Is LTC really this bad?

donmomofnine · Jun 6, 2004

I work for a not for profit, church affiliated home (CCRC)and it is a wonderful place! I have worked for a chain and it was a nightmare!

Reimbursement does not work well if you are doing a GOOD job with your residents! You get more reimbursement for PROBLEMS, such as wounds! Not for preventing problmes! :angryfire Go figure!

Sheri257 · Jun 6, 2004

Reimbursement does not work well if you are doing a GOOD job with your residents! You get more reimbursement for PROBLEMS, such as wounds! Not for preventing problems! :angryfire Go figure!

Interesting. I did not know this. So the incentive is all wrong. No wonder everybody quits.

:rolleyes:

NursesRmofun, ASN, RN · Jun 6, 2004

Well, the NHs may get reimbursed more for wounds, but the state cracks down hard on them. I don't really think the admin. want them either. At least not my facility. I think admin. really cares for the residents at my facility, even if they care about money just as much. Like I said though, I don't think any LTC facility can afford to have decubs. The fines are looming with the state and they may be shut down with too many such problems.

Destinystar · Jun 6, 2004

2/3 quit. What about the staff that are involuntarily terminated? It is a labor intensive profession. Until the federal and state regulations mandate a smaller CNA resident ratio the seriouse problems that plague nursing homes will continue. It is unrealistic and impossible for a CNA to comply with the current regualtions dictated in OBRA, so the CNA's are forced to be in a position to be out of compliance. The residents are the real victims who dont have the choice to quit but have to live in uncomfortable, unsanitary, unsafe conditions. Until the Sate and Federal government is willing to allocate more money to pay nursing homes with this problem will continue. Remember "Good" nursing homes are meeting the minimum standards. So I interpret a 3 star nursing home as probably just being average. The majority of the people investigating nursing homes have little or no experience as a staff membe or patient and I find their reports missing quiet a lot of details. This is due to their lack of education and hands on experience in the field. QUOTE=lizz]Hopefully the moderators won't mind, since I did post this article on the California board ...

But I was also wondering what you LTC folks thought about this ...

Two-thirds of the staff in 1,400 California nursing homes quit in 2002. Yikes!

Is LTC really this bad?

http://www.sacbee.com/content/news/medical/story/9518819p-10442632c.html

:uhoh21:

Blackcat99 · Jun 6, 2004

:) My experiences with the big chain LTC's are that they usually pay better than the mom/pop homes. However, it seemed that the residents received better care than the big chain LTC's. I am certainly no medicare expert but it seemed to me that when a resident was first admitted from the hospital that medicare would pay 100% for the first month. After that they paid part of it.

And once the resident was considered "stable" they could get no funding from medicare period. Once they were considered "stable" they would be considered to be 'long term care" which medicare doesn't pay for at all. Nursing homes prefer residents that are receiving medicare because it pays well. However, the medicare residents received the same poor care as everyone else. :crying2:

donmomofnine · Jun 6, 2004

I don't know if reimbursement is the same everywhere, but we get reimbursed for our medical assistance patients by an averaging of the degree of "problems" that they have. If they are just doing fine, our RUGS category is low and the reimbursement is low. Unfortunately, it still takes money to keep everyone highly functioning and doing well! We get a daily rate for all medicare patients. So if their care costs more than the reimbursed rate, then we eat the difference. And then there are the HMOs.....

As far as staffing and turnover goes, my latest figures for NAs are about 30%, with most turnover in the first year. Many of those were terminations, so I don't count that. Others were staff who found out that this kind of work isn't for them. One way we prevent that is having prenurse aid trainees. They do helpful things, like make beds, but no direct resident care. After about three months, we put them in the NA class if we like them! Till then, they are familiar with the facility, the staff and the residents and they know whether or not they want to work in LTC (and our facility). Many express they cannot wait to start their classes, so they can do hands on care!:)

Hellllllo Nurse, BSN, RN · Jun 7, 2004

Another question: Is low medicare reimbursement the crux of the problem? If you could fix this, what would you do?

I feel that for-profit corporations are the problem. the less they spend on their resident's the more they keep, the more profitale their facilities are.

jyoung1950 · Jun 7, 2004

2/3 quit. What about the staff that are involuntarily terminated? It is a labor intensive profession. Until the federal and state regulations mandate a smaller CNA resident ratio the seriouse problems that plague nursing homes will continue. It is unrealistic and impossible for a CNA to comply with the current regualtions dictated in OBRA, so the CNA's are forced to be in a position to be out of compliance. The residents are the real victims who dont have the choice to quit but have to live in uncomfortable, unsanitary, unsafe conditions. Until the Sate and Federal government is willing to allocate more money to pay nursing homes with this problem will continue. Remember "Good" nursing homes are meeting the minimum standards. So I interpret a 3 star nursing home as probably just being average. The majority of the people investigating nursing homes have little or no experience as a staff membe or patient and I find their reports missing quiet a lot of details. This is due to their lack of education and hands on experience in the field. QUOTE=lizz]Hopefully the moderators won't mind, since I did post this article on the California board ...

But I was also wondering what you LTC folks thought about this ...

Two-thirds of the staff in 1,400 California nursing homes quit in 2002. Yikes!

Is LTC really this bad?

http://www.sacbee.com/content/news/medical/story/9518819p-10442632c.html

:uhoh21:

I'm a CNA at an LTC and Wednesday is my last day there. I got a nursing assistant job at a hospital.

I've worked at this facility for 2 1/2 years and prior to that did office work, which I do not want to go back to.

I'm burned out. I am assigned to a certain unit and I have 13 residents to care from from 3-11:30 pm. There are 2 other CNA's on the unit; one has 14 residents and the other has 13 also. We can't work together because of the way the unit is laid out. If we are in one area, we can't see or hear about 30 other residents at all.

Of my 13 residents, 8 wear alarms because they are fall risks. Only 4 are incontinent and total care which is easier than the others because the others are all mentally alert, more demanding, want to go to the potty more often, vie for more attention and a couple of them are alert enough to threaten to report you if you don't cater to their every whim and need.

I'm too burnt out to switch to another unit of the home. I just don't want to deal with it any more.

And alot of the burn out is the realization that try as I might to meet their every need - because I really love my ladies -I can't because I'm always going 90 miles an hour 40 hours a week and I am not exaggerating. The state regulations and rules frustrate me because they are beyond reason. The people who run things cut back on things like food quality and staffing which, to me, is indirect abuse and yet when we get our in-service meetings about abuse, of course it is all directed at what we nurses and aids may or may not do.

I am not a person who is easily angered or tempermental. But I find myself getting short-tempered more often now and I better stop before I end up abusing someone. These poor souls don't deserve that and they don't deserve the abuse of poor staffing, food that isn't even as decent as criminals in jail get, second hand beds, rules from state that now are complaining that our nurses should have all 4:00 meds passed out to 40 residents in an hour, and other stuff that administration causes.

I am so drained that I can only function at a bare minimum at home. Putting dishes in the dishwasher is like climbing Mt. Everast. I don't want to deal with the phone ringing or socializing because I have nothing to give anyone else.

New CNA's? Especially the ones here that want to make a positive difference in the residents' lives, please go for it. You are needed even if you only last a couple years. My residents really do like me alot, but it's not enough to overcome my burnout. If I can't function properly, I can't take care of them.

I'm looking forward to working at the hospital and will have a chance to learn other skills. I can't think of too many other jobs that are a stressful as working as a CNA in a nursing home.

End of rant.

Sheri257 · Jun 7, 2004

I feel that for-profit corporations are the problem. the less they spend on their resident's the more they keep, the more profitable their facilities are.

True, although you don't hear about two-thirds of staff quitting at for-profit hospitals (or other for-profit facilities) Maybe I'm missing something but, what's the difference with LTC?

Or, does two-thirds of the staff quit at other for-profit facilities too, and you just don't hear about it?

:confused:

veteranRN · Nov 18, 2004

Lizz, completely off topic I know but I just love your little rock band. What song are they singing? I think it is Jump by Vanhalen

Simplepleasures · Dec 29, 2006

2/3 quit. What about the staff that are involuntarily terminated? It is a labor intensive profession. Until the federal and state regulations mandate a smaller CNA resident ratio the seriouse problems that plague nursing homes will continue. It is unrealistic and impossible for a CNA to comply with the current regualtions dictated in OBRA, so the CNA's are forced to be in a position to be out of compliance. The residents are the real victims who dont have the choice to quit but have to live in uncomfortable, unsanitary, unsafe conditions. Until the Sate and Federal government is willing to allocate more money to pay nursing homes with this problem will continue. Remember "Good" nursing homes are meeting the minimum standards. So I interpret a 3 star nursing home as probably just being average. The majority of the people investigating nursing homes have little or no experience as a staff membe or patient and I find their reports missing quiet a lot of details. This is due to their lack of education and hands on experience in the field. QUOTE=lizz]Hopefully the moderators won't mind, since I did post this article on the California board ...
But I was also wondering what you LTC folks thought about this ...
Two-thirds of the staff in 1,400 California nursing homes quit in 2002. Yikes!
Is LTC really this bad?
http://www.sacbee.com/content/news/medical/story/9518819p-10442632c.html
:uhoh21:

Once again, STILL NO CHANGE.

adrienurse, LPN · Dec 29, 2006

deleted