Do LTC nurse-resident ratios reflect how society feels about the elderly?

realnursealso/LPN, LPN · May 15, 2010

I guess I would agree with you, although I also think it has to do with the bottom line; MONEY. When I first started 30 years ago, it was mostly the rule that one nurse did meds, charge, and treatments for 40 residents. It was doable, no such thing as nurse managers, ect. I was able to complete all my duties, have my lunch, and take my breaks. When things made an abrupt change, people were sicker, more paperwork, all these extra upper staff were added, they continued for a while to work LPN's to death. Using the old adage, you've always had 40. While technology advanced, more complex patients were admitted to "nursing homes", and medications continued to increase, they still tried to work LPN's to death. Finally some LTC's as they were renamed, began to see the folly of the expectations they had for a workload that was impossible. In my area this happened maybe 10 years ago. Some places cut floors in half, and you have 20 residents. But these staffing situations are still few and far between. Alot of emphasis has been placed on staffing ratios in hospitals, and little continues to be done in LTC"s. I am going to mention something, and it is in no way a flame to anyone. LPN's have long been looked upon as the workhorses in LTC settings. Upper layers continue to be increased, instead of the "frontline" caregivers. Not enough nurses aides or LPN's. I see a trend starting from some areas, and I am very glad, because staffing issues are finally starting to be addressed, but I also notice a trend for new RN's getting jobs in LTC's that were tradionally held by LPN's, because the job outlook for new grad RN's, is so bleak. Wow, trying to say this nicely, for years, "We got no respect". I do believe that these unrealistic staffing ratios have everything to do with the "bottom line", MONEY. LTC's have gotten away with this for years, maybe we can change this together!

fuzzywuzzy, CNA · May 15, 2010

I think they reflect how society feels about nurses and CNAs.

Moogie · May 15, 2010

As a nurse who previously worked in long term care, I chose to leave the field because I felt that the nurse-resident ratio was too high to provide quality care. I'm sure not all facilities are like the ones I am familiar with, but I was given 24-28 residents every day. The population was a mix of general LTC and sub-acute rehab (patients needing therapy to recover from an illness or surgery lasting several weeks to months), and many I felt needed more nursing care than I had time to provide. Not long before I left, the corporate office began to push a new initiative to treat residents in house for pneumonia, UTIs, and other common infections with IV antibiotics, rather than send them to the hospital. This meant many more IV starts for the 1 RN in the building per shift (the rest were LPNs who could not start IVs or hang the first dose of IV antibiotics).
Nurses can debate the problems of LTC all day... I want to know if nurses feel that the current situation of LTC, particularly nurse-resident ratios, reflects how our society values the elderly?

If corporate is going to push initiatives for treating sick residents in house, then they need to back up those initiatives with more nurses. If the facilities are in states that limit the scope of practice for LPNs, corporate needs to make sure there is RN coverage. Don't just substitute RNs for LPNs. Add more nurses. Period.

And don't cut back on the nursing assistants. Maybe they could spend more time----God forbid---talking with the residents! Doing the little things that add to the quality of life of the people who are in LTC. But no---if the Powers That Be catch a nursing assistant doing something as "wasteful" as conversing with a resident they start cutting staffing. They pay people to work, not to chitchat! :madface:

I agree with realnursealso/LPN that it is all about money. LTC is expensive but what do people get for their money? They might see the nurse for 2.4 minutes a shift while he/she is doing a med pass. Maybe they don't even see a nurse. Why hire an LPN if a medication aide is cheaper? Nurse assessments? Honestly, if these weren't required by the state, would they get done? When does the nurse who is passing meds have time to complete assessments? The only time many residents get assessed by a nurse is if there is a problem---if they fall or get sick. Otherwise, forget it. There's no time and that is utterly WRONG.

It is amazing to compare the staffing ratios in subacute and LTC with acute care. Granted, the acuity in subacute and LTC is not what it is in acute care but it boggles the mind to think how delirium and dementia contribute to higher acuity (which SHOULD translate to more nursing care) in a hospital but seem to make no difference in LTC. It doesn't matter if there are 40 people who are A & O x 3, up without assist, and don't need to be fed but the staffing is the SAME if there are 40 people who are confused, combative, need assist of two and are complete feeders. The staffing remains the same.

I definitely think this is indicative of how our society puts some of its most vulnerable members out of its mind. But it's also indicative of how little society values the contributions of those who take care of the vulnerable. CNAs, LPNs, even RNs are considered as disposable as three-day old Chux in most LTC facilities. Wages are poor, staffing is worse, and anyone who tries to affect change is told to get out of Dodge on the next available horse. Administrators, especially at the corporate level, wax nostalgically when they talk about the "service" they provide to the elders of our society while making damned sure that the priority is the bottom line rather than the condition of the bedsores on some 98-year-old's bottom.

Really makes a person wish that karma comes and gets these people where it counts. How many CEOs of nursing homes would want to be residents in their own facilities?

SuesquatchRN, BSN, RN · May 15, 2010

I think tha they reflect that health care is a limited resource and a very small population that is increasing daily consumes a great proportion of it at government (read: us) expense.

husker_rn, RN · May 15, 2010

Seems like we are good at lip service about caring for kids and the elderly but unfortunately we seem to fall short on actually delivering many times.

kcochrane · May 15, 2010

I think they reflect how society feels about nurses and CNAs.

I agree. I think that the residents coming in have a higher need. It isn't just your general geriatric patient. We as a society have a real issue with realizing when the end is near. We try at all costs to delay that - even at the expense of that resident. Used to be if you stopped eating at 90, you were allowed to die. Now we stick a g-tube on you and let you linger for years. Unfortunately I don't think facilities are keeping up with thesw times we created. These residents need more treatments, more meds and more ADL care. You need more staff to take care of these type patients. But the admins either don't care, don't have the money or haven't figured it out. It is taking a toll on both staff and residents.

Moogie · May 15, 2010

I agree. I think that the residents coming in have a higher need. It isn't just your general geriatric patient. We as a society have a real issue with realizing when the end is near. We try at all costs to delay that - even at the expense of that resident. Used to be if you stopped eating at 90, you were allowed to die. Now we stick a g-tube on you and let you linger for years. Unfortunately I don't think facilities are keeping up with thesw times we created. These residents need more treatments, more meds and more ADL care. You need more staff to take care of these type patients. But the admins either don't care, don't have the money or haven't figured it out. It is taking a toll on both staff and residents.

If I could give you a dozen kudos for this post, I would.

The other thing contributing to acuity is that facilities need to be able to fill their beds in order to run more efficiently. Unfortunately, that means that many will accept residents whose needs are more complex than they can realistically handle with the staff they have. They don't want to hire more staff because that means their costs increase.

I think many administrators genuinely do not know and are relying on outmoded models and perceptions of nursing care. Those who are nurses have been away from the floor for so long they haven't an idea of how things have changed. Some, particularly facilities that may be owned by municipal or county governments, don't have the money to make changes even if they want to.

But many do not care or at least they give the impression that they do not care, which is demoralizing.

TDCHIM · May 16, 2010

This is an excellent question! I guess I have a follow-up to it: do you think there will be a big push to improve staffing/resident ratios as the boomers age and become candidates for LTC facilities? Or will the big emphasis be on trying to do everything even remotely possible from the individual's home using home health nurses and equipment/medication previously only seen in skilled nursing facilities?

Ruthiegal · May 16, 2010

No it reflects how the LTC owners feel about money!

makes needs known · May 16, 2010

I wonder if family members of patients read this discussion, what would they think? I know they don't realize what caring for their mom/dad and the 40 other patients entails. The ever increasing paperwork and the patients with a grocery list of diagnosis, make it almost impossible. Too many rules and problems that have to be dealt with. People have needs and sick people have even more needs. If the ratio were better the caring would be easier and more personal, but the way it is, some nights I feel lucky if I make it out alive.:)

kcochrane · May 19, 2010

If I could give you a dozen kudos for this post, I would.
The other thing contributing to acuity is that facilities need to be able to fill their beds in order to run more efficiently. Unfortunately, that means that many will accept residents whose needs are more complex than they can realistically handle with the staff they have. They don't want to hire more staff because that means their costs increase.
I think many administrators genuinely do not know and are relying on outmoded models and perceptions of nursing care. Those who are nurses have been away from the floor for so long they haven't an idea of how things have changed. Some, particularly facilities that may be owned by municipal or county governments, don't have the money to make changes even if they want to.
But many do not care or at least they give the impression that they do not care, which is demoralizing.

Filling beds..the common theme for LTC and hospitals.