Need ideas: Ideal Nursing Home

jaimemds · Apr 16, 2005

The biggest problems in nursing homes is understaffing, lack of monies and caregiver attitude. What first needs to happen is congress needs to alot more money to nursing facilities to provide the care care that they mandate. Right now those of us who work in NH's are struggling just to get the basics done, meds, tx's, pericare. The ideal ratio would be 20 pts. per 1 nurse, 3 cna's and a tx nurse. Those 20 pts. would range in acuity from independent with most adl's to total care. The activities department also needs more funding to provide activities and intellectual stimuli to pts. based on cognitive ability and more 1:1 stimuli. Staff should have special training in regards to the elderly, a kind of mini gerontology course for nurses, aids and activities aide, to help them understand why the elderly are the way they are. Special training in the needs elderly psychiatric care is also needed as most staff in nursing homes have no idea how to deal with the pysch pts. the design of the facility would be one that allowed for the most amount of interaction between residents and staff. So far, I have not found a facility with this setup and I have been working in NH's for over 10 years. I hope I helped.

Jaime :rolleyes:

Antikigirl, ASN, RN · Apr 16, 2005

I do not work in a nursing home, but I work in assisted living! This is an up and comming trend, and has it's ups as well as downs! Here are some differences...and maybe some of these would mesh with a home atmosphere to make it a bit better for residents.

First, CNA's do all ADL's and Med passes. They are specially trained and attend classes every other friday to keep up skills and learn the latest in elder care/rights. I just went to one yesteday and it was awesome, about the creation of the patient bill of rights and the advent of the elder perspective in it...then on to explaining the nitty gritty about the three hospices we have available (so we can all help in making the choice of which is best for what client), and about POLSTS. Last time it was definitions and newer treatments for skin issues! They are always getting CME from us nurses...and that pays off!

Our CNA's all work with 12-13 people a day, and it is a mix of slightly dependant to totally dependant...sadly the totally dependant folks are starting to age and are becoming more dependant and getting outside the scope of assisted living...but family doesn't want them to leave our facility...so we are hitting walls about getting them out to more skilled facilities with direct RN care...so it is weighing heavy on us! This is something that needs to change, and once someone hits certain criteria they need to move to a SNF..that has yet to be done and is being looked into now at our facility (due to complaints from nursing staff because we don't have the equipment to handle it).

We have one nurse per shift that oversees the CNA's, does diabetes checks/insulins, any complex issue or dressings, triage, incident reports and prevention, MAR's, you name it! Considering we have one nurse per 160 could use a vast improvement ratio! I suggest 2 floor, 1 supervising for this situation...and the days where this has occured we have had enough coverage! :)

We have an in facility pharmacy, with on call! Awesome!!!! Big bonus!

The residents have their own apartments, and they are just like any small studio apt! Kitchenette included in most, but meals served in a restaurant style area, or tray service if you are too ill too attend. The only medical equipment is usually what the patient provides, O2 tanks or concentrators, wheel chairs, walkers, bath benches, etc. We have call light cords in every room and sometimes two...lots of them with easy access in mind, all rooms are elderly friendly with options to raise toilets, handles everywhere, non-skid flooring in bathrooms etc. Very elder friendly.

The downside like I said was the fact that our complexity of residents is increasing and without a crash cart or AED, no emergency respiratory equipment, in wall O2 or suction, it is very difficult to handle emergencies like I can when they need it (like acute respiratory failure, and non DNR status!), or even handle end of life issues like some suctioning and O2 to make the patient comfortable. That is usually when we get hospice involved and they provide the equipment.

This assisted living is going to be the wave of the future and needs a serious look to perfect it. It is homey and provides independance, freedom, dignity, privacy, and a style of life more open to individuals and choices. We are also privately owned which provides for the abilities to change and grow without depending on state/federal moneys...a big bonus but WHEW expensive!!!!

So there is a look at assisted living..I think some of those concepts blended with LTC would make a great place! WITH STAFFING to do it all too! (I think we need more CNA's like a 1 CNA to 6 max!).

lpn1313 · Apr 16, 2005

although older people prefer to live independently in the community, and most are successful in doing so, institutional care is an essential option for an aging population. some facilities are excellent, providing high-quality care, comfort, and intellectual and social stimulation. however, even in these excellent settings, there is probably some room for improvement. develop a description of an ideal nursing home. your description should include the approximate number of residents, the approximate number of staff members, the qualifications of the staff, the physical design of the facility, provisions for promoting contact between residents and the community, and activities offered within the facility.

ok here's my $.02- and remember it said ideal- not real :rotfl:

no more than 200 residents total divided into units of 25 with one nurse, three nursing assistants for each unit. all staff trained in geriatric and gero-psych care. full time tx nurse for every two units. pt/ot for rehab.

all rooms should have large windows. adequate space to maneuver wheelchairs and geri-chairs without difficulty. in room bath and shower units-again with room for chairs. toilets at the angle so that they're easier to get on to with assist. large halls with windows!!!! ample living/parlor space for large family visits. a dining area that doesn't look like a cafeteria. decor in the rooms that isn't exactly the same as everyone else's room. hand rails in the hall that are pretty, not ugly pipes.

full service beauty shop for residents, a 'general store' type place for the residents. a mini bus for field trips out to the store, restaurants, the bowling alley, the theater, etc. how about an arrangement with the local school for visits with the children. pet therapy is a must.

please please please offer something other than bingo! themed bulliten boards that the residents can decorate. let them have a garden. how about a fishing pond? for the residents that like to tinker, a small maintainence shop. more activities designed around resident hobbies. an enclosed area outside for those residents that wander. w/c accessible gardens with elevated beds for easy tending and admiring. a library with print and audio books. computer classes and access for those who wish.

food that's appealing. just because a person's diet is modified doesn't mean that they don't care what it looks like. and treats once in a while- i don't know a single diabetic who wouldn't kill for a 'bad for them' treat.

LPNandLUVINIT? · Apr 16, 2005

lpn1313, I would love to work at a place like that. Where I work they try (or so they say) to provide a good atmosphere for the residents, I can't help but pray for more changes. The activities dept. does offer crafts now and then, but they're has got to be more they could do than BINGO three times a week.

Long Term Care Columnist / Guide · Apr 16, 2005

Private rooms with big picture windows, facility pets, resident-to-CNA ratios of 5:1. Individual freedom to eat when the residents want, sleep when they want, get up when they want. A schedule that fits the RESIDENT'S convenience instead of the lockstep routines most nursing homes have. Plenty of interaction with the environment for those who want it; a quiet place with calming colors, decreased stimulation and 1:1 for those who become agitated. Attractive, well-seasoned foods to tempt the senses, even for those on mechanical soft or puree diets, and more choices.

No 'forced' showers twice a week whether they need it or not, and NO cold gray-tiled shower rooms that frighten dementia patients. Enough caregivers present at meals to allow slow eaters to take as long as they need to finish. Enough equipment to meet the needs of every resident in the building. Pay nurses and aides enough to make LTC worthwhile, and give them the respect they deserve. :)

Fun2, BSN, RN · Apr 16, 2005

Thanks for everyone's replies so far.

Please keep them coming. It's hard to make the ideal facility when you only see the bad points from a family member's point of view.

I really appreciate the help. :)

Fiona59 · Apr 16, 2005

PT, OT and activities staff working a seven day week. It is supposed to be the resident's home, but please the staff working weekends just don't have time to do the activities, physio, etc. Nurses and other direct caregivers work 24/7, residents need stimulation seven days a week....

Fun2, BSN, RN · Apr 16, 2005

PT, OT and activities staff working a seven day week. It is supposed to be the resident's home, but please the staff working weekends just don't have time to do the activities, physio, etc. Nurses and other direct caregivers work 24/7, residents need stimulation seven days a week....

Would you think that the activities staff needs special geriactric training, or just have knowledge of whatever they are involved in, for example, crafts. Should they be required to be CPR certified, or should that be left to the medical staff?

Should the activities staff, as well as all others, undergo a background check as stiff as the ones for volunteering at a school?

What would be the ideal pay to make LTC more appealing to everyone?

Marie_LPN, RN, LPN, RN · Apr 16, 2005

In regards to someone saying CNAs doing med passes, that might do more harm than good.

germain · Apr 16, 2005

All of the above AND- a home that is the center of the larger community. Activites for families that visit- formal dinners or movies etc. Recreation all the time but not too much, a garden is important, outside access is important. Volunteers would be strongly encouraged to help out.

leslie :-D · Apr 16, 2005

where i worked, there was a ltc facility attached to my hospice unit so i certainly got to know all of the residents, most w/demential.

one day a resident and i were talking about what changes we would make to the facillity.

she wanted to change the name of the facility to the 'pink flamingo' and have the sign in neon lights :chuckle ....

then she proceeded to say that all the walls would be light pink;

my input= nothing but the best for these residents which encompasses:

top notch staff (sensitive, warm and skilled)

much more appealing meals;

more diverse activities;

a couple of cats or dogs that lived there (w/a hired person to manage them). much more greenery and a cozy, inviting home environment.....

getting them outside more in the nice weather to get fresh air and sunshine on the acre of fresh green grass.

less regimented schedules and letting them eat when they wanted to rather than getting them cleaned and fully dressed by 7:30am to be in time for breakfast- let them sleep!

good pay and more recognition for the cna's.....if they're top notch, they're our backbone, our eyes and ears as well as treating the pts. like gold.

if i owned a snf, i would start the cna's at $15/hr then give them a raise after 3 month probation period.

i would appreciate my staff and never take them for granted. you get what you give.

oh. and i'd also have a few extra rooms for when a pt is very sick or dying, the families could stay.

leslie

if i think of more, i'll add to it.....