I work as a PCA at a ALF, yesterday the daughter of a family member called and was extremely upset, she said that NOONE has washed, dressed, showered, or changed the linens of her father in OVER A MONTH. He is Very HOH and can barly see at all, but he is capable of getting himself dressed, and in AL thats what I was advised to do. We are suppose to let the patient do as much as they can for themselves. As for his shower, we have been low on staffing, and my boss is just finding random PCAs to come in a cover the 7 to 3 shift (i work 3 to 11) Well this random PCA said that he gave this man a shower, signed it in the ADLs, and on our report. I know I gave the man a shower two weeks ago, because the fill in PCA didnt say they did, so I did it when I came in. However, 2 weeks ago, I didnt change his linens, I didnt have time because he is scheduled shower on the 7 to 3 shift. He is a very aggitated patient, might I add, and why I am 'talking' to him I have to scream so he can hear me. I find myself being very short when trying to talk to him, because he cant understand ANYTHING. Also, I went in last night to help him into his PJs, and 'wash' him up, etc, etc. He was already in bed, not in his Pajamas. I tried to get him to change into his pajamas, he got irritated and started yelling at me! I'm not going to FORCE someone who REFUSES. Do you think this could be considered neglect or abuse?? If he blantley refuses to get into his pajamas?
I think the daughter might try to put a hidden camera in the room. Is this legal? We have cameras pretty much everywhere else except in the residents room. It just makes me feel weird knowing someone can see me all the time like picking my wedgie or my nose or something lol.
I know, I hate the way the place is run. I really want to look for a new job, but I have completely fallen in love with all the residents. I wouldnt want them to feel as though I am abandoning them=( I am completely caught between 2 worlds.
Moogie is absolutely right. You need to get out of Dodge now. You can't change the world. You can't even change that small corner of the world where you work. Those statements are not very idealistic of me but it will save your sanity, your health and your license.
I know you feel you are abandoning people who trust you, but what about you? You are stressed and upset. Do you really want to work where you have to document extensively every day to defend your actions? What happens on the day you don't have time to document? Or you overlook something that should have charted? The facility will absolutely throw you under the bus, as other members have posted. Then, you will not only have not "saved" your residents, but you will have damaged your reputation. Looking out for yourself first is hard for nurses to do as we have been trained to put others' needs before our own.
I know, I hate the way the place is run. I really want to look for a new job, but I have completely fallen in love with all the residents. I wouldnt want them to feel as though I am abandoning them=( I am completely caught between 2 worlds.
Obviously their families don't love you(or won't love you back when something happens).
I've worked as a caregiver and Med Aide at an ALF for the past two years. From reading this forum and from my personal experiences, here's what I've come up with:
ALF's are the new nursing homes.
Nursing homes are the new acute care units.
Acute care units are the new ICU's.
Makes you wonder what the ICU's are becoming, doesn't it?
Anytime a patient refuses care the Nurse should be informed. OR....another Aide that may have a special technique for coaxing them into the shower. The Nurse should help the aide out and if that fails. Leave the patient alone for awhile...not too long and try to come back and attempt again. Use reverse pyschology such as "Oh, if we do this tonight you will have more time for the party tomorrow they are having" Or....It will help you sleep better. Usually its best to find out WHEN the patient Takes his shower or bath. Morning , Afternoon or Evening. I try not to upset the apple cart so to speak but I know this may be impossible in todays medical establishments. I always try to put myself in their shoes and visualize myself sitting there being annoyed by a person trying to make me do something. Good luck
I know, I hate the way the place is run. I really want to look for a new job, but I have completely fallen in love with all the residents. I wouldnt want them to feel as though I am abandoning them=( I am completely caught between 2 worlds.
I know how you feel I'm in the process of trying to transfer to a sister facility..it truly is an assisted living(meaning the residents aren't all total care!) & it even pays better too. You have to remember though, no matter how much you love the residents or co-workers, the minute something goes wrong- MANAGEMENT WILL THROW YOU UNDER THE BUS. Look out for yourself first & foremost. Good luck!!
You have to remember though, no matter how much you love the residents or co-workers, the minute something goes wrong- MANAGEMENT WILL THROW YOU UNDER THE BUS. Look out for yourself first & foremost. Good luck!!
very wise advice.
each and every one of us, is expendable.
it's a hard lesson to learn, but something worthy of keeping in the back of your mind.
Specializes in Professional Development Specialist.
I've worked as a caregiver and Med Aide at an ALF for the past two years. From reading this forum and from my personal experiences, here's what I've come up with:
ALF's are the new nursing homes.
Nursing homes are the new acute care units.
Acute care units are the new ICU's.
Makes you wonder what the ICU's are becoming, doesn't it?
And yes, it's all about the $$
I couldn't agree more! I see people we recommended for total care (ie LTC) discharge to ALFs. Someone comes out and "assesses" the patient but often they aren't even a nurse! The last patient really needed a 1:1 person to be sure they didn't fall and guess what, they fell within 24 hrs. Of course they did, the ALF was set up to fail by the person who assessed her as appropriate. The fact that she was on alarms and we ran like crazy every time it made a peep should have been a clue.
OP I don't honestly know that it would be different at another facility. I see a lot of "find a new job" advice in any thread but IMHE that isn't always possible. ALFs take care of people who used to have home health and tons of family support. Now they go to ALF and all the family assumes you will do total care. If they refuse, document. Tell your nurse they refused so they can (hopefully) address it in their notes.
Words to the wise.. I have seen families in LTC mark the sheets with dates to determine if they have been changed or not, so I imagine this would definatley happen in ALF also but the scary part is when I caught a daughter marking sheets with a date 2 days earlier than the actual date, so even if sheets were changed and bath given LTC would have been "wrong!" Some families are wachy and do strange things, perhaps out of guilt or lookinf ro money or just because they are plain old "mean". I always warned my CNA's to be very careful. Sometimes it was a racial or cultural thing. patient loved the CNA but family did not.. Very sad.
I actually resigned once because LTC facility wanted me to lie and say CNA had done many things wrong and she had not..She was not the best but far from the worst . I certified to corporate that mgmt was after this girl then took lots of heat and found myself a new job.. But CNA"s do not count on all mgmt to go to bat for you.
Make sure you report all of these problems to your shift supervisor. Try to find time in a quiet place to explain to the family, with your supervisor present, the inherent difficulties in dressing someone who doesn't want clothes on. Many residents with dementia etc won't keep clothes on - we use micropore tape around their belts etc as they can't figure out how to get it off.
It is very difficult making family members understand the nuances and problems when caring for their relatives. Many relatives haven't cared for these types of patients and don't understand what it is like. They need to be educated.
Don't ever try to stop someone from falling - you will only stuff up your own back and believe me, no-one will care about you after that. Document EVERYTHING to do with this patient in an objective manner - patient agitated and uncooperative, wouldn't keep clothes on, condition deteriorating - unable to ambulate. That way you cover yourself, and the relatives can be shown these notes if possible.
I think the issue is (at least at my work) is that they have Level 4(highest level of care) people living in AL, so they are more vulnerable to falls, etc. Well, these people fall, get sick, and stuff, so they send them to the hospital. While they are still in the hospital, the family is still paying for their apartment in AL (about 6000 a month) then they come back from hospital, they put them in skilled nursing for a few weeks, so the family has to pay for the skilled nursing room PLUS the AL apartment. Its just a circle of events, because these people keep getting sent to the hospital, then to skilled, then back to AL, and so on. So the facility is making BANK. and the residents i take care of are REALLY SUPER RICH people so i dont think they care that they are blowing their money. but its still not right.
Irene,
You are a smart girl and definitely know what is going on . Those residents are lucky to have you please just keep documenting your care is the best thing you can do but I know its wrong . We nurses and PCAs see it all all the time..
Yes, absolutely. I was working in a LTC facility for 4 years. One day the social worker got fired. They never hired another. Then a LPN, then one by one the nurses were being let go with the lame excuse that there was "lack of work" WHAT????? the whole facility got cleared out of the nurses , kitchen manager, and some CNAs. and lucky for the DON she QUIT on her own. SCAREY STUFF.........we were going to put this on the news in the NYC area. Not one nurse is there now that I worked with. No union in LTC facilities for Nurses too. Not good in a way, otherwise they wouldnt have done all this.
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I'm in the process of trying to transfer to a sister facility..it truly is an assisted living(meaning the residents aren't all total care!) & it even pays better too. You have to remember though, no matter how much you love the residents or co-workers, the minute something goes wrong- MANAGEMENT WILL THROW YOU UNDER THE BUS. Look out for yourself first & foremost. Good luck!! 
imintrouble, BSN, RN
2,406 Posts
Moogie is absolutely right. You need to get out of Dodge now. You can't change the world. You can't even change that small corner of the world where you work. Those statements are not very idealistic of me but it will save your sanity, your health and your license.
I know you feel you are abandoning people who trust you, but what about you? You are stressed and upset. Do you really want to work where you have to document extensively every day to defend your actions? What happens on the day you don't have time to document? Or you overlook something that should have charted? The facility will absolutely throw you under the bus, as other members have posted. Then, you will not only have not "saved" your residents, but you will have damaged your reputation. Looking out for yourself first is hard for nurses to do as we have been trained to put others' needs before our own.
Good luck. Take care of yourself.
Good luck.