Department heads yippeeee!

oramar · Nov 24, 2007

If I talk about this subject I will get overly emotional and my blood pressure will go up.

NurseCherlove · Nov 24, 2007

Money is the biggest problem with LTC. So tired of administration trying to make a buck and screw the patients. Anyway on to other topics. That is all. Feel free to discuss.:trout:

I wonder if there are any forums out there where administrators discuss how no one understands just how hard they have it and why everyone thinks they are so greedy and disgusting?

Another thought...Couldn't you just hear this in an interview for an admin position: So, do you think there is any shame in our business trying to make a profit? After all, isn't that the main objective of all businesses?

I guess I just wonder sometimes how these people sleep at night. Do they just go into some sort of denial mode after accepting such positions? Guess you'll like never hear someone say, "I'm damn proud to be an administrator."

abooker · Nov 24, 2007

I work for a non-profit LTC. I hope our residents and their families don't feel abused or neglected.

We lose about $30 per day on our Medicaid patients, but their care is as good as private payers, sometimes better. A resident who is getting a chest x-ray for free tends not to hesitate, while one with out-of-pocket expenses might delay treatment by waiting to see if that pesky wet cough goes away on its own.

From my perspective, a huge problem with Long Term Care isn't that we're dealing with limited resources (and who in health care isn't?) but that LTC has this nasty reputation. Residents and families come in and scrutinize us, looking hard for evidence that administration is "trying to make a buck and screw the patients."

LTC is the most highly regulated industry in my state. If things really are bad in the industry, I'd like to hear some suggestions (other than more regulation) for improving things. I think most homes do a darned good job - otherwise I wouldn't be working in this area.

NurseCherlove · Nov 24, 2007

I work for a non-profit LTC. I hope our residents and their families don't feel abused or neglected.
We lose about $30 per day on our Medicaid patients, but their care is as good as private payers, sometimes better. A resident who is getting a chest x-ray for free tends not to hesitate, while one with out-of-pocket expenses might delay treatment by waiting to see if that pesky wet cough goes away on its own.
From my perspective, a huge problem with Long Term Care isn't that we're dealing with limited resources (and who in health care isn't?) but that LTC has this nasty reputation. Residents and families come in and scrutinize us, looking hard for evidence that administration is "trying to make a buck and screw the patients."
LTC is the most highly regulated industry in my state. If things really are bad in the industry, I'd like to hear some suggestions (other than more regulation) for improving things. I think most homes do a darned good job - otherwise I wouldn't be working in this area.

Frankly, I was speaking more from the hospital point of view. Moreover, I was really thinking more about the perspective of nurses/working conditions. Sorry, got a little off from the original topic (screwing the patients directly). I guess I was thinking more along the lines of patients getting screwed when they have a stressed out nurse who is spread too thinly. Thus, I suppose I just enjoy chiming in anytime there is a vent about administration (in general).

abooker · Nov 25, 2007

A stressed-out nurse who is spread too thinly can't be good for patients/residents in any context, LTC or Hospital or anywhere, really. My own administrator toilets residents and answers call lights as needed, so I'm a bit protective of *my* administrator, but I'm with you in not understanding how some folks sleep at night.

I don't know what can be done.

Can't join unions:

https://allnurses.com/forums/f100/split-decision-nurses-lose-crucial-ruling-union-representation-but-win-right-7852.html#post37157

Can't engage in whistle blowing:

http://www.nursinglaw.com/Nov07PageOne.pdf

It's not even a USA thing:

http://www.freedomtocare.org/page73.htm

Are there any differences in for-profit and non-profit hospitals? I think there might be, in LTC.

IMHO there's a myth that administrators (in general) can "trim the fat" from their budgets by "reducing staffing costs". One problem I've seen is managers listening to consultants or colleagues more than to their own employees. If an employee voices an actual concern, he or she risks being branded as "resistant to change" or "not a team player" and bad things can happen.

I cringe at the "us vs. them" language, like "Nurses vs. Administration", but there are real problems ...

NurseCherlove · Nov 25, 2007

My own administrator toilets residents and answers call lights as needed ..

Now THAT is quite unusual. Given the state of affairs these days, I guess I would feel a bit protective too.

Simplepleasures · Nov 25, 2007

I work for a non-profit LTC. I hope our residents and their families don't feel abused or neglected.
We lose about $30 per day on our Medicaid patients, but their care is as good as private payers, sometimes better. A resident who is getting a chest x-ray for free tends not to hesitate, while one with out-of-pocket expenses might delay treatment by waiting to see if that pesky wet cough goes away on its own.
From my perspective, a huge problem with Long Term Care isn't that we're dealing with limited resources (and who in health care isn't?) but that LTC has this nasty reputation. Residents and families come in and scrutinize us, looking hard for evidence that administration is "trying to make a buck and screw the patients."
LTC is the most highly regulated industry in my state. If things really are bad in the industry, I'd like to hear some suggestions (other than more regulation) for improving things. I think most homes do a darned good job - otherwise I wouldn't be working in this area.

You have one year of experience, I hope that you are able to keep this positive attitude after 30 years in LTC.

Simplepleasures · Nov 25, 2007

Are there any differences in for-profit and non-profit hospitals? I think there might be, in LTC.

In my almost 30 years in LTC I have worked in both for profit and in non profits, there is not much difference, even in non profits the CEO is given bonuses for keeping costs down and staffing is the first to suffer.I have also seen principled nurses retaliated against by non profit LTC management. LTC's cannot operate in a manner that is conducive to both the nurse and the resident until nurse patient staffing ratios and stronger retaliation protection laws are mandated. I know you dont want to see more regulation, but in REALITY, doing the right thing for the resident and the employee will not happen if we expect the owners and management to do it. Profit IS the bottom line and dont buy the "we are losing money" baloney. The LTC industry is still a multi billion dollar a year industry and wont get any sympathy from me.

sharlynn · Nov 25, 2007

Now THAT is quite unusual. Given the state of affairs these days, I guess I would feel a bit protective too.

In the facility I worked at last, the administrator and the DON toileted, answered lights and gave baths when necessary!

Boopette RN · Nov 28, 2007

i guess i am very lucky that my facility puts the residents first. that is because we are the county home, and 98% of our resident are on public aid. our don does not mind spending money on things that make the resident's life better. we have drawings called 50 50 where you donate a dollar and your name is put in the jar, 1/2 the proceeds go to the activity department and the other 1/2 to the winner, sometimes the pot has been as large as $150.00. i am the in-service director and i still work the floor when ever needed on all three shifts. another aspect of our department heads i have to share is we have an employee who has been off work for several months and now he has to pay for his own health insurance, he currently is in a coma, they started a fund to cover his premiums and to help out his family and this is not the first time they have done this. our don and administer have been at this facility for at least 12 years. our staff, even though we still have problems, are really one big family

Nascar nurse, ASN, RN · Nov 29, 2007

I have kindly refrained from responding to this for several days... but my mouth is about to over ride my good sense. I only hope someone will come along to stick up for me. (Get your flames ready people). (Side note.. I am not and have never been an administrator or DON)

1. I 100% agree it is disgraceful to not adequately care for our elderly folk. It is our legal, moral and ethical responsibility to do so. As a department head (and like all other department heads in my facility) I do hands on care, toileting, feeding, transfers, etc nearly every day. There is a part of me that does agree we should have mandated care ratios in place to protect elderly from bad corporations.

BUT... BUT.... BUT

2. Health care IS a business. The purpose of any business, be it KMart, the local grocery store, or many health care facilities, etc is for someone to make a profit. If nobody ever worries about the profit margin, eventually that business will be forced to go out of business.

3. Most LTC facilities in todays market are corporation owned and managed. The administrator may be the highest on the "food chain" that you actually see on a day to day basis... but reality is that person is often just a more glamorized/fancied title pee-on like the rest of us. If they do not make the budgeted bottom line in profits then they get canned. That IS their responsibility just as much as it is to provide quality resident care. So please consider yourselves lucky if you have someone in that position that has found the key to pleasing corporate and budgets as well as having compassion for the residents. It is a very fine line to walk and easy to get kicked off! Trust me, it is not your administrator pulling the budget strings... it is way above them to.

4. Health care waste. How many of you walk out of your facility every day without turning in EVERY charge stickers for all the dressings, syringes, etc that you have used. How many of you got caught up in conversation with coworkers during your shift and then needed to finish up on overtime because of this. I'm sure 90% of those reading this have "wasted" money or time within just the past week - it tends to be human nature. BUT... someone has to be accountable for this and someone HAS to control this.

Ok. I'm done for now. Please don't kill me