Nursing Home conditions are unacceptable!!! (vent)

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and I am darn mad about it!!!! :madface:

It really hurts my heart that these people can't get better treatment than this.

As you probably can tell, I work in LTC. And right now, I am wanting to turn some facilities in for unsafe conditions and deliberate understaffing. However, as we all know here, state by state nursing home inspectors are aware but turn a blind eye to the staffing guidelines of nursing homes. Who do we have to tun to if not the state watchdogs? Why is it acceptable for this to go on? I just got off of my 2nd shift where I just had 48 patients on a dementia/Alzheimer's unit. There was only 1 nurse and two CNAs to 48 patients. And to add to the equation, the moon is full. So, y'all already know the rest.

This was my night, last night (and on most nights):

I have 4 tube feeders, multiple diabetics, 20 of the residents are total care, the other 28 are walking "time-bombs" just waiting for a fall, or worse, to happen. I am trying to do med pass in only 2 hours for all these people. I have resident's that are sundowning and having some psychotic issues. I can't finish my med pass because I keep having numerous issues that interrupt me. I have mostly 48 people that you have to sit with for 10 minutes each to convince them to take their medicine due to their mental incapacity. You have 30 of them that will hold the meds, which are crushed in applesauce, in their mouths forever. You can't leave them because of fear of aspiration, so the clock is still ticking. You have the other residents that I have to keep running to check on every 5 minutes because I hear bed and chair alarms going off, all while trying to stay in compliance with med pass. You have only 2 CNAs that are working their butts off. So of course, I won't let them drown. I help them feed and do peri-care (they are lucky to get a bed bath tonight. Showers just ain't going to happen tonight). I have 4 tube feeders that, unfortunately, have not been flushed on the previous shift, so you know what's next. I spend 15-20 minutes on unclogging their feeding tubes just so I can give them their meds, not to mention feed them, flush them, etc.

During the first part of the shift, the doctor was in the building seeing residents on another unit. I have a couple of patients with issues that he wasn't scheduled to see today. Instead of him walking around there to come LOOK at these patients, as I begged him to do, he just gives me orders based on what I tell him. He won't even come and see them. Okay, that pushes my buttons even more. So now I have extra charting to do to cover my butt (and his), if anything worsens with these patients. And lastly, I have a man that was confirmed MRSA positive, but the DON refuses to move his roommate. This man is allowed to wonder around touching other residents because nobody has the time to keep him from coming out of his room. Not to mention that I am getting calls from other units to come and help out when needed.

I ask all of you. What can be done? I hate to refuse to work because this place has some nurses there that will work, but when they do work, they don't hit a lick at anything. I hate to follow them because I have to make up for what they didn't do. We have nurse supervisors that do the paperwork part of their job, but nothing more. They never work the other cart when there is no one else. They just leave you hanging out to dry. This facility does not advertise to get more nurses, so I don't know how they expect to hire any. And because a lot of nurses just accept these conditions, it continues to happen. It's not fair to the residents and it's not fair to the nurses. What can we as nurses do to make a difference and stand up for these patients? There has got to be a way to make these people's quality of life, during their final days, better. They have worked hard and made this country what it is so that we can live and this is how they are repaid? Something has got to be done about this. I'm pretty sure it's not just my facility, but others across the country as well. And y'all, with the baby-boomers growing older and living longer, it's going to get worse. But it has to stop.

Your input and comments will be much appreciated.

Thanks, you guys!!!!!

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Just a hug.

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Life sucks when a person gets to the point of being totally dependent on others for their care and they don't have famiy who wants to do it.

Hope I step off this mortal plane before it happens to me.

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Life sucks when a person gets to the point of being totally dependent on others for their care and they don't have famiy who wants to do it.

Hope I step off this mortal plane before it happens to me.

Thank you for responding. But isn't it sad that it comes to that notion? The notion of rather dying than to go through what these people are going through. It shouldn't be so bad in these type of institutions that you have to dread going into one. I mean these people have worked, raised families, paved the way for us only to be half taken care of. I would think that the AARP or someone would have done something by now. Especially with the political powe the AARP has.

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Just a hug.

Thank you so very much for that, love. I really need a hug because my feelings are hurt having to watch these people go through this.

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I doubt there's little one can do to change this problem across the board. However, if your heart's really in it, maybe you can find a way to carve out some time to participate in or help coordinate a larger effort to push for change. Maybe a political approach or a garnering more publicity on the working conditions in nursing homes.

I specifically note that attention needs to focus on the working conditions, not just the patient conditions. Some reports of poor nursing home care make it sound like the problems lay with uncaring staff as opposed to the staff being faced with impossible demands. How to pay for quality care can't be left out either. Nurses need to make a living, too.

This site may be a way to find others with a similar interest in trying to effect change beyond refusing to accept employment at subpar facilities or making do in poor working conditions. Whaddayathink?

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This site may be a way to find others with a similar interest in trying to effect change beyond refusing to accept employment at subpar facilities or making do in poor working conditions. Whaddayathink?

LTC will not change until the entire paradigm of end of life care in this nation - in the western world - changes. And the powers that be - and I'm including DONs, social workers, and administrators with "evil" big pharma and the insurance companies - all accept that this is the best way, except maybe to break it up into "neighborhoods" instead of wards.

You can not maintain function in an Alzheimers patient with Parkinsons, yet the state mandates that we do so and reimburses us $7 an hour for labor. We have to do two things: we have to accept that old, sick people deteriorate and die, and permit that, and we have to pay enough money to attract and retain employees.

But again, those working in LTC are as bureaucratic and moribund and set in their ways as the government, and you go up against your DON. I ain't goin' there. Mine told me ystdy that she'd never even heard of a "cheat sheet" for meds. Yeah, right.

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Well I guess first of all I thank you for doing your best with what you have to work with. I'm a senior nursing student now and LTC is not part of our focus, but I was a CNA and part of our training was 2 weeks in the nursing home and 2 weeks at the hospital. I went home every single night in tears after working at the nursing home. They were so pathetically understaffed, undersupplied, overwhelmed. I told everyone I knew how I could not believe that this is what we do to our elderly in this country! With all of our advances shouldn't there be a better way? I vowed no matter what I had to do, my parents would NEVER be placed in such a facility and I hope to God that there conditions never become such that I cannot care for them at home or afford to shell out the BIG bucks for something better.

A solution? I don't know. I'd love to do my part to help bring this to the attention of people who might be able to bring a change, but I don't know where to begin. Maybe rotating nursing students through nursing homes more frequently could at least provide extra hands who are able to pass meds and perform other skills. It would be good experience for us and help relieve the staff. Although, I think a lot of my fellow classmates would probably shoot me for suggesting it. Across the board, I do not know of ONE single person in my class who wants to graduate and work in LTC, even myself. With conditions that deplorable and the nurses feeling SO overwhelmed, most who have another option are choosing it.

I'm sorry I can't do more than empathize with you at this point. I guess at the end of the day all you can do is remind yourself that you ARE making a difference just by being there and providing the best care you can. You choose to make a difference where a lot of us do not, and I hope there are some special blessings somewhere along the line for people such as yourself. Thanks for what you do.

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Specializes in critical Care/ICU-traveler.

I worked LTC for 15 yrs as an aide before becoming a nurse. I have seen more then my share of this as well. It seems to be a problem even in the nicer nursing homes.

The one thing that seems to make any difference at all is if the families of the residents start to complain. It usually gets the attention of the administration and management. They usually want to keep these people happy for fear of losing the buisness.

I have been tempted in the past to make an anonymous call to the Department of Health (or the overseeing body for your state). I never did, but I know people who have. They have to investigate all complaints and concerns. The families need to know that they have the power to make these calls as well.

I'm sorry it is so terrible for you. I hope it gets better soon!

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I think the old story about the Eskimos pushing their elderly out to sea on a block of ice is pretty much overstated however I have to laugh when people gasp at that concept when what we do to our elderly is a lot worse.

The state doesnt care for the most part, sure if there is a complaint they will investigate to "act" as if they are doing something. All of these rules and regulations especially in regards to paperwork do not help as well.

There are things you can do, I give my personal opinions to people when they ask in a professional way. Support legislation that promotes paying for care in the home as opposed to only a nursing home. Currently it costs the state 55,000 a year to keep someone in a nursing home but as part of an aged and disabled waiver service it can cost around 20,000-25,000 to keep someone in their home.

Typically it is called something like "money follows the patient." It just makes sense to save 30,000 dollars and let someone stay at home. But long term care conditions are horrid in the US. I am surprised the AARP hasnt done more but for the most part these people in nursing homes are demented or have severe physical limitations hence they no longer have a loud voice.

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I agree that home care is a good alternative. It does have the down side in that then those in nursing homes are only the very lowest functioning folks and so you need more intensive staffing. There may be less nursing home beds all around, but each nursing home would look like it was MORE expensive to run because you'd need more help per resident/patient. Actually, I think this has already happened to some extent. By looking at the staffing numbers, one might think it ought to suffice, but then one has to consider that these folks have tons of meds, need lots of assistance with ADLs, have several multiple health concerns, have dementia of varying degrees, etc.

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I doubt there's little one can do to change this problem across the board. However, if your heart's really in it, maybe you can find a way to carve out some time to participate in or help coordinate a larger effort to push for change. Maybe a political approach or a garnering more publicity on the working conditions in nursing homes.

I specifically note that attention needs to focus on the working conditions, not just the patient conditions. Some reports of poor nursing home care make it sound like the problems lay with uncaring staff as opposed to the staff being faced with impossible demands. How to pay for quality care can't be left out either. Nurses need to make a living, too.

This site may be a way to find others with a similar interest in trying to effect change beyond refusing to accept employment at subpar facilities or making do in poor working conditions. Whaddayathink?

Thank you for replying. I sure hope I can make a difference somehow. I think I will be getting in touch with the Agency on Aging and the AARP to bring up this issue and maybe get some wheels turning. I'm willing to put my foot in it if necessary.

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