If you could build your perfect Nursing Home......how would it be?

[Ling07]

If I could create a perfect nursing home, it would be like:

-NO CNAs with attitudes. You can not have a nasty attitude and work in Geriatrics. It takes a lot of patience and compassion to work with the elderly and if you have a nasty attitude, how will that work?

-CNA/Resident ratio will be 5:1. I think it's unfair to give CNAs 10+ residents. Many of them are stressed out because of all the work. I would want them to spend time with the resident. Have them play games with them. I would want them to create a bond with the resident.

-Nurse/Resident ratio will be 10:1. The workload for the nurses is ridiculous. I'm not a nurse, I work with the administration side of things, but I can clearly see that the nurses have a lot to do. Like the CNAs, I want the nurses to build a relationship with the resident. How can you create a relationship with a resident if you're busy talking to pharmacy, passing out meds, charting, paperwork for administration and serving the residents for whatever need?

-I would pay CNAs $15 minimum. I think some of them would care more about their jobs if they made a little bit more.

-NO CELL PHONES ALLOWED. They must be locked up somewhere. It annoys me when I see a nurse on a cell phone.

-An equal amount of male and female nurses. Too many female nurses creates too much drama.

-No residents in the hallway!! That irriates me!!!!!!! That is a pet-peeve of mine. I do not like to see residents sitting in the hallway like they're useless. All residents must be placed in an activity room or sitting in their room watching TV. If a resident is in the hallway longer than 5 minutes, then the CNA will be written up.

-There would be a gated park outside of the building for the residents to sit around and get fresh air. GIVE THEM FRESH AIR!! Sometimes I want to shout this out loud when the nurses are wondering why a resident wants to escape. Give them a change of scenery!!

So there you have it, my perfect nursing homes. :)

[Nurse Blaker]

Have you ever heard of Lenawee Medical Care Facility in Adrian, MI ? We've spent the last 10 + years making our nursing home a HOME. Our residents have choices. They get up when they want to. They eat what they want to. The staff are cross trained. We are an Eden facility. Check it out...It takes time, training and people who care...I'm proud to be a geriatric nurse!

[Morning-glory]

Bigger rooms, bathrooms that will fit a w/c, the resident and a couple of nurses. Doors that are wide enough to get the bed out without squishing your fingers. Management that knows what we are doing and understands that when we ask for something it isn't because we are trying to make their lives more difficult. Be nice to all.

One RN and 3 LPNs for 96 patients is not reasonable.

[Ling07]

Have you ever heard of Lenawee Medical Care Facility in Adrian, MI ? We've spent the last 10 + years making our nursing home a HOME. Our residents have choices. They get up when they want to. They eat what they want to. The staff are cross trained. We are an Eden facility. Check it out...It takes time, training and people who care...I'm proud to be a geriatric nurse!

No, I have not heard of that facility. Sounds wonderful though!

[Ling07]

nurses. Doors that are wide enough to get the bed out without squishing your fingers.

YESSSSSSSSSSS! I am so tired of knocking residents into the doors by accident. It's especially embarassing when a visitor sees it!!

[Riseupandnurse]

Pets. Definitely pets. The caged birds some of them have are fine, but you can't...pet them.

[Lovely_RN, MSN]

I would dispense with the crazy diets and let them eat whatever they wanted. Is it really necessary to put a 90 year old on a 1200 cal 2-3gm Na, NCS diet? If I live to 90 I want to eat as much chocolate and McD's fries as I want to.

Also meal times need to be flexible and more choices need to be available. If a resident doesn't want to have a hot meal at the regularly scheduled meal times there should be a kitchen stocked with cold foods that they can eat whenever they want to.

I would let them wake up and go to bed when they wanted to. If you're a night owl being forced to wake up before 6am and be put to bed at before 8pm is abuse.

I would let them wear what they wanted to. If the resident wants to stay in their PJs or wear a fur coat and a tiara let them as long as it's appropriate for the weather and it's clean.

I would let them do the things that they are interested in. If the resident wants to stay in their room watching T.V or reading books all day that's their business. I don't see why they have to be forced to go to a day room with people they may not like to participate in stupid activities that wouldn't interest any one over 5. Some residents have been life long introverts and it's not a sign of depression if they don't to want a lot of interaction with their peers.

I would make sure that everyone received adequate pain medication.

I would make sure that the choices of those who are willing and capable of making choices are respected. If the resident doesn't want artificial nutrition or wants to be a DNR than that is what goes and a relatives wishes will not supercede the residents.

This is a touchy one because I'm not a doctor and I don't claim to know as much as one but...less medications. Especially the drugs like Namenda, remeron, exelon etc....how effective are they really? They might provide some very mild improvement but they can't turn back the hands of time. When you add in all of the anti-htn, cardiac, and anti-diabetic meds....thyroid...Parkinson...etc to infinity meds along with these dementia drugs it's just too many meds to take in a day. Oh yeah and can we dispense with all the vitamins already? Let's stop at one mult-vitamin a day.

Also no one likes that dang protein powder and it doesn't matter what you mix it with everyone hates it.

I mean these people managed to live as long as they did without all of these pills. How much longer is all of that extra stuff going to extend their lives and is it a quality life if your choking down tons of pills everyday or sucking it down with applesauve or pudding?

Finally, I would staff enough nurses and CNA to patient ratios so that we can provide dignified care.

[Ling07]

Bronx_RN,

Your perfect nursing home isn't too far-fetched. Where I'm currently working, the residents have options on what they want to eat, they can wear whatever they want and if they want to stay in their room, most of the time they allow it.

[systoly]

Harley rides for any resident who wants to (side cars available).

[skyandsydneysmom]

I would dispense with the crazy diets and let them eat whatever they wanted. Is it really necessary to put a 90 year old on a 1200 cal 2-3gm Na, NCS diet? If I live to 90 I want to eat as much chocolate and McD's fries as I want to.

Also meal times need to be flexible and more choices need to be available. If a resident doesn't want to have a hot meal at the regularly scheduled meal times there should be a kitchen stocked with cold foods that they can eat whenever they want to.

I would let them wake up and go to bed when they wanted to. If you're a night owl being forced to wake up before 6am and be put to bed at before 8pm is abuse.

I would let them wear what they wanted to. If the resident wants to stay in their PJs or wear a fur coat and a tiara let them as long as it's appropriate for the weather and it's clean.

I would let them do the things that they are interested in. If the resident wants to stay in their room watching T.V or reading books all day that's their business. I don't see why they have to be forced to go to a day room with people they may not like to participate in stupid activities that wouldn't interest any one over 5. Some residents have been life long introverts and it's not a sign of depression if they don't to want a lot of interaction with their peers.

I would make sure that everyone received adequate pain medication.

I would make sure that the choices of those who are willing and capable of making choices are respected. If the resident doesn't want artificial nutrition or wants to be a DNR than that is what goes and a relatives wishes will not supercede the residents.

This is a touchy one because I'm not a doctor and I don’t claim to know as much as one but...less medications. Especially the drugs like Namenda, remeron, exelon etc....how effective are they really? They might provide some very mild improvement but they can't turn back the hands of time. When you add in all of the anti-htn, cardiac, and anti-diabetic meds....thyroid...Parkinson...etc to infinity meds along with these dementia drugs it's just too many meds to take in a day. Oh yeah and can we dispense with all the vitamins already? Let’s stop at one mult-vitamin a day.

Also no one likes that dang protein powder and it doesn't matter what you mix it with everyone hates it.

I mean these people managed to live as long as they did without all of these pills. How much longer is all of that extra stuff going to extend their lives and is it a quality life if your choking down tons of pills everyday or sucking it down with applesauve or pudding?

Finally, I would staff enough nurses and CNA to patient ratios so that we can provide dignified care.

What an amazing post!!!! Everything you say is soooo true!!! I promise you that if I make it to ninety and you tell me I cannot use salt on my food we are going to have a problem. The only thing I would add is what a previous poster said about the "Eden Alternative". I think every home should have a childcare facility attacted to the grounds for the staff (the children participate in intergenerational activities). Another thing is the animals...I love my cats and dog. I have always been an animal person and when I get old I want access to animals, not to look at but to pet and love. Someday I hope I will be able to make these things a reality!

[CITCAT]

Iwould have a nursing home each room of side of room the eact replica of there bedroom,also lets have a couch or loveseat lets make it home and the outside let there be a alz garden with shredded tires as walkway to prevent injury, how about friendly dog or two to visit residents,how about this a building for assisted living a cottagetype area for independant living and transitional ltc home setting what about those eletric fireplaces too and why must the staff wear uniform how about jeans and tshirts with logo on it with a name tag to desinate your professional area rn,lpn,cena,cota etc. how about a central area in dining with the kitchen prepartion in the center like franks house in tupulo miss. You can make these things a reality you make have to te boomers dont ant to live in instituational like setting they want there doggone internet too, believe me times wll be a changin go for your dream talk is cheap you can make it happen.

[JB2007, ASN, RN]

Better staffing ratios. 30 residents to 1 nurse and 3 CNAs on day shift is crazy. We are not able to meet the residents' needs by a long shot. Managers that acually care about the residents and staff. Social Service that asks the nurses about whether a new admit is apprioriate for the facility or even the room mate that they are going in with.

To the OP that stated no residents out in the hallway: There are several residents on my hall that likes to sit in the hall an watch the staff work. They enjoy this and so does the staff. We joke around and visit with these residents all the time. Most of the time these resident choose to sit out in the hall rather than an activity. Also, there are many times that my dementia residents have to come out in the hallway and sit by my cart or at the nurse's station for their safety. They will stand unassisted and they will fall if they are in their room. There just is not enough staff to allow for 1:1 most of the time and these residents will not remember to ask for help, so we do what we need to do for their safety.