is also memory care. i have worked there for almost a year *6 shifts a month* and i am now just really getting my time managment down where i can get two showers done and still have everyone in bed in time.I also dont dally around, when its time i get it done! i guess it just takes time. it also depends on how much help you have and what kind of people your are dealing with! good luck either way!!
  10. by   azcna
    Rehab facilities/halls usually have a higher staffing ratio. They want to impress the people that are there so when they need to be in long term care they will come back.

    If you have three hours, and 12 residents you have 15 minutes per resident. 15 minutes is doable, some take less and some take more. Get as much ready as you can ahead of time. I fold down the residents bed, have their linens, brief, toothbrush, powder, all at the end of the bed or in the bathroom. Never be doing nothing. Have the resident wash their face as you brush their dentures. I even get the bags for the linens/brief out ahead of time.

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