roxyblueyes

This is new to our facility, not really to sure of what to expect ( living in New York probably will never be sure ). We ran the gammot of reimbursment " updates" as referred to in many of your comments. It seems like walking a very unsteady tight rope between meeting DOH regulations for survey and ensuring accuracy in RUGS for reimbursement - if RUGS increase too quickly or too high that triggers sig. changes and red flags for the DOH as to why the rapid decline. I find I am questioning the sensibilities of climbing the perverbial " ladder" more often now - wishing I was back to being a staff nurse or even a CNA again - where my heart lies - actual hands on care good old fashioned nursing!

The MDS definition on "falls" and " level plain" certainly presents a challenge to the mind - once in desparation we tried using another mattress next to the low bed to allow for more unrestricted space to roll without actually rolling out of bed - did it work? - not - It still created a non level plain due to the frame of the bed. As far as an earlier reply about mats and people getting up for the bathroom - if a resident does try to independantly transfer / ambulate it's best not to use the mats for the sole reason of the increased risk of injury - keep the bed low and enlist the use of a bed alarm - in the time it takes them to get up from the low bed - if they can at all - the alarm should have sounded at first attempt giving added time for staff to respond. The roll or fall would still be less severe then if the bed had been in a higher position and with out the mat - But of course that is my opinion and you can choose to accept it or reject it - just offering some advice to a truly challenging issue. Take Care !!!!

When I started working as a CNA at the facility I am employed by ( quite some time ago mind you ) basically a big portion of residents were physically restrained to " keep them safe". :uhoh21: When it was mandated to do away with these restraints visions of bodies all over the floors went rampant through out the facility. To our amazement the tidal wave of falling bodies didn't materialize; in fact episodes of depression,adverse behavior and injuries from resident's trying to escape the restraint were significantly decreased if not eliminated. The residents were more receptive to requests as well as care provided. A couple of years ago, new to the position of RCC / Asst. manager an edict went out for zero tolerance to the use of side rails secondary to the risk of serious injury or death if entrapped in the side rail. Old feelings surfaced once again - bodies on the floor as opposed to in bed - a care planners nightmare for sure. Once again removing the side rails didn't create falling bodies chaos. Overtime one or two residents may fall out of bed usually without serious injury - if injured at all. That's when a low bed comes into play ( with mats on the floor) to keep residents safe. When providing care we just raise the bed to an optimal height ( the beds are electrically controlled ) and ensure the bed is in it's lowest position when we leave the room. Take Care everyone!

My mother was sick the majority of my childhood and I watched in awe wonderful people being attentive to her as well as my dad and me when she was in and out of hospitals as well as in a nursing home. I have inherited the syndrome she had and have been on the receiving end of care once again from some pretty amazing people. I began as a CNA at the facility I work at 20 years ago. It was my way of giving to others what others had given my mother - comfort, dignity, encouragement to allow her as much independence as her condition would allow as well as assistance when she could no longer participate in activities of daily living. She had a peaceful passing under the watchful eyes of a caring staff. I was hooked - geriatrics was my "niche"- so I returned to school and became an RN. My "forte" is the resident's with dementia - if I can get them to do things they may not want to do it's great. Grant you there are times I Feel like the Pied Piper of dementia when some of our wanderers latch on to me going to meals or activities but I know they feel secure. I've sat with people that didn't want to be alone and watched as they took thier last breath. I've counseled and hugged family members that weren't ready to let the resident go and made them ready and at peace when the time came. You can come away with soooo much knowledge if you just listen to their life experiences. Not to say there aren't hard times - when the unit gets busy and you are Manpower challenged because of call ins - you just feel like calling it a day and put nursing behind you. But you are quickly brought to your senses and realize that this is where you are meant to be when a resident gives you that certain smile or a family needs your assistance. I love working the holidays - if I can get someone to smile who may not have anyone - then i have received the best present ever - the gift of love. Any way I'm afraid I have run off at the mouth a bit much but I just wanted to give you what you asked for - positive re enforcement. LTC may not be for everyone but you won't know unless you give it a try - so go for it and best wishes in whatever you choose to do! :redpinkhe

The key word in your statement is "won't let go". It's difficult to let go to the finality of death, also the unknown precession to the final days and the thereafter. There are a miraid of books on the birth experience and next to none on death - possibly because no one has came back to relate how to die???? Anyway Health Care workers have an insight the family doesn't as we walk that final road with some one frequently. If you become the families "guide " and educate them on what to expect, and show them you are there for them to they may mellow. As far as not letting them go - I remind the families that thier loved one is very tired and needs that final rest. I ask them to think of the worst work week they ever spent in thier life and try to remember the exhaustion they felt. Then I remind them that thier loved one has spent a life time of exhausting exerting experiences and need to be allowed to seek rest. With many families guilt and fear of the unknown keeps them on the defensive - stay calm and break through the barrier with education and support and the family should begin to become more receptive to the passing.

The key word in your statement is "won't let go". It's difficult to let go to the finality of death, also the unknown precession to the final days and the thereafter. There are a miraid of books on the birth experience and next to none on death - possibly because no one has came back to relate how to die???? Anyway Health Care workers have an insight the family doesn't as we walk that final road with some one frequently. If you become the families "guide " and educate them on what to expect, and show them you are there for them to they may mellow. As far as not letting them go - I remind the families that thier loved one is very tired and needs that final rest. I ask them to think of the worst work week they ever spent in thier life and try to remember the exhaustion they felt. Then I remind them that thier loved one has spent a life time of exhausting exerting experiences and need to be allowed to seek rest. With many families guilt and fear of the unknown keeps them on the defensive - stay calm and break through the barrier with education and support and the family should begin to become more receptive to the passing.

I think this latest epidemic of families going from caring for resident to overbearing crazed zealots is a result of the commercialized legal Media ad Bug. You know the one that starts - Do you have a loved one in a nursing home ------- and ends call 1 800 law suit. If the legal system is so concerned for these old folk why aren't they using thier position to create reform instead of lining thier pocket with the families money. Documentation is crucial as a vaccine to this bug. Although if there wasn't somemuch CYA to do maybe we could focus on care.