123becky

I know that it does cost a good deal of money to have a parent in LTC. the only reason that someone is a resident is because the family is unable to provide the care needed 24hour a day. We go back to the money. People assume in LTC that their loved one will essentially be receiving 1:1 nursing support 24/7. I have to fault the Admissions coordinators for not explaining the care to be provided (wait, I did this for a couple of years, & I am guilty as well). Usually a person admitted has been in a hospital where the nurse to patient ratio is a great deat smaller, & admissions coordinators must keep the beds full. We are in competition with other facilites for the same residents. We have 1 nurse for 49 residents in my facility. She has a MED AIDE, & 4 CNA'S. Our LTC unit has residents with a varied degree of assist needs. Most need extensive support with ADL's in one way or another. These CNA's are running their collective butts off and give excellent care. We also have families who are overbearing to the point that they will enter a closed room where the CNA or nurse is providing care to tell them that their loved on has to go to the toilet (usually the most incontinent resident there, thats why they are there). NO matter what, you just can't please them. We also have residents who lay guilt on their family, "They neve come when I put on the light for help" When the family isn't there they are the nicest folks, but they have to punish their kids because, "they put me in a home". I just keep smiling & tell them as soon as I can, I will be in there, but please don't impede the work I am doing right now. It is a "me first" mentality, nothing will ever change this.

Everyone in my facility has 7 care plans. !. Information. i put discharge plan, code status. MD visits. Pod visits, DDS, Ocular visits. Ability to self medicate, elopement risk. Next is COGNITIVE FUNCTION/COMMUNICATION, THEN ADL SELF PERFORMANCE/ RISK FOR FALLS, CONTINENCE / SKIN INTEGRITY, NUTRITION/HYDRATION, MOOD/BEHAVIOR, THE POTENTIAL FOR INFECTION. I manage to cover about everything this way. It is easy to follow. & I update as needed. I follow the RAPS to the care plan. Haven't had any problems Yet. I have heard that some facility can have 20 to 30 separate care plans. How the heck can they be followed & updated? Back in the early MDS days a surveyor told me to keep it simple, it will get done.

I am a lucky nurse. My software takes from the MDS into the roster from the most recent MDS.. on the face sheet I can adapt who is admitted with contracture, or foleys, or if someone is on an ABT. Also where I put the flu shot & the pneumovac. When I update the care plans (as needed every day) I review this area as well. The better the computer program The better things work.

As far as contractures, the best thing would be to document their presence in the admit assessment, most are admitted with these damn things anyway. All assessments should include that range of motion was done & resident shows limitations. Why else would they be here? I haven't had a recent admit over the age of 75 w/o contractures.

I have been offered a similar opportunity. My ADM. has offered to send me through School for the few classes I need to complete my RN training. The ADM is also the owner. I have worked for this Facility for 13 years. I have been doing the MDS's & the state has complimented me repeatedly on my RAPS & care plans. The Current DON will be promoted to the ADM. so that my Boss may retire. The ADM. wants me to now work as the ADON to learn the ropes. I really want to do this.Has anyone else become the DON in this manner?

Please do work as a CNA prior to becoming a nurse. I have 33 years of nursing experience (I include my years a a CNA & CSM, as well as the last 27 years as an LPN). From my observations, CNA's make the best nurses, LPN or RN. You will appreciate the CNA's more as well as develop deep respect for what they are doing, they are really the "nurses" at the bedside. I wish you well. There are a lot of plsces that do need GOOD CNA's in Omaha right now. Go ahead & take the training. you will not regret it. Good Luck (remember, nurses eat their young, get thru that you can get thru anything). 123becky

Please check out metro or iowa western first. I have heard the cost of this (Hamiltons) program rivals my son's 4 year BS. I went to Metro a million years ago. The program was tough, but very well worth it.

First post. I have been doing MDS RAPS & CARE PLANS since OBRA went thru. I just can't keep on doing them, I guess I am crispy when it comes to this position. I have been trying to train a new nurse on how to do this job, & I am failing. Problems at this point are. 1. She has never worked LTC, Only in hospitals & Home health. 2. She is a BSN, I'm an LPN. 3. She is not getting how the MDS >>RAPS>>CARE PLAN Flow. I have tried to explain to her not to delete previous info on the care plans, just update with the new (So the state does see that we are using the care plans & tracking progress of where on resident was & where they are now). Anyone have any simple ways to go about this training? She did go to a 3 day workshop on MDS, but said they did not touch on the RAP to care plan process. Just how to fill out the form. I had her log on to CMS for the tutorial (which I wish they had a long time ago), & this didn't help either. My Admin. & DON are becoming impatient with her (& probably with me as well). I want to go on with my new position & get away from the MDS, but I want the job done right as well. Any suggestions? TY 123becky:o