Perpetuating the Stigma of LTC

mirandaaa · May 28, 2015

As someone who worked as a CNA in LTC for 3 years, LTC nursing staff are some of the hardest working employees out there. For as understaffed facilities are, the nursing staff as a whole for this specialty do a great job.

The "outsiders" unaccustomed to this area just don't get it. Pressure ulcers and skin tears happen A LOT and it's not always due to lack of care from the staff, but just because the skin is old and fragile. I had a resident once who had new pressure ulcers constantly, it didn't matter how much preventative care we provided, his skin was just easily broken down. I also had MULTIPLE residents who left at different times to go to the hospital and they ALL returned with extremely soiled briefs, HORRIFIC pressure ulcers, and had not been bathed the entire time they were gone and we had those pressure ulcers cleared up in just under a week.

I really feel that until someone actually experiences working in LTC, they are unable to form an unbiased opinion.

LTC nursing staff are there because they CARE about the well-being of people who sometimes don't care about themselves anymore. It's important to realize that elderly residents don't heal like young patients do and often much slower, they are more fragile, they require a lot of extra cares that younger people don't.

Red Kryptonite · May 28, 2015

My recent clinicals were in a LTC facility that really opened my eyes. It was well-staffed and the nurses and CNAs working there were caring and attentive. I saw dietary and housekeeping staff pushing wheelchairs and talking to residents. They all knew names and saw the people often enough to say things like, "I like your new outfit. Did your daughter bring that in for you?" In looking through charts, I saw example after example of people who came in with serious skin issues healing. I saw almost no pressure ulcers the whole time and those I did see originated outside this facility.

I had thought all LTC was like the place I did my CNA clinicals (truly awful), and I apologize if I ever insulted LTC staff based on that. I'm grateful for the experience I got in this other place. Apparently, the recent one is independent and family-owned, while the other was part of a huge well-known corporate chain. Maybe that's the difference?

mirandaaa · May 28, 2015

Apparently, the recent one is independent and family-owned, while the other was part of a huge well-known corporate chain. Maybe that's the difference?

I personally feel as though that makes a huge difference. Generally the family-owned ones have owners that genuinely care for their residents and make a point to get to know everyone personally and ensure they all have the best care possible. The corporate ones make it all about money. And not money for the employees or for the building.

Ruby Vee, BSN · May 30, 2015

I've never worked in LTC, but both my mother and my mother-in-law have been in various LTC facilities. I have nothing but the utmost respect for the nurses I've encountered there and my impression of most of the CNAs is that they border on sainthood. I couldn't do what they do for even one day, yet they seem to come to work every day with a smile on their faces and a "can do" attitude. I've seen first hand the sort of disrespect and demonization they've had to endure from patients, families, EMTs and ER nurses and I don't get it.

LTC nurses have more patients to look after than those of us in the hospital -- and I've been in critical care since the early 80s, so I definitely have no clue how they do it. Yet they seem to know their patients inside and out. They know their health histories, their med lists and those little quirky things that make everyone an individual. "Oh, this is Peggy. Her husband was a pharmacist, so she knows the names of everyone's medications." Or "This is Joe. He worked his dairy farm for sixty years, so he's up and at 'em every morning at 5:00." More than that, those LTC nurse and CNAs deal with even the ornriest patient, and they still find something nice to say about them. I asked one nurse how she did it.

"I love my patients," she said. "I love coming in to see them every day. I've worked here since I graduated from nursing school and I wouldn't work anywhere else." She graduated the same year I did.

To all those who are determined to put down our colleagues in LTC, I'd ask that they go spend a day or a week following a LTC nurse or CNA. I'm not at all sure they could keep up. I KNOW I couldn't.

brandiep1982 · Jun 1, 2015

I personally feel as though that makes a huge difference. Generally the family-owned ones have owners that genuinely care for their residents and make a point to get to know everyone personally and ensure they all have the best care possible. The corporate ones make it all about money. And not money for the employees or for the building.

THIS! I feel for you OP. I know there are some wonderful LTC facilities out there. I have seen them and was fortunate enough to work at a couple of them. However, when I relocated and left my first CNA position, as I searched for a second CNA position, I never returned after first visits to a few facilities... they were shocking and I was enraged. I did finally find a great place to work at, though.

As a paramedic, I took patients out of LTC facilities frequently. There were one or two that were great. Most, unfortunately, were not so great. I always assumed the difference was in what the staff was paid... but listening to my mom (whose passion is geriatrics, and has been in that field for over 15 years), it seems it has a lot ot do with who runs the facility.

Independent facilities do really well. But the moment a corporation takes over or buys them out, care takes a landslide. Policies go down the tubes. Just recently we watched a beautifully run facility just sink within a few weeks of being bought out. It is heart breaking. These corporations are all about the money and that affects the employees. It isn't like it changes the employees. They just tend to leave, and are replaced by staff that did not know what it was like before. Some stick around, but they can only improve the care of their residents during their shift, and that is all.

golson · Jun 2, 2015

What are good ratios in LTC? I was led to believe the place I did my CNA clinicals at was pretty good (10:1 CNA, 20:1 RN), but it just wasn't enough to answer call lights, toilet residents, or ambulate residents. We were barely holding it together even with the students there. Only one resident in 20 could walk without assistance, we had to use a lift for over half the residents to even get out of bed, and there would have been a line to help with feeding them had we not been there. There were ongoing infections on several incontinent residents, one of which I had to follow up on about 4 times throughout the day before one of the RNs could take a look at it (had to go to another unit to get one, eventually). Good on the folks that can do this for indefinite periods of time, but I think it would wear me down inside of a year.

mirandaaa · Jun 3, 2015

THIS! I feel for you OP. I know there are some wonderful LTC facilities out there. I have seen them and was fortunate enough to work at a couple of them. However, when I relocated and left my first CNA position, as I searched for a second CNA position, I never returned after first visits to a few facilities... they were shocking and I was enraged. I did finally find a great place to work at, though.
As a paramedic, I took patients out of LTC facilities frequently. There were one or two that were great. Most, unfortunately, were not so great. I always assumed the difference was in what the staff was paid... but listening to my mom (whose passion is geriatrics, and has been in that field for over 15 years), it seems it has a lot ot do with who runs the facility.
Independent facilities do really well. But the moment a corporation takes over or buys them out, care takes a landslide. Policies go down the tubes. Just recently we watched a beautifully run facility just sink within a few weeks of being bought out. It is heart breaking. These corporations are all about the money and that affects the employees. It isn't like it changes the employees. They just tend to leave, and are replaced by staff that did not know what it was like before. Some stick around, but they can only improve the care of their residents during their shift, and that is all.

Exactly. It's so sad. My first LTC job was privately owned, very nice, and in the heart of a very small town. It was wonderful; the residents were happy and well taken care of, we were staffed appropriately, the pay was decent, and the staff were also happy.

I moved to a different state and began working for a corporate LTC facility and it was horrendous. WAY understaffed (I was the only CNA for 26 people), the pay was even less than I had been making before (even with 2 years of prior experience), the residents were unhappy (guessing because the staff were all too busy to give them more TLC), the staff hated it there (actually were in the process of getting a nursing union; this was successful my last week of employment). It was just unreal.

Corporate LTC facilities are no good and I do not support them whatsoever.

Animal House R.N., ADN, CNA, LVN · Jun 4, 2015

And the bigger the

business gets the more it is all about bottom dollar.

Here.I.Stand, BSN, RN · Jun 7, 2015

I'm sorry you were subjected to such ignorance. I've said on other threads, but my one grandpa had to move into LTC when he was 102 yrs old. I credit his awesome geriatric nurses with getting us two more years with him, and for keeping them comfortable years.

I'll also add that (at least in my experience), pressure ulcers happen WAY more in the ICU than in LTC. I worked as a CNA in LTC for three years, and I only saw one. That was a 40-something, big, basically quadriplegic man with CP. His own preference was to sit in his motorized wc all day. If most of your 300 pound weight is focused down on the butt all day, every day, skin is going to break down.

Meanwhile, my patient I took care of recently had five PUs. Not the result of neglect either; it was that she was prone for 27 hours. If we put her supine, her O2 sats dropped to the low 60s. Not sure if you've ever seen a Rotoprone bed, but the pt is very tightly strapped in, and you can't position them with pillows. It's really, really difficult to prevent all PUs when someone is this sick.

All that to say PUs are not always avoidable, and the idea that Grandma will get one in an LTC because they are soooooo negligent is simply not true.