Culture Change In LTC?

TrickieTam · Feb 6, 2007

The idea sounds wonderful, but it would only encourage lazy staff. Everyone would wait on the resident to say so and all form of routine and order would be tossed in the trash. The residents who can't make a verbal comment would get the short end of the stick.

mercy1975 · Sep 6, 2007

That sounds very nice for ALFs, but LTC needs more routine than that. If you left it up to some residents, they'd NEVER bathe. Either because they don't want to or are unable to make the decision to do so--and eating may be the same way. Some residents are unable and staff would have to be increased by quite a bit to meet the many different demands of people who need assistance with their ADL.
I'm not getting the part about eliminating nurses stations--but I do realize they take away from the home-like atmosphere. But with nothing put aside, LTC is STILL a healthcare environment. Nurses need a place to do their work and what better place than somewhere that all the residents can find help if they need it?

Maybe you still have to have bathing on a schedule but one thing you can do for bathing is to make the experience more holistic. Make the bathing areas into spa like area. Lots of plants, nice pictures on the wall, using epsom salt for a foot soak ( the foot soaking would also be a nice activity.), having low music playing, low level lighting, use a nice bifold screen to cover up the laundry baskets, use a hand massager on their back or feet, etc. Make the bathing experience into relaxing enjoyable experience. This would be one step towards the journey to cultural change.

CapeCodMermaid, RN · Sep 7, 2007

I have to disagree with the whole bath thing. While your idea of soft music, salts, ambient lighting and the like sounds wonderful to ME, you are talking about a generation who didn't bathe as often as we do. They had functional bathrooms not spas...no double sinks , no granite countertops.

Until Medicaid reimbursements go up we won't be able to afford their idea of culture change. The increase in staff alone is prohibitive. And until we will further have to segregate the relatively healthy elders in our care from the subacute population who NEED the medical model we have now because they are quite ill.

mercy1975 · Sep 7, 2007

I have to disagree with the whole bath thing. While your idea of soft music, salts, ambient lighting and the like sounds wonderful to ME, you are talking about a generation who didn't bathe as often as we do. They had functional bathrooms not spas...no double sinks , no granite countertops.
Until Medicaid reimbursements go up we won't be able to afford their idea of culture change. The increase in staff alone is prohibitive. And until we will further have to segregate the relatively healthy elders in our care from the subacute population who NEED the medical model we have now because they are quite ill.

I think even though the residents did not grow up with certain "luxuries,I'm sure we all feel that they deserve all we can give them now. Most residents would love the idea once they had the bathing experience.

I realize that there is never enough money to care for our residents, and homes are always understaffed.

But cultural change happens a step at a time. It seems everyone thinks it needs to happen now and all at once. It will take time and small steps.

Another example is starting to offer residents a selection of meals.

One of our facilities has done this and it is working very well. The residents are given a menu for the next day and can pick from two selections of each food group. This allows them some control and has saved food wastage. The dietary knows how much of each item to cook. The residents love this. They still don't have open hours, but it is a step in cultural change.

Hospice Nurse LPN, BSN, RN · Sep 7, 2007

It all sounds wonderful, but in reality who isn't short staffed? Every evening when I go to work I pray we have enough CNA's show up to work. Our residents are fed dinner at 4:30 and are offered a snack at 6:00 p.m. It's sad to see folks having to get up at 5:00 to shower....again it's due to staffing. There are 54 (half the facility) people to shower before breakfast. There are very few geri pts in our facility (mostly psych), but even still, it's as if they are "warehoused". I worked in the MR/DD field before going to nursing school and there is much more respect and dignity there. I wish more people would keep in mind that we'll all be old someday. Oh well, I know I can't change much, but I can make life a little bit better for the folks I do care for.

mercy1975 · Sep 10, 2007

It all sounds wonderful, but in reality who isn't short staffed? Every evening when I go to work I pray we have enough CNA's show up to work. Our residents are fed dinner at 4:30 and are offered a snack at 6:00 p.m. It's sad to see folks having to get up at 5:00 to shower....again it's due to staffing. There are 54 (half the facility) people to shower before breakfast. There are very few geri pts in our facility (mostly psych), but even still, it's as if they are "warehoused". I worked in the MR/DD field before going to nursing school and there is much more respect and dignity there. I wish more people would keep in mind that we'll all be old someday. Oh well, I know I can't change much, but I can make life a little bit better for the folks I do care for.

State surveyours would have a big problem with residents being gotten up an 5:00 to shower (unless the resident was up or restless, etc and care planned.) They shoud not be awaken before 6 AM just to get cares done. Administration will figure it out once they get tagged. Never hurts for someone to "mention it" to a surveyor while they are asking you questions.

Sorry to hear management wants it that way. You sound like a very caring person. Thank goodness the residents have you!!

CapeCodMermaid, RN · Sep 10, 2007

State surveyours would have a big problem with residents being gotten up an 5:00 to shower (unless the resident was up or restless, etc and care planned.) They shoud not be awaken before 6 AM just to get cares done. Administration will figure it out once they get tagged. Never hurts for someone to "mention it" to a surveyor while they are asking you questions.
Sorry to hear management wants it that way. You sound like a very caring person. Thank goodness the residents have you!!

Oh please ! "Mention it to the surveyor"....You should be working WITH management not whispering to the surveyors behind their back. Don't you realize that ANY care issues reflect on YOU.

mercy1975 · Sep 11, 2007

Oh please ! "Mention it to the surveyor"....You should be working WITH management not whispering to the surveyors behind their back. Don't you realize that ANY care issues reflect on YOU.

I was responding to the quote that stated management did not respond to staff's concern regarding getting residents up at 5am. I agree you should be working with management. But when management fails you and you have tried all other avenues, there is still another opportunity to help the residents. If the facility received a tag they may change their ways so the poor residents do not have to suffer.

Dixiecup · Oct 29, 2007

We are implementing some of the changes now.

The way we did the "get up when you want to" thing is we interviewed each resident (the ones who were cognitively impaired, we interviewed family members to see what their routine was like earlier in their life) and asked what time they would like to get up in the morning. Then we made a list of all the times and that is when they were assited with getting up.(in other words, they just couldn't choose a different time each day but they could pick a later time than they were getting up now.)

We are trying open dining for breakfast only right now. From 7am-9am. There are menus on the table and we take their order every day and they can pick from virtually anything on the breakfast menu. The residents seem to really like this.

We just ripped out our old nursing station that was, as someone put it, right in the middle of their living room. We still have a nurses station but it was moved to an office room out of the way.

Haven't tackled the shower issue yet.

We are taking it little steps at a time and it hasn't been to bad.

Hellllllo Nurse, BSN, RN · Oct 29, 2007

If these changes are to be successful, LTC facilities need to markedly increase staffing, and spend a lot more money. But we know they won't.

The culture change will fail. More nurses will leave. The suits will spend millions of dollars on consultants and studies trying to figure out why.

Sorry to be so negative, but this is what I think will happen.

(BTW- I am not talking about any one specific unit. Some individual units do provide good care. I'm speaking of the LTC industry in general).

Hellllllo Nurse, BSN, RN · Oct 29, 2007

State surveyours would have a big problem with residents being gotten up an 5:00 to shower (unless the resident was up or restless, etc and care planned.) They shoud not be awaken before 6 AM just to get cares done. Administration will figure it out once they get tagged. Never hurts for someone to "mention it" to a surveyor while they are asking you questions.
Sorry to hear management wants it that way. You sound like a very caring person. Thank goodness the residents have you!!

I have worked at facilities where residents are gotten up @0400 for showers. This is with a "fully staffed" unit. What mgmt considers fully staffed, and the number of staff required to actually provide good care are two totally different numbers.

Hellllllo Nurse, BSN, RN · Oct 29, 2007

I tried. I got fired.

I have eight years in LTC- as a CNA, then LPN, and finally RN.

In my experience, any nurse who voices her concerns about residents, talks about things that need to be improved, or tries to be proactively involved in improving care in LTC, is labled a trouble maker, is seen as a threat by mgmt, and will be forced out.