Nursing home/LTC getting more acute

CapeCodMermaid, RN · Oct 8, 2011

I've been in long term care since (aaarrrgggghhhh) the 70's and have seen the change from the knitters and sitters to the medically complex resident. So....medicaid in my state caps out at less than $300 a day, so clearly we aren't admitting these people for the money. It's the way healthcare is.

As for the admissions on 3-11....most if not all rehab patients are transferred with at least a weight bearing status. And since there have been nurses longer than there have been PTs, it is within the scope of practice to determine/assess someone's mobility.

At my last building, we often had 2 or 3 residents on one unit who needed frequent trach care including suctioning. The nurse had 20 residents in total and still was able to provide care for these people. The local hospital on the other hand.....THOSE nurses didn't have to do trach care since anyone with a trach was admitted to the ICU. Go figure.

Forever Sunshine, ASN, RN · Oct 10, 2011

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?

Usually if the patient is Alert and Oriented they can answer our questions.. "I can stand but I need help getting up" or "I can stand but this leg is weak". And then theres some who it takes 3 people to get them up out of the chair and into bed or on the toilet.

Arrival time of admissions have been very sloppy lately. It depends on the hospital. One hospital they arrive 30 minutes within pick up time. Another hospital that is 20 minutes away .. has taken up to 5 HOURS to transport an admission. Don't tell me its a 4pm pick up when the resident doesn't get arrive until 9pm.

And they don't even let us know if theres a delay or the admission isnt even coming. We have to call... I think we should be notified of that. I called twice. Once at 6pm and again at 8pm. The response was.. "yep hes coming".. ok but whats the hold up? "Hmmm... Not sure" The patient was pretty ****** off and I don't blame him. Who wants to be dragged and moved around at 9pm on a cold rainy night. They really should have waited until the next morning.

Another thing that bursts my bubble is sloppy paperwork. All I ask is a nice typed up or written neatly discharge med sheet. The summary is typed but reading messy handwriting is not my strength.

CoffeeRTC, BSN, RN · Oct 10, 2011

I don't mind that the times have changed and the acutiy is different. I actually enjoy it. What I do mind is that the staffing or regs haven't changed. 10 years ago, when we had more LTC residents with dementia and bed sores and no one was discharged unless it was to a funeral home....the staffing was just about the same. Yes, more total cares then but with the sicker, younger residents and the "customer" service requests (not nursing care requests) the staffing needs to change.

I honestly thought is was really only my place that gets the poorly arranged admits on 3-11 shift. LOL. I don't know why we can't get the process to go better always seems like some info is missing or they are coming so late that it is a cluster getting things from pharmacy.

Yes..we get the late night admits and transfer assessments need to be done. Thanks heavens most will just tell us how they've been doing in the hospital and we go from there. Sometimes you can find good info in the hospital PT records or the info you get with the referal from the hospital.

Forever Sunshine, ASN, RN · Oct 10, 2011

I honestly thought is was really only my place that gets the poorly arranged admits on 3-11 shift. LOL. I don't know why we can't get the process to go better always seems like some info is missing or they are coming so late that it is a cluster getting things from pharmacy.

Nope us too.. so next time its 7pm and your admission that was a 4pm pick up is just rolling through the door.. remember you are not alone and we are probably in the same boat. lol

WittySarcasm, BSN · Oct 11, 2011

I like it a lot! Because I hope to go to a hospital sometime and I am learning so many skills. Where I work we have a respiratory unit (with a lot of vented patients, though we don't touch the vents- that's RTs job).

My unit is a rehab, so we get people that are just out of the hospital. My unit is also a hospice unit so you get the end of life care too, I've done IVs, foleys, dressings, PICC care (we have a picc nurse so I haven't put any in). Our patients there seem to get sick easily also; though we do take anyone who is sick enough from the long term care units (like is one of our LTC people gets sick enough they come up to us until they are either better or management decides to move them back down).

Then of course we have the long term care units. In reality we have more younger people then what you would expect when I say "Nursing home," or "Long Term Care."

WittySarcasm, BSN · Oct 11, 2011

Nope us too.. so next time its 7pm and your admission that was a 4pm pick up is just rolling through the door.. remember you are not alone and we are probably in the same boat. lol

Ah man that was us today! The guy was supposed to come in at 9am, he comes in on my shift at 5pm (right at dinner which ticked the kitchen off since I had to have them make him a tray). And because it can't go easy half the info was missing so I had to wait till 6:30 before I could call the doctor to verify the meds. :crying2:

CoffeeRTC, BSN, RN · Oct 11, 2011

None of our admits are even scheduled to be on 7-3...never ever. I understand the hospital is a busy place and they wait for docs to round to DC but most of these residents are expected and planned discharges from the hospital and admit to the nursing centers. Why can't it happen.

When we do get them they come in at 2:30 (change of shift) or then they are expected at 5pm (dinner) but son't come until 7-8 or 9pm!!!

We do not have pharmacy in chouse...they are 1hr away for a STAT STAT( not a slow STAT or a ha ha..you want that STAT) and of course they are day 2 or 3 post op hips or knees and need the pain meds etc.

Forever Sunshine, ASN, RN · Oct 11, 2011

None of our admits are even scheduled to be on 7-3...never ever. I understand the hospital is a busy place and they wait for docs to round to DC but most of these residents are expected and planned discharges from the hospital and admit to the nursing centers. Why can't it happen.
When we do get them they come in at 2:30 (change of shift) or then they are expected at 5pm (dinner) but son't come until 7-8 or 9pm!!!
We do not have pharmacy in chouse...they are 1hr away for a STAT STAT( not a slow STAT or a ha ha..you want that STAT) and of course they are day 2 or 3 post op hips or knees and need the pain meds etc.

We are in the same exact boat. Mirror image! Admissions come at the worst time and never on 7-3. Maybe once in awhile. Once a month the most. We do get most of the admissions and most come during dinner time and I'm not allowed to leave the dining room.

We have a book with all of things that were sent to pharmacy and weren't brought. I call it the ***** book. lol I have to use it a lot. lol I think they stole a med from us but thats a whole other can of worms. We have to use the e-kit to give the new admits pain medication and we've run out of it from the ebox and the pharmacy took FOREVER to bring it. I sometimes get off the phone with them and want to scream and cry and yell and throw stuff at the wall. I don't get how it takes 7 hours to bring a stat medication!

But ok on top of all of this chaos. I feel its preparing me for when I apply for a job in the hospital. I just hope those hiring managers realizes that LTC isn't just changing briefs and popping pills, theres a lot more skills required.

LPNnowRN · Oct 13, 2011

Yeah--what's the rush to get a hospital job when the hospital comes right to you? Wound vacs, IV vanco, morphine pumps, fresh ostomies, and on and on...