Any LTC DONs out there??

sinead · Apr 26, 2002

I WAS A DON OF A 120 BED FACILITY IN WISCONSIN. AS FOR RETENTION THE BEST WAY TO RETAIN IS TO GET THE STAFF INVOLVED. I HAD ONE PERSON FROM DIETARY,HOUSEKEEPING,NURSING(CNA),AND MYSELF COVER THE ISSUES THAT WERE FRUSTRATING THE STAFF. YOU KNOW THE STUFF NO ONE EVER TELLS YOU.. AND IT HELPED THE STAFF FEEL IMPORTANT AND THEY ACTUALLY CAME UP WITH WONDERFUL IDEA'S ON RETENTION AND RECRUITMENT. THE MOST IMPORTANT PART WAS I WAS NOT THERE TO RUN THE MEETING I HELPED THEM FIGURE OUT DETAILS AND BUDGET CONCERNS BUT THEY RAN IT AND KEPT MINUTES THAT THEY DISTRIBUTED TO ALL STAFF. THEY ACTUALLY CAME UP WITH A MENTORING PROGRAM FOR NEW STAFF THAT HELPED RETAIN NEW HIRES BY 50 % OVER A 6 MONTH PERIOD. THE BEST PART WAS THAT THEY BECAME SO INVOLVED IN THE COMMITTEE THAT EVENTUALLY I DIDN'T HAVE TO ATTEND.THEY WOULD HOLD THE MEETINGS AND ASK FOR FINAL APPROVAL FROM ME WHEN THEY HAD A GOOD IDEA..

ALSO THE BEST WAY TO GET WHAT YOU WANT FOR THE NURSING DEPARTMENT IS FIRST PUT IT IN WRITING(AND ALWAYS KEEP A COPY) THEN CITE THE REGULATIONS THAT THE FACILITY WILL BE CITED ON IF NOT IN COMPLIANCE AND COST OUT A CITE VS OBTAINING THE EQUIPMENT. THIS USUALLY WORKED FOR ME,IF IT DOESN'T THEN AT LEAST YOU HAVE PROOF THAT YOU DID ATTEMPT TO RECTIFY THE PROBLEM

KlareRN · Apr 26, 2002

Hi- I was a DON in long term care for several years and now do consulting work. I work for the same company but now I go to our facilities and support/assist the DON with problems, concerns, audit charts for legal issues, help them set up programs, etc.... I have to admit this consulting job is MUCH easier than being in the trenches....it is easy to go in and tell the DON what is wrong and not have to stick around to fix it!!! (Just check up on it my next visit!) Seriously, I do help to get things implemented...I'm not as cold as that statement sounded! I do not miss being a DON at all. I have found out that the "corporate" nurses/consultants lose touch with reality very quickly. It is easy for us to say "just get it done" and walk away. I try to remind my peers that the DONs spend much of their day putting out fires that pop up all over the facilities. Even if they have a list of things to do when they get to work- chances are the same list (with more added) will be waiting for them the next day. Good DONs are hard to find and alot of the good ones burn out because of the stress. I am in Indiana and several facilities are looking for DONs and can't get anyone to take the job! I think being a DON is the hardest job there is in a long term care facility-most administrators say they would never be a DON!

I think this board is a good support system. A good place to share ideas, solutions, and vent!! We are all in this together with one goal in mind...to provide care that will enhance the quality of life for those we love.

To all the DONS and ADONS out there- keep your chin up. You are the heart and backbone of your facility and they could not do it without you!

ltcconsultant · Dec 17, 2007

This is to those of you have either eliminated CNA documentation or reduced to the bare minimum (meal consumption and BM): Have you noticed any adverse effects from it? Also, has anyone tried cutting nursing documentation down to the bare minimum?

marymack57 · Dec 17, 2007

We seem to be getting more documentation...not less. With all the assessments and risk scales, its daunting.

ltcconsultant · Dec 17, 2007

I was at a MDS training session with Andrea Platt two years ago and one of the things she mentioned is that a lot of the assessments being done are redundant because they are already included as part of the MDS. I did look this up in the RAI manual and lo and behold, it said it too. The RAI manual says that completing a mini-mental status exam is "a poor use of time" because there is already a cognitive assessment on the MDS. There is also a falls assessment on the thing to, and RAPS can be used as an assessment tool because there is absolutely nothing that prohibits a RAP from being filled out before it is triggered. The QIO put up audio files of this session on the internet; I'll post a link if anybody's interested. I also want to know if anybody has actually done this at their facility.

OneThunder, BSN, RN · Dec 17, 2007

We seem to be getting more documentation...not less. With all the assessments and risk scales, its daunting.

Its a game. Medicare doesn't want to pay, so they cite the nursing homes.On a patient care issue, when in reality, it is a matter of something not being documented. The nursing homes draw up a plan of correction which, 99% of the time includes MORE documentation. And with a corporation,if nursing home xyz in MIchigan gets a cite for something, the abc nursing home owned by the same corporation has to initiate that new documentation. The bottom line is it costs more to take care of a resident than what Medicare is paying. How can a nursing home hope to compete with hospital wages for RNs? So everyone must spend their time documenting instead of taking care of the residents.

CapeCodMermaid, RN · Dec 17, 2007

I'm a fairly new DNS but have been in the business for most of my 25 years as a nurse. A question to those of you who don't do ADL flow sheets: How the heck do you get paid?

In Massachusetts the medicaid patients are paid for using the ADL flow sheets to formulate a summary which gets turned into an MMQ ...the patients get points based on how much care they need and the points all have a dollar value.

How in the world do you do MDSs without ADL flow sheets?

I know Massachusetts has more regs then any other state,but I don't understand how all y'all operate without documentation.

I have been at my facility only since July and I can honestly say I love going to work every day. We have finally developed a team of people who have the residents' best interests at heart, and an administrator who doesn't mind spending money if we tell her we need it for the patients.

We have 135 beds and are owned by a small (6 facility) corporation.

OneThunder, BSN, RN · Dec 18, 2007

I'm a fairly new DNS but have been in the business for most of my 25 years as a nurse. A question to those of you who don't do ADL flow sheets: How the heck do you get paid?
In Massachusetts the medicaid patients are paid for using the ADL flow sheets to formulate a summary which gets turned into an MMQ ...the patients get points based on how much care they need and the points all have a dollar value.
How in the world do you do MDSs without ADL flow sheets?
I know Massachusetts has more regs then any other state,but I don't understand how all y'all operate without documentation.
I have been at my facility only since July and I can honestly say I love going to work every day. We have finally developed a team of people who have the residents' best interests at heart, and an administrator who doesn't mind spending money if we tell her we need it for the patients.
We have 135 beds and are owned by a small (6 facility) corporation.

w

A few years ago, I heard of one nursing home nurse that told me that they made their policy and procedures say "it is our policy to bath residents twice a week"...etc. This way, if surveyors ask, they say "it is our policy"

I'm not sure how that flew....

marymack57 · Dec 18, 2007

w
A few years ago, I heard of one nursing home nurse that told me that they made their policy and procedures say "it is our policy to bath residents twice a week"...etc. This way, if surveyors ask, they say "it is our policy"
I'm not sure how that flew....

Our biggest problem is we DON'T get paid for the work we do. Our state has 2 designations for Medicaid reimbursement. Low and High. Its danged near impossible to get the High level. Doesn't matter if they are total care for aides, and frequent hard care for licensed nurses (ie: trachs, colostomy, SP cath, respiratory therapy, etc.) if they are stable, we get low reimbursement, no matter how much time or effort it involves. Sad state of affairs in New Mexico. And we require CNA documentation of ADLs, mood, etc. daily.

OneThunder, BSN, RN · Dec 19, 2007

Our biggest problem is we DON'T get paid for the work we do. Our state has 2 designations for Medicaid reimbursement. Low and High. Its danged near impossible to get the High level. Doesn't matter if they are total care for aides, and frequent hard care for licensed nurses (ie: trachs, colostomy, SP cath, respiratory therapy, etc.) if they are stable, we get low reimbursement, no matter how much time or effort it involves. Sad state of affairs in New Mexico. And we require CNA documentation of ADLs, mood, etc. daily.

I feel for you. When I was in LTC, our state had ONE payment for medicaid, no matter what the intensity of care. Facilities were closing their doors, they couldn't afford to provide care. The state was actually offering grants to facilities if they would provide vent care to chronic patients. Not too many took them up on the offer, the money wouldn't cover the cost of 24/7 respiratory therapists or the needed renovations to the buildings to have in wall 02. So they had to up the payments. They went to a kind of RUGS program like medicare. It looks good from the onset, but then documentation entered the picture. The care all had to be documented, taking time away from the bedside. I'm talking serious documentation, pages and pages per shift. And of course flow sheets had holes in them, and who the heck has time to read the care plan? I don't know for sure, but I'd be willing to bet, the facility who had the happiest, healthiest residents, has the lowest amount of documentation. Somehow it just doesnt seem right that a DON has to write up staff that tenderly cares for the residents, they just don't write it down correctly. And you get written up enough, you gotta go. And the facility just lost a golden caregiver. There has to be a better way.

marymack57 · Dec 19, 2007

bet, the facility who had the happiest, healthiest residents, has the lowest amount of documentation. Somehow it just doesnt seem right that a DON has to write up staff that tenderly cares for the residents, they just don't write it down correctly. And you get written up enough, you gotta go. And the facility just lost a golden caregiver. There has to be a better way.

I agree. The fact that our residents are high care, but very seldom have complications should be enough of a "document" for anyone. I have a trach patient, who has been with us for seven years, and has never had one respiratory infection or trip to the hospital, has never developed a decub, even though he is in a persistent vegetative state, and even had his acne treated with high end medications when he was still a teen. Do we get compensation for the hours we put into the care of a young man that has no other caregiver? Nope, can't even get high rate of reimbursement for his care, because we keep him to stable. Do we have time for the "above and beyond" for him? Nope, not that either. Who in the world has time for massages, tactile stimulation, or relaxation therapy?

Oops, you got me started. I won't even go into why the state can't tap into Medicare MDS's for a picture of what we do for all patients so we can cut some of that dreaded documentation in half...that's ANOTHER subject, I guess