medicaid cutbacks: what changes do you see in ltc

[Zen123]

Curious to hear changes in your neck of the woods. Im seeing more residents returned fron e.r. after being sent out for eval and tx. Omnicare no longer provides orc mess. Something is up in the air.

[hope3456, ASN, RN]

I've been wondering about this....I personally haven't seen any but it seems it is all you hear about on the news (medicare and medicaid cuts). I know it has to happen but wonder how it is going to 'come down the pipes.'

[TheCommuter, BSN, RN]

Hospice providers would come into the LTC facilities in the area and provide continuous care for their actively dying patients or sit through a crisis prior to the Medicare cutbacks. However, Medicare no longer pays for a continuous care hospice nurse at the bedside during a 'crisis.'

[VivaLasViejas, ASN, RN]

It's really bad in the assisted living communities now. It's next to impossible to get a Medicaid patient admitted to the hospital unless they're up to both hips in the grave. I've lost track of the number of times I've sent someone out who's unresponsive with a BP in the 70/50 range, HR in the 140s, O2 sats in the dumper, etc., and four hours later the freaking ER sends 'em back to me with a newly-diagnosed pneumonia, and if I'm really lucky they'll have orders for PO antibiotics that I'm going to have to wait at least 4hours for our pharmacy to satellite to us.

Forget the fact that we are NOT an acute-care facility of any kind, nor are we equipped to deal with life-threatening emergencies: it takes an act of Congress to get these folks taken care of in the proper setting.......and 9 times out of 10, they won't be. We just have to suck it up and deal with situations we aren't set up to handle, and the resident suffers. Makes me mad enough to bite a rock.

[Zen123]

Thanks for the feedback. I hope to hear more about this from other nurses. I do see beds staying empty longer now which tells me NH will probably get more picky now who they take as far as insurance is concerned. Now OTC meds are no longered covered which means more bottles and added weight to our med cart.

[Zen123]

"I've lost track of the number of times I've sent someone out who's unresponsive with a BP in the 70/50 range, HR in the 140s, O2 sats in the dumper, etc., and four hours later the freaking ER sends 'em back to me with a newly-diagnosed pneumonia, and if I'm really lucky they'll have orders for PO antibiotics that I'm going to have to wait at least 4hours for our pharmacy to satellite to us."

I am going thru the same thing at my work. With this change; I feel Dr.'s should change their approach instead of telling us to send them right out. Which brings to mind dealing with the family who wants something to be done "right now"; dr.s who don't call you right back; and waiting for pharmacy to send you the med. I could go on.

[knexx]

With regard to the ATB and waiting for deliveries, many times LTC has an emergency kit with a few doses of certain meds... when I worked LTC I had an issue with the pharmacy not having a certain ATB at their warehouse, so I called the MD back and gave him the list of what I had in the e-kit and he switched it to another med...

[TheCommuter, BSN, RN]

Also, the following gripe has nothing to do with Medicare. It is more of a DEA regulation that suddenly tightened down last year.

Since LTC nurses are no longer considered 'agents of the prescriber' for certain controlled medications, this means that residents must wait for specific pain meds while the pharmacy attempts to locate a doctor for a verbal order. A faxed order from the LTC nurse is not good enough for pharmacies any longer. They must have a copy of the doctor's prescription or a verbal call-in from the doc. In addition, the LTC nurse cannot pull from the narcotic Ekit without an authorization number from the pharmacy.

http://drugtopics.modernmedicine.com/drugtopics/article/articleDetail.jsp?id=678155

[Psychtrish39, BSN, RN]

Commuter,

I agree and I know because it happens in LTC. I understand the diversion issue however then LTC facilities need to mandate that physicians call pharmacies directly with orders for opioids. Now I least know who is to blame for why it takes so long. The physicians then need to man up and do it then.

In regard to other things happening in LTC in the last year or so . I do see census going down in some places and I do think it will lead to certain persons not being admitted. Most LTC facilities already kind of practice that... off the record of course. Last place I worked some of the nurses that had been there for years said they had heard that the corporate owners were going to replace all licensed staff with med techs and MAs but I know they couldnt keep their licenses as a long term care provider in this state because RN hours are mandated but I think some facilities would get rid of nurses if they could due to the budget cuts. To keep the corporate coffers full we cost money.

[Bbo.W]

At my LTCF we have recently admitted several psych patients...we are not staffed/trained/equipped to do so. My nurses tell us to keep them calm, get through the shift, and keep them off the floor. It is very stressful, and the residents in question are basically PRN Haldol IM/Ativan patients, so they are always heavily sedated (thus increasing fall risk). It is really sad...