I work in ICU. Time and time again I have gotten an admission from a NH were the patient looks as though they've been left to rot in a corner until someone finds them in such an awful state that they call EMS.
Now please dont think I'm saying ALL nursing homes are like this. I'm sure they aren't. I simply need to vent a little.
90% of the NH pts I get need a complete bath at the time of admission. This includes scraping off old stool and providing oral care for 10 minutes because there is so much gunk in their mouths, among other things.
What topped it off was Wednesday, when I admitted a patient who had been in our ICU for months with multiple problems, VRE, MRSA, and had finally gotten out of the hospital just recently. She had been placed in a local NH. I admitted her, intubated...foley in "place"... lactate 7.5 and in septic shock. No urine in foley tubing or bag. Not a CRF patient. We turn her to do the usual complete bedbath for NH pts and we see urine coming out. Ok no biggie, we figure the foley is leaking. Well turns out it's not even in the right spot. We inserted a new foley in the CORRECT orifice and out came about A LITER of PURULENT OPAQUE "URINE".
Now I'm not going to point fingers, but isn't it a common nursing practice to check for URINE when inserting a foley??? I wonder where her septic shock came from!
I do agree with all of you. The fact that there are 3 CNA's (4 on a good day) to care for 42 residents is nearly impossible.
A CNA...
diapers changed? at least 30
feeds? 3, 2x a day= 6 (but add in prep for food and it jumps to around 20)
dress and redress? lets say 25
tables cleared? 5, 2x a day= 10
showers? 7
And that is on people who weigh on avg 200 pounds and don't stand well, if at all!!!
so are we working hard, are we doing all we can? yes
is it enough??? no, but how much more is humanly possible?
Amen. I would like to add that the above is also harder when residents require a mechanical lift, because they ususally require 2 CNAs, and that other CNA may not be around when you need to use the lift.
If the residents are combative, add more time.
If the residents are contracted, add more time.
If the residents takes 30 minutes to complete a meal being fed to them, add more time.
Most CNAs, because of the understaffing, don't have time to take every resident in their assignment to the toilet every 2 hours, for instance. If it takes a CNA 10 minutes to take a resident (and ones that need lifts can take longer) to the toilet, and she has 12 residents in her assignment, then it would take 2 hours to toilet them all. And when she is done, its time to take the first one to the toilet again! Many CNAs also don't have time to take 30 minutes to feed a resident. For example, if she has 3 residents to feed, that is 90 minutes of the 8-hour shift spent feeding. What about the other 9 in her section, and what if a resident takes 45 minutes instead? These two ADLs are often not able to be done properly because of the horrible staffing levels in nursing homes.
Sue, I see the same stuff all the time. Unfortunately, I never see the patients that come from NICE nursing homes, because they don't die of septic shock. It gives me a bad impression of nursing homes. I should go work in one for a little while so I can see great care, instead of the 'usual'.
There is a certain nursing home in the area that we have gotten SEVERAL patients from. They look just as Sue said, like someone left them in a corner to rot. A DARK corner. Filthy, stinking, obviously no bath in WEEKS. Skin breakdown, sepsis, etc. It is a real shame that when I think of nursing home care, that kind of thing comes to mind first, because those are the incidents that stick in my mind.
And I am aware that most nursing homes are not like that. :) No flaming....lol :flmngmd:
I don't know how these places pass yearly inspections. At the facility where I work we are meticulous. If we get a lazy aide he/she doesn't last long.
That said, it is 10x harder to care for invalid adults than babies. Someone can look from afar and say, oh how horrible. But try pulling and tugging on people who are dead weights at best and who need need need because they can't even feed themselves. Not only can they not feed themselves every bite of pulverized meatloaf you can get in them is a struggle. Then, you have the heavy wetters, the ones who soil themselves frequently. It is a monumental effort to even get them in a shower room. Where I work the patients are given DAILY showers, too. The work is incredibly hard, I can assure you. And skin breakdown can happen in a matter of hours.
This is why these people are in nursing homes. This is why their family is not taking care of them. Most always the workers are doing the best they can, and it's a thankless, filthy job.
Old age is sad and it's even sadder when a person has died and their bodies keep functioning. It's a losing situation.
I would like to agree with the previous statement by Tommybabe, which saddens me. It is so hard, especially when State is in the building because you literally have to pretend you always do things the "State" way, even though it's impossible. I really doubt they are fooled though! I once tried to explain that same exact toileting theory to my D.O.N., and she agreed that it was impossible but we just had to do it anyway.:banghead::banghead::banghead: We were supposed to toilet every two hours, and so we had to have everyone toileted right before lunch, and start over in two hours. It took us 45 min just to move everyone in the dining room. By the time it was all said and done, lunch took right at two and a half hours. Then, by the time we had everyone out of there, it was atleast three hours. When State was in the building some of us CNA's had to quit helping some of the residents eat, and start toileting. We even have to toilet people who don't need it or want it. It's like a horrible nightmare. I love the elderly, and after schooling want to spend my nursing career helping them, and I find it so unfair they are expected to live the way they do. I don't want to get nursing homes in trouble, but surely State has to know it's impossible that everyday things are done by the book, I wonder when anything will be done about it?
I am going to be rather blunt, and my reply might offend some people. At my workplace, caring nurses are viewed as a threat to the nursing home operation. The DON and management will do underhanded things to rid the facility of good nurses, because they are more likely to report wrongdoings. Since many LTCs suffer from bad management, the only people who can get along with bad managers tend to be uncaring nurses and rough CNAs. Like attracts like. Being a good nurse in a bad LTC is a drain to the soul, like a vacuum that sucks the joy out of you. I'd hate to sound pessimistic, but it is immensely difficult to bring about change in a vacuum.
Nursing homes tend to get the short end of the stick because of societal attitudes regarding the elderly. Elderly people in America are marginalized and often deemed no longer useful to society, so they are shoved to the background by lawmakers, administrators, and some family members.
Any nurse who works in LTC knows very well that a significant number of their elderly patients never receive any visits from family or friends. The ones who actually get visits typically receive them on a very infrequent basis. Only about 25 percent of my elderly patients are visited regularly by their loved ones. So, yes, many family members are using nursing homes to shove their elderly, unwanted relatives to the wayside. And, how can lawmakers, administrators, and the state care if countless family members no longer care? I call it the circle of uncaring...
And I understand your frustrations!
I must be living in another dimension. The nursing home where I work is a 5 star facility. No, it doesn't have big chandeliers and expensive furniture. It is quite simple and plain, actually: a plain brick H-shaped, one story building that houses 108 residents.
People who have never been there before comment on how clean the place is. The floors shine, there is NO smell. Everything is in order and in good repair. We do get some very poor quality staff, but they don't last very long. The people there have been there on average 10 yrs. or longer. The same people, including the DON, have been there since the 1960's.
I don't know how these places pass yearly inspections. At the facility where I work we are meticulous. If we get a lazy aide he/she doesn't last long.
They last long because they know ahead of time when the state is coming. At my old place they made sure we were over staffed even the receptionists, rehab, and therapy passed trays helped feed and get people up.
They should do unexpected visits like food critics.
They last long because they know ahead of time when the state is coming. At my old place they made sure we were over staffed even the receptionists, rehab, and therapy passed trays helped feed and get people up.
They should do unexpected visits like food critics.
I understand. It seems though, that if things were that bad they couldn't just quickly cover it up.
But I know what you are talking about.
There was a nursing home in Manchester, TN that was shut down by the state. I never saw it but heard the stench of vomit, urine and disease was awful. I say it was probably a blessing BUT what I never learned was what they did with the residents. Did they go somewhere as bad or worse? I never found out.
Interesting, cos in NZL it seems to be the opposit. I used to work part time in an elder hospital and we'd get patients from the main hospital and they'd have the most necrotic pressure area sores and horrible wound infections.
of course, just recently in NZL there was a case where a rest home was shut down after one of the staff gagged a demented patient with tape to "shut them up", as was her justification.
Thankfully she's been charged by the cops and the ministry of health has shut down the resthome and launched a huge investigation.
but what got me was the family of the gagged woman was like "we're happy with the care".
WTH?
It was a tradesman hired to fix something that took the photo of the gagged woman on his cellphone that was how the news was broken.
They last long because they know ahead of time when the state is coming. At my old place they made sure we were over staffed even the receptionists, rehab, and therapy passed trays helped feed and get people up.
They should do unexpected visits like food critics.
I oftened wondered about how some nursing homes remained open, despite the horror stories we hear about them. Based on what I've heard from agency coworkers, all of the nursing homes (and some hospitals) seem to know ahead of time when they will be inspected, and so they scramble to make sure everything looks allright. The same with the visits from the ombudsman (shouldn't it be ombudsperson?). What is the point of having inspections and an ombudsman if the facilities know when they will be coming?
I must be living in another dimension. The nursing home where I work is a 5 star facility. No, it doesn't have big chandeliers and expensive furniture. It is quite simple and plain, actually: a plain brick H-shaped, one story building that houses 108 residents.
People who have never been there before comment on how clean the place is. The floors shine, there is NO smell. Everything is in order and in good repair. We do get some very poor quality staff, but they don't last very long. The people there have been there on average 10 yrs. or longer. The same people, including the DON, have been there since the 1960's.
when i graduated from nsg school, i was working 2 jobs for a yr.
one, where i still remain, and one in ltc (love our elderly!!)
i remember going from ltc to ltc, observing staff and residents.
the facilities where there were persistent odors, residents strapped in their chairs and watching cartoons with disinterested staff, i walked away.
finally, i found a facility that was old but clean as a whistle:
the don had started out as a nurse and grew in her position, working there for over 25 yrs;
many of nurses/aides had been there for yrs;
their surveys were either perfect or near perfect for many consecutive yrs.
and, the residents were gathered in the dayroom, listening to music from their era!!
people were engaged, busy, interactive and seemed happy.
it was a wonderful experience working there.
given the right circumstances, i'd return to ltc in a minute.
shame on those people who make our elderly live out their lives in hellhole conditions.
shame on them!!
'beautiful', posh facilities are meaningless.
they tell you nothing.
what does hold merit, are those who have made these facilities, a true home.
I have to agree with the commuter, ltc can suck the life out of a good nurse. You feel like you are banging your head against the wall literally. I just gave my notice at my weekend job in ltc.
After four weeks of passing my own meds all day or being forced to work two halls I have had it . Add to that week day nurses who don't give a crap and won't get orders for things pts need , don't do their tx, and management that knows the problems but chooses to ignore them I am through.
I would like to say however that we get some crap from the hospital to . Have received a pt back from the hospital with the same dressing they had on when they left. [After a three day stay] Sent them without skin breakdown received them back with breakdown. Sent them out with signs and symptoms of chf got them back same day and had to send them right back out in resp distress 30 minutes after readmission.
I guess their are nurses who don't give a crap all over.
They last long because they know ahead of time when the state is coming. At my old place they made sure we were over staffed even the receptionists, rehab, and therapy passed trays helped feed and get people up.
They should do unexpected visits like food critics.
That is exactly how these places remain open. They know when their window to have state come in is. I have worked in several LTC facilities in different states and I seem to pick the awful ones, but, thats another thread within itself. I have seen too many times how they will work with the bare minimum of staffing and then BAM when state is due to come in or are there, everyone including management is all of a sudden helping to pass trays. Do you think they do that when state isn't there..ummm no! It's all for show and it really is a shame. These are someone's loved ones and in some places they really do suffer.
I really doubt they are fooled though! I once tried to explain that same exact toileting theory to my D.O.N., and she agreed that it was impossible but we just had to do it anyway.
Plagueis
514 Posts
Amen. I would like to add that the above is also harder when residents require a mechanical lift, because they ususally require 2 CNAs, and that other CNA may not be around when you need to use the lift.
If the residents are combative, add more time.
If the residents are contracted, add more time.
If the residents takes 30 minutes to complete a meal being fed to them, add more time.
Most CNAs, because of the understaffing, don't have time to take every resident in their assignment to the toilet every 2 hours, for instance. If it takes a CNA 10 minutes to take a resident (and ones that need lifts can take longer) to the toilet, and she has 12 residents in her assignment, then it would take 2 hours to toilet them all. And when she is done, its time to take the first one to the toilet again! Many CNAs also don't have time to take 30 minutes to feed a resident. For example, if she has 3 residents to feed, that is 90 minutes of the 8-hour shift spent feeding. What about the other 9 in her section, and what if a resident takes 45 minutes instead? These two ADLs are often not able to be done properly because of the horrible staffing levels in nursing homes.