How to Determine Whether a LTC / SNF is Well Run

[vintagemother]

Hello Nurses!

I am taking the prereqs to apply to nursing school and recently became a CNA. I'd read and heard that working in a SNF / LTC facility was not desirable to most nurses and I (wrongly) assumed that people who didn't want to work in LTC / SNF didn't care for caring for the elderly or thought the work was unfulfilling.

After my first experience landing a FT job in an SNF went horribly awry (scabies + MRSA, C-diff + no gloves, no PPE and no real training) I learned that these types of issues are at the root of the reason why many chose not to work in SN / LTC facilities.

The reality of it is that many of the available jobs that exist are in these facilities.

How can a new (RN) nurse (or CNA) tactfully determine whether a particular facility follows proper procedures prior to becoming employed?

Are there certain questions that can be asked or things to observe for?

eg Is it appropriate to ask about the ratios? What would good ratios be? Is is appropriate to ask about the policy for supplies being replenished during the interview process? How much /what type of training is appropriate to receive?

I am most concerned with protecting my own liability and keeping myself (and my family at home) safe from communicable diseases.

[BrandonLPN, LPN]

This is why I'm so glad I don't work in a for-profit nursing home. I find it hard to believe that any nursing home, anywhere, can't afford to provide the CNAs with bottles of body wash or with plastic linen bags. Really? Really??

[LadyFree28, BSN, LPN, RN]

The best SNF/LTC I worked in my area was a government-run veterans home and a privately run facility. I enjoyed both places because how the treated staff and agency staff equally, and they had a culture of "resident first" mentality.

I remember when I was finishing my upper level courses in my BSN program in my management classes where we discussed the issues of staffing, ratio and the effects of the quality care from hospitals as well as nursing homes we looked a study where the largest FOR Profits were WORSE than government ran (state and federal). I don't have the study anymore, however I found the article from Advance for nurses:

http://long-term-care.advanceweb.com/Columns/Gerotalk/Study-Finds-Largest-For-Profit-Nursing-Home-Chains-Providing-Lesser-Care.aspx

One of my friends works at one of the for profits, but the place is wonderfully ran...I worked there as an agency nurse (I told her to take the job, and she loves it) and have done chart reviews at a few if their facilities for Medicare...at least IMO for this non-profit, they may have ones that follow a "gold standard" while some may not. I have rotated at another fir profit when I was in LPN school and we would smell urine when we came in the door, but the floor we worked on did their work and really seemed committed to working for the pt...and the usual "stolen clothes" incident would happen as well. In my senior rotation, I rotated in a city ran nursing home that was transitioning into state-privately run...kind of like purgatory I guess. The nurses were mostly ran by travel nurses...but the staff overall tried their best. They had WOCN services, respiratory therapists, coordinated care, NP's and MDs for every unit and the did daily visits and would visit if the nurses called the providers. They all worked as a team. The clientele were lower income...one our clients assigned was a registered sex offender on the Megan's Law Website...they took everybody that needed nursing, and at least did the best they could. I learned the most from this nursing home as far as how you can still give your clients the best nursing care, against all odds and situations.

Although I no longer work in LTC, I commend the nurses who are truly serving in this area! :)

[vintagemother, BSN, CNA, LVN, RN]

I started this thread nearly a year ago and am still working as a CNA, albeit super part time. I am currently in an LVN program and know I am likely to land a job in a SNF.

I appreciate these comments, as I still see things in some SNFs that don't seem quite right, but may be a matter of course. I am sensitive, maybe overly so, to the needs of others and perhaps am bothered by things I shouldn't be.

Thank you all for posting your varied input.

[LadyFree28, BSN, LPN, RN]

I started this thread nearly a year ago and am still working as a CNA, albeit super part time. I am currently in an LVN program and know I am likely to land a job in a SNF.

I appreciate these comments, as I still see things in some SNFs that don't seem quite right, but may be a matter of course. I am sensitive, maybe overly so, to the needs of others and perhaps am bothered by things I shouldn't be.

Thank you all for posting your varied input.

Nah, not overly sensitive, only a nurse who cares about pts and....possibly a nursing activist in the future :)

[vintagemother, BSN, CNA, LVN, RN]

Aww thanks LadyFree28!

[nurse4sale]

You asked, " How can a new (RN) nurse (or CNA) tactfully determine whether a particular facility follows proper procedures prior to becoming employed?" THE ANSWER TO YOUR QUESTION IS THIS: YOUR NOSE WILL TELL YOU AS SOON AS YOU WALK THROUGH THE FRONT DOOR!

[nikkibobicky]

I'm late to this conversation, but I just wanted to second the seniment that SNFs get a bad rap in the world and I think it sucks. I spent 6 years as an LPN working in various SNFs- first long term care, then sub-acute, then in administration- before I went back to school, got my RN, and now work in an acute hospital. After spending so much time in different kind of SNFs, it's hard for me to comprehend why they would be thought of as "old people warehouses," because more often than not, they're communities where the residents have extremely close relationships with other residents.

Yes, the patient to nurse ratio is way higher than in an acute setting, but then again, you're most likely going to have the same patients day after day for months or years wheras in an acute setting, you may only have 6 or 8 patients but with admissions and discharges, it's not unreasonable to see 12 different patients in a shift.

Personally, I think medicare.gov is a good judge of how a nursing home is run overall. But yeah, the biggest clue is if you walk in the door and it doesn't smell like it should.

[gabulldogs]

Charge Nurse on 7pm-7am Shift Full-time at LTC/rehab. Didn't see the bad stuff until I started working. Things just keep getting worse. I am looking for other employment BUT I have to try to advocate for the residents and the associates. Management is horrible!!!!!

The Corp. that owns it also owns 50 more and my research showed they don't all run the same way. WE rated below average on the list of inspected/recommended LTCs. Guess it wouldn't have matter when I was looking because I was in Need of a job.

I'm 50 years old and trust me when I way I've worked with many different companies and this by far the worst managed.

Adm./DON demands far too much of the staff. Good people are leaving and I'm not far behind.

Neglect of the Residents is evident. Trust me my list would blow your minds. I have contacted Corp. HR person and was asked to try talking to the Adm. one more time. (I am documenting) Then to get back with them on the results. My attempt with the DON was a waste of energy. I am so distressed. My main concern is the res'.

Other employees (been there few years) said its a waste of time. Others have tried. Just feel so alone and tired all the time.

[nurse4sale]

Charge Nurse on 7pm-7am Shift Full-time at LTC/rehab. Didn't see the bad stuff until I started working. Things just keep getting worse. I am looking for other employment BUT I have to try to advocate for the residents and the associates. Management is horrible!!!!!

The Corp. that owns it also owns 50 more and my research showed they don't all run the same way. WE rated below average on the list of inspected/recommended LTCs. Guess it wouldn't have matter when I was looking because I was in Need of a job.

I'm 50 years old and trust me when I way I've worked with many different companies and this by far the worst managed.

Adm./DON demands far too much of the staff. Good people are leaving and I'm not far behind.

Neglect of the Residents is evident. Trust me my list would blow your minds. I have contacted Corp. HR person and was asked to try talking to the Adm. one more time. (I am documenting) Then to get back with them on the results. My attempt with the DON was a waste of energy. I am so distressed. My main concern is the res'.

Other employees (been there few years) said its a waste of time. Others have tried. Just feel so alone and tired all the time.

Call the State if you're not getting anywhere with management! You don't have to identify yourself. Tell them what shift the crap is happening on, or all shifts, and tell them to make a surprise visit to the facility. It makes me so mad that family members don't see this to, but they too seem to turn a blind eye to what's going on because they don't want to get stuck, or have the time/energy to care for their loved one.

So, anonymously, you can call you State Health Dept., Ombudsman Office, or just seek advise from you States nurses organization for advise on what to do.

[gabulldogs]

Call the State if you're not getting anywhere with management! You don't have to identify yourself. Tell them what shift the crap is happening on, or all shifts, and tell them to make a surprise visit to the facility. It makes me so mad that family members don't see this to, but they too seem to turn a blind eye to what's going on because they don't want to get stuck, or have the time/energy to care for their loved one.

So, anonymously, you can call you State Health Dept., Ombudsman Office, or just seek advise from you States nurses organization for advise on what to do.

Thank you. That's exactly the answer I needed. Already submitted with Ombudsman online. Will talk to Nurses Org. and see what to do. I've already been advised by friends (rn) to get out of there, I'm risking my license.