I am interested in the process for assisting residents in your facility when they deteriorate and require additional care. I am dealing with this with a family member and in the process of trying to get my grandmother proper care I am stepping on toes. It is an exasperating process.
The issue I am facing is trying to figure out who and how one determines and then communicates to all CNA's that someone needs additional help. Until very recently my grandmother did most of her care independently. I'm not even sure what has caused the deterioration as no one has spoken to us about her condition...in fact I was concerned they didn't notice. When I raised the issue with them initially they assured me they could offer her more help but that didn't happen. There are two CNA's on her section and they are very busy at bedtime which is when she needs the most help. There is also different CNA's working throughout the week so it isn't just a matter of needing one or two people to be on board. Management at this particular LTC is useless. The nurses and CNA's are almost all really nice, helpful, kind people who certainly seem fond of my grandmother but still haven't stepped in to fill this new need. One of them told me that they pretty much need permission from management to make her care part of their daily routine as until now she is 'designated' as independent care and so there is no time allotted to her. They also don't really realize how much difficulty she is having as when an aide/nurse comes in my grandmother becomes very stoic and insists she is fine/doesn't need help. Then when they leave she tells me she doesn't want them to know she can't walk/toilet herself anymore. She wants to be independent (but physically can't do the tasks now) and has the mindset that she is an inconvenience/burden.
I have been providing most of her care since she went downhill however I have to go back to work and I really the whole reason she is in LTC is to get help - but we can't seem to access that. I have a meeting next week with the DON to try and get somewhere and I gave a list of tasks she needs help with to the staff but the once night I didn't go in she didn't receive any help at all. It is so strange I really thought the staff there would step in and help her when she needed it and it is pretty upsetting to not see that happen. I'm not sure who though is dropping the ball. Do they need permission from the DON/manager? Is it the RN / LPN who assigns the CNA's their responsibilities for the shift? How is it communicated to casual/agency/part-time/floats that she now needs help? Is there a checklist typically or something they work from?
Any ideas based on your facility policies on how to get her on the 'list' to get assistance on a regular basis would be appreciated.
Where I work we don't need 'permission' to give care to someone who is designated 'independent'. We do however relate this info back to the nurses so their care plans can be updated. And this part is very important because unless it's in the care plan, not all caregivers will give that support. Some caregivers are by the book, others are more flexible, so between the caregivers, the family and the nurses and doctors, a solution must be found. The feelings and independence of the senior must be respected, yet at the same time the care that is needed must be there. I find I must build a relationship with my residents, based on trust and caring, before we can work together and get the job done.
Thanks to all for the responses - it is great to hear from others who work LTC as it is a bit far from my specialty!
I went in this afternoon and she had been in the same brief for 10 hours. She was soaked from head to toe as was her wheelchair and cushions. She simply can't toilet herself anymore, and she forgets to go as time has kind of become abstract to her. I went to the admin and met with the DON on the spot. They are going to rewrite her care plan and change her designation from independent to assisted. They have promised to help her but time shall tell. I spoke with my grandmother about accepting help and she says she wants help as she knows she can't do it on her own but that no one ever offers. She and I discussed what she wants help with and the DON said she will meet with her Monday and review the new care plan with her. The DON has also said she will herself meet with each aide to ensure they are aware that she needs assistance. The charge nurse on days is pretty good - gets things done. The one on evenings, not so much.
Whoever said independent is a misnomer is so dead on. She uses an electric wheelchair and therefore seems independent as she zips around. Outside of the wheelchair she can walk about 10 wobbly, off balance steps with a walker which has until now gotten her from chair to bed to toilet and back. She can not take her hand off the walker or she loses her balance. Now she can't even make it the ten steps. She has minimal use of her arms so toileting/dressing is a challenge but she does manage it with difficulty (she is stubborn!). She had polio and has major orthopedic issues affecting her spine and legs. However she refuses to ever ask for help and as someone mentioned, if she is asked - do you want help - she says no.
I have tried to reach the MD all week with no luck, have left messages and all. Apparently, according to the nurse the MD thinks this deterioration is a side effect of a medication (Lyrica) he started a few weeks ago so he will take her off it and we will see. Regardless, she still needs more help then she was getting. She has lost about 40 lbs this year and overall her health is much worse, this deterioration aside.
I am hoping the fact I put everything in writing and emailed it to them detailing health and safety issues has made the admin realize they have to do something. I have no idea if I've offended the nurse and CNA's by going to the DON but something had to be done ASAP and nothing was happening despite me trying to get people on board.
Time will tell...I am not planning on going in tonight and will see if she gets help. The DON told me the CNA's don't need permission to provide extra assistance however the official board is what they look at and that is only updated if the care plan is updated.
I'm glad you spoke up. And too bad if you offended anyone. You gotta do what you gotta do - get the care plan updated to match her condition so she is mandated to receive the help she needs.
As i understand it, activities of daily living include detailed descriptions of toileting and dressing in the CNA duties and the Careplan.. Independent living? In a long-term care facility? Have heard of assisted living but that may be a private insurance thing. Please share what you learn from the meeting with us.
As i understand it, activities of daily living include detailed descriptions of toileting and dressing in the CNA duties and the Careplan.. Independent living? In a long-term care facility? Have heard of assisted living but that may be a private insurance thing. Please share what you learn from the meeting with us.
You can be independent with ADLs in LTC, generally with dementia/memory issues or a chronic condition that can't be managed at home or in an ALF. It's rare, but we have some. However, we have to keep an eye out to watch for deterioration. I changed a care plan this week for one of our ladies who WAS independent but now just goes back to sleep if you set her up with the wash basin, etc. I also have all of the CNAs sign an update sheet because goodness knows they don't always check the plans when they start their days. A little laziness, mostly just being accustomed to doing certain things for certain people and also always hitting the ground running. That's a hard job, CNA.
You can be independent with ADLs in LTC, generally with dementia/memory issues or a chronic condition that can't be managed at home or in an ALF.
and this
A little laziness, mostly just being accustomed to doing certain things for certain people and also always hitting the ground running. That's a hard job, CNA.
We tried to get her into an assisted living facility initially but they wouldn't take her - said she needed too much care! Then the nursing home designated her independent!! She did do her own ADLs independently albeit with great exertion and difficulty until recently. The nursing home she is in is probably 20% independent, 40% assisted and 40% total care, give or take.
The facility has an extremely frustrating policy of continually rotating their CNAs through the 4 wings. So just when they get to know the residents and their routines they get moved. This is very upsetting to my grandmother to have to get to know new CNAs all the time and explain what she likes/needs/wants again. By the time they rotate back, she has forgotten them. Also some have very strong accents and limited English which combined with her hearing loss makes communicating with them a challenge. The CNA on tonight is fantastic and I know she'll be well looked after for today at least!
for the life of me, i don't understand how anyone with an electric wc, can be independent?? as for her weight loss, she's likely tagged as independent for eating as well, and this status needs to be changed. some residents need a physical assist, whereas others need to only be cued. at a minimum, it sounds like she needs some form of supervision.
lastly, make sure any other etiologies have been r/o...uti, uri, pain, depression, lyte imbalances, etc.
I think because she could transfer independently (she wedges the chair and walker against her desk and then leans against the desk to pull herself up to use the walker) she was independent. She was also eating, toileting and ambulating without assistance - although barely! She has fallen a good many times but thankfully most of her is metal so nothing has broken so far!
I asked them to check for UTI's last week...pain is an ongoing issue. Apparently she is maxed out on meds/patches and there is nothing more they can do. She is in constant chronic (joint, bone and muscular) pain.
The cueing/supervision is exactly what she needs in some areas along with physical assistance as the day goes on. She can still make the ten steps in the morning but by bedtime she is too tired and can't get her feet to move.
whtg, I can tell you that little things mean a lot to the aides. When they change rotations bring in a dozen Dunkin' Donuts or Krispy Kremes. Word will go out by break that whtg's gd brought them treats. It's a little thing, but it means a lot. Remember that rotating is hard on them, too, Just when they settle into a routine and know the residents and their routines they're gone. The only plus to it is that little cliques don't form.
What I DON'T like is that she was saturated for the day. Someone had to have smelled that and kept on walking. "She's not mine." Um, I don't think so!
Wherehas, you don't seem to fully understand the nursing home side of the problem. CNA's have the most difficult and trying aspects of the facility. In order to keep the good CNA's from burning out, they rotate sections to have a different workload and it helps to keep their observations skills sharp. Not all sections have the same workload. Most times CNA's work short and take on more than their scheduled load.
Wherehas, you don't seem to fully understand the nursing home side of the problem. CNA's have the most difficult and trying aspects of the facility. In order to keep the good CNA's from burning out, they rotate sections to have a different workload and it helps to keep their observations skills sharp. Not all sections have the same workload. Most times CNA's work short and take on more than their scheduled load.
I do understand why but it doesn't change how frustrating it is for both the residents and CNAs to continually have to get to know each other and learn what each residents likes and routines. The home has one wing that is a heavy dementia wing and another that has more total care patients so there are two heavy wings and two light wings so they all rotate to each to have their share of heavy and light (er). I was also told that it was to make sure that no residents/CNA got too close as favoritism might happened. They also rotate the CNAs in different directions so they are also continually working with different teams / partners. Regardless of good reasons to do it, it remains exasperating and very confusing/frustrating for my grandmother. My grandmother is on a lighter wing - there are 2.5 CNAs for 28 residents - there is no doubt they (well 92.4% of them) work very hard. They also have a serious problem with no shows / calling out and being short staffed so the reliable ones are burnt out. I served dinner the other day as there were no staff to be seen!
And honestly as I said other than a couple bad apples they are great people - they often offer me in a drink and a cookie when I'm there and always greet me, ask me about my life and are very friendly. I know about their kids/pets and I always stop to chat for a couple seconds. Not all are super efficient workers but they are friendly and treat my grandmother very kindly (other than not helping her!). I don't bring them treats and I probably should - I have made sure to individually thank those who are particularly helpful/caring.
Frustration is part of the LTC scenario. You can always consider hiring a private sitter/cna. Perhaps it may be best to look elsewhere for your GM. Sadly, call-offs and short staffing is a fact of life in ltc. Until healthcare corporate decides to pay the price, things will continue the way they are.
68wildcat
17 Posts
Where I work we don't need 'permission' to give care to someone who is designated 'independent'. We do however relate this info back to the nurses so their care plans can be updated. And this part is very important because unless it's in the care plan, not all caregivers will give that support. Some caregivers are by the book, others are more flexible, so between the caregivers, the family and the nurses and doctors, a solution must be found. The feelings and independence of the senior must be respected, yet at the same time the care that is needed must be there. I find I must build a relationship with my residents, based on trust and caring, before we can work together and get the job done.