Do you work in a Neighborhood/Household LTC model?

[withasmilelpn]

I work at a retirement community that plans on converting from a traditional LTC setting with a central nursing station and halls to a Neighborhood model. In this model, there are households of 10 -11 people centered around a kitchen. The nursing assistants prepare dinners, help with meals and Nurses are expected to help also - with tasks like cleaning the kitchen. Does anyone work in a community like this? Does it work? How many patients do you have? Right now I have the same amount of patients I believe I will have once the construction is complete. I don't see how I'll have time to do extra duties in addition to our charting requirements and nursing duties and we are better staffed than most nursing homes. I love primary care, I have no problem with the new model if it's feasible. But it sounds frustrating. I've been at this a long time and there is no question LTC needs to change- but is this the way to go? From what I've read, communities like this are boasting less staff turn around and higher staff satisfaction, but they are relatively new, so I'm not sure time will prove them effective. I'm a but nervous frankly. Ours is a good home, the residents are taken well care of, unlike others I've been in. I would so hate it to be a change for the worse! Foes example if the CNAs are stuck cooking, whose toileting? Etc, Etc. Do things get done timely. The meds in the room are good, but not having my unit clerk handy is - stuck in an office away from us is going to be difficult to say the least. Thoughts? Advice?

[withasmilelpn]

Sorry for the errors - can't correct properly on an iPhone!

[CoffeemateCNA]

My facility is in the process of doing this as well. Not only do we have our regular nursing duties to do, but they have also stuck us with all housekeeping, laundry, and maintenance. In the near future they plan to do away with our dietary/main dining room model and place a dining room on each hall while having nursing responsible for cooking meals.

Just having the additional housekeeping and maintenance duties is an absolute fiasco. I feel like a jack of all trades. They seem to be constantly switching around the way they schedule nursing. Sometimes they will schedule each person from nursing (CNAs AND nurses) to do one task for the whole shift. Other times, they have us vacuuming, then answering call lights, then plunging toilets one right after the other (can someone say "cross-contamination?"). So far we don't really have any additional staff either (just one or two people here and there).

The whole thing sounds great in theory, but in real life, it sucks. I don't know how well things will go over when management hands CNAs and nurses some spatulas and expect us to flip burgers in between toileting residents and passing meds. It's not that I'm completely against doing these additional tasks, it's just that when I become I CNA I envisioned myself doing more "nursing"-type duties. If I wanted to cook for people, I would have opened my own restaurant.

[withasmilelpn]

Reviews on these communities focus on the relationships being built between staff and residents in a more homelike atmosphere, but I wonder how much of it is really a cost saving measure. I don't have a problem with people sleeping until when they want and food being served when they want it- but what's wrong with having a residential 24 hour chef? Many of my residents actually had household cooks- many are from wealthy backgrounds. I worked as a homecare nurse for a wealthy women who had me, a cook, a housekeeper and a groundskeeper. No one was expected to do everything. It sounds like they want 'mothers' - and I don't know about you , but I'm pretty stressed out as a mom with all my hats and I don't have all those charting/legal requirements that come with my duties. And I only have 3 mostly healthy kids! For me, the jury is out.

[SuesquatchRN, BSN, RN]

I love the model but it sounds as if these facilities are using it to decrease staffing at the same time. There is no earthly reason aside from budget to do away with housekeeping and dietary and have the cooking done on the unit. And what of all those people on specific diets? While I think it's nonsense to keep a salt shaker away from someone who can't taste anything but salty and sweet until I have clearance to give a CHF or HTN person that shaker I ain't.

We couldn't do it in our current building.

[malem]

I worked in one of the first places to change over in my area. They got rid of the housekeepers as well. It was a nightmare for the cna's and the turnover was really high after that. To answer your question "NO ONE is toileting" They are taking out the garbage and cooking and the residents sit in urine.

[Forever Sunshine, ASN, RN]

I worked in one of the first places to change over in my area. They got rid of the housekeepers as well. It was a nightmare for the cna's and the turnover was really high after that. To answer your question "NO ONE is toileting" They are taking out the garbage and cooking and the residents sit in urine.

Which is why I don't like the idea of this. Residents care will be compromised while the nursing staff has to bake cookies.. Its not- "home like" at all. Its going to cause UTI's, skin breakdown, increased falls, possible injury etc.. all because some higher up wants the nursing units to look more like a "house"

I am all for making the place look nicer and upgrades and remodeling. But our focus is the care of the resident.. and it requires multi-disciplines to make that happen.. from housekeeping to nursing.

[TakeOne]

I love the model but it sounds as if these facilities are using it to decrease staffing at the same time. There is no earthly reason aside from budget to do away with housekeeping and dietary and have the cooking done on the unit. And what of all those people on specific diets? While I think it's nonsense to keep a salt shaker away from someone who can't taste anything but salty and sweet until I have clearance to give a CHF or HTN person that shaker I ain't.

We couldn't do it in our current building.

I still can't understand how the model is supposed to work successfully when it flies in the face of survey protocols, food handling and commercial kitchen regulations, environmental and life/safety regulations, etc. I have seen the milieu done with great results on locked dementia units but housekeeping/laundry was still provided by the facilities and food still came from the facility kitchens prepared to order and portioned out according to dietary guidelines by kitchen staff. I was done to keep things quieter for the people with dementia and it worked well for them (except we still had the problem of how to keep them from getting on the elevators when kitchen and housekeeping moved their big carts on and off the units ).

[SuesquatchRN, BSN, RN]

No elevators here. Rural. I think a big problem is that many of these units are being carved out of older buildings that were never designed to keep medically fragile demented people safe.

The way the OP and others have described implementation it's a half-assed method to use the best model - which it is - while cutting personnel. Give with one hand, take with the other.

[Neveranurseagain, RN]

Does this mean that every one who cooks is going to have a food service handlers card? Not everyone practices safe cooking practices...

I like the idea in theory and I think it would work, but I see it as a cost cutting technique, which doesn't have the residents best interest at heart.

[Not_A_Hat_Person, RN]

Reviews on these communities focus on the relationships being built between staff and residents in a more homelike atmosphere, but I wonder how much of it is really a cost saving measure.

The ALF where I worked decided to assign aides and nurses to serve meals in the dining room, instead of replacing servers. The servers made less than the aides, and a lot less than the nurses, so I don't see how that saved money. They also expected the nurses to pick up serving on the fly, instead of training them. It just made things harder on everyone.

[SuesquatchRN, BSN, RN]

The ALF where I worked decided to assign aides and nurses to serve meals in the dining room, instead of replacing servers. The servers made less than the aides, and a lot less than the nurses, so I don't see how that saved money. They also expected the nurses to pick up serving on the fly, instead of training them. It just made things harder on everyone.

Of course it saved money. No servers, one more task added to the nurses and aides.