Nursing home/LTC getting more acute

Quickbeam, BSN, RN · Oct 7, 2011

This has been going on forever. when I started in LTC in the 1970's, perfectly healthy older peole retired to nursing homes. Seems odd now but was the norm then.

I di hope there continues to exist a model of care that is less intense than you describe for the sake of the residents. I wouldn't want to live out my life in that setting with vent beeps and alarms all day/night.

beast master RN · Oct 7, 2011

yea theres even ltac units, long term acute care, when pt are to acute to stay with us they go there

optimist · Oct 7, 2011

I think a lot of this trend is $ related. The SNF Im at is beginning to accept more and more acute pts because they can charge more for their care. As the older 'retirement home' pts expire, they are replaced by trachs, fresh off the vent with multiple wound vacs and a tube for every bodily function. Unfortunetly, though they can charge medicare/aid more $ for the care of these people its not directly improving the care we can provide. We're not educating staff on proper care of such acute patients. We're still using outdated generic supplies and equipment for them as well. Nurses in todays LTC have their work cut out for them, we take care of patients sick enough to be in the hospital but without the supplies or resources a typical hospital would have.

adoglover · Oct 7, 2011

Optimist, I agree with you on that. It's a way for the private facilities to make more money even during the times of Medicare reimbursement dwindling. I know one of the facilities are training their nurses on the cardiac and vent unit for a total of fifteen shifts(3weeks). I don't know if that's enough time to become adequately comfortable with handling those types of patients.

Forever Sunshine, ASN, RN · Oct 7, 2011

I think a lot of this trend is $ related. The SNF Im at is beginning to accept more and more acute pts because they can charge more for their care. As the older 'retirement home' pts expire, they are replaced by trachs, fresh off the vent with multiple wound vacs and a tube for every bodily function. Unfortunetly, though they can charge medicare/aid more $ for the care of these people its not directly improving the care we can provide. We're not educating staff on proper care of such acute patients. We're still using outdated generic supplies and equipment for them as well. Nurses in todays LTC have their work cut out for them, we take care of patients sick enough to be in the hospital but without the supplies or resources a typical hospital would have.

Thats basically it. A few rooms in my hallway all had LT residents. They eventually expired and they facility fills the empty beds with patients who really should be on a med-surg unit in a hospital. We have not had an admission in a while where were able to say, "ok we have the supplies in the facility to care for this residents needs"

LouisVRN, RN · Oct 8, 2011

I am seeing this trend in the hospital as well. Our med surg unit is taking pts that 3 years ago when I started would have been admitted to tele or step down. Step down and icu are taking pts that before would have been shipped to another hospital. I know it comes down to money but you have to wonder about the quality of care these pts are receiving and if it negatively effects pt outcomes. I know working medsurg even if I want to spend as much time as possible with a pt I feel is getting septic and should be on a higher level of care I still have 4 other pts that I need to assess/medicate do treatmentts on etc.

Forever Sunshine, ASN, RN · Oct 8, 2011

I am seeing this trend in the hospital as well. Our med surg unit is taking pts that 3 years ago when I started would have been admitted to tele or step down. Step down and icu are taking pts that before would have been shipped to another hospital. I know it comes down to money but you have to wonder about the quality of care these pts are receiving and if it negatively effects pt outcomes. I know working medsurg even if I want to spend as much time as possible with a pt I feel is getting septic and should be on a higher level of care I still have 4 other pts that I need to assess/medicate do treatmentts on etc.

I think it does negatively effect patient outcomes. These patients are full codes(90%) and we admit them.. either do labs on them.. get the labs back and end up shipping them back out to the hospital because their labs are critical, or they become unresponsive and we send them to the hospital.

They also LOVE to accept rehab patients on 3-11. Rehab is long gone when the admission gets here. So its up to me.. to decide how the patient transfers until rehab can evaluate them. I'm not a physical therapist .. I'm not trained in assessing transfer status.

xtxrn, ASN, RN · Oct 8, 2011

LTCs w/vents and LTACs are not new. There may be more of them, but they've been around for decades. :)

1986- 30 bed LTC/Medicare unit (SNF) w/4-6 vent beds and one RN, one RT, and 2 CNAs for 7-3 and 3-11; shared 2nd CNA for 11-7. :up:

SuesquatchRN, BSN, RN · Oct 8, 2011

Thanks Medicare for much of it. There's a big push not to transfer acutely ill residents to the hospital, but to run abx and fluids there.

On any new admit pre-PT eval, two assist with a gait belt. Period.

:)

JenniferSews · Oct 8, 2011

It's the same here. Our medical director has told me the same thing. His point was a lot of patients who would never have survived their illness 20 years ago now do, but are far sicker afterward. Those patients end up in my facility, and then transition to the LTC unit. It's tough having 15 patients who would have been on a med surg floor just a few years ago. I don't even know how the LTC nurses do it, although their pt load recently went from 30/1 to 20/1 on the day shift. You know it's crazy when even corporate realizes they have to add another nurse! When was the last time you heard of that happening?

DixieRedHead, ASN, RN · Oct 8, 2011

They also LOVE to accept rehab patients on 3-11. Rehab is long gone when the admission gets here. So its up to me.. to decide how the patient transfers until rehab can evaluate them. I'm not a physical therapist .. I'm not trained in assessing transfer status.

This used to drive me crazy, but unless it is not Friday, or it is very, very evident how the resident will transfer, I note "Tranfer status pending therapy evaluation" and keep them in the bed. It has worked so far.

And I too don't get a hospital SW calling at 8:30 to tell me a resident will be coming and them arriving at 6PM. Are they that unorganized?