sls73

Congrats! I agree with the above post about not making changes right away. You need to learn the processes and procedures before you make improvements. Do not forget you have three shifts you are responsible for, not just dayshift. Come in during the night and see what is happening or stay for second shift. Be willing to lend a hand- I recognize you have a job to do too, but a simple offer means more then you know. More times then not, staff will handle on their own, but it is the thought that counts. Last be fair, consistent, and treat others with respect. You will be fine. Remember you will not learn everything over night, so don't beat yourself up if you make a mistake. It will take time to make it your own and to feel comfortable in the role. I believe I started feeling confident in the role- year 2 or 3(yes that long). If you need any support or help please feel free to post your questions on this board as others may have thoughts and suggestions to help you out. Best Wishes!

I took 6 weeks off under FMLA for a hip replacement. I had to report it to the state for length of time I was off and had an interim DON cover me. She was not the ADON, but someone who worked in staff development part time. She had been a previous DON in another facility, so felt comfortable helping out. My administration was also supportive of me taking off this time which I know is half the battle. They even allowed me to come back 1/2 days when I came back to gradually build my endurance.

We have staff dress up day and then we have trick or treat. Staff bring their children and residents hand out candy for about two hours. We were supposed to do it tonight but due to the hurricane it has been post-poned. I believe the residents enjoy that more then staff dressing up. It's also a safe place for the staff to bring the kiddos and it helps build the inter generational gap. We are a church based facility- we just ask the the staff and children not dress up as anything deemed inappropriate.

Well citation is in- we did get cited for F 0226 on accuracy of heights. Scope and Severity- D. On with the POC. I guess if that's the worst they could find I should be happy, it's just irritating.

We didn't used to measure again either after the admission height was obtained. When MDS 3.0 came into effect the dietician was asking us to do so. It is part of the RAI manual in section K 0200 that states "for subsequent assessments(after the admission/re-admission) if the last height recorded was more than one year ago, measure and record the resident's height again". UGH....but now it is setting us up for those folks that we have measured for the first time in years and the height is off. I am curious too as to the citation it will be.

We just finished our annual survey. We are still a traditional state, and they spent 4 days in our facility. We came out OK- infection control and heights are our two concerns. I will take it in the scheme of things as I know we are not perfect, nor do I even attempt to be. My question is this- you obtain a height on a resident at admission and then the following year with their annual assessment. When you obtain the later height you find that it is off by a few inches (for example 3 inches shorter). What procedures do you have in place to fix this? You cant make them grow the 3 inches- so do you follow a guideline sort of like weights. For example, if the weight is off 5 pounds we have the LPN verify the weight immediately. If it is still off 5 pounds we notify the unit manager and dietitian. In this situation you can adjust calories and fluid requirements and implement interventions for the weight. I am assuming if I re-verify the height and accept the new height as correct, I would complete a significant correction on the previous MDS heights? Do most get their heights on the evening shift with the resident laying in bed? Do you complete with each comprehensive MDS or do you only complete it a the beginning of the year? Thanks- I am curious...

NA/LPN 2 weeks minimum, sometimes if you are new I find you need more help with time management then I increase it to make it 3. If you are a RN it goes 2 to 4 weeks. The new RN's from school generally need the 4 weeks. I always tell the staff though I will individualize to their needs.

Our building is 59 beds. We only average around 7 on Medicare A caseload. I have one MDS nurse, but she does not complete the MDS/Care plans in their entirety. Social Services, Restorative, Wound Nurse, Activities, and Dietary have their own section and CAA's they complete. The MDS nurse reports to me(DON). She is hardly overworked and cant wait for the clock to strike 4 so she can leave. She is on-call one weekend a month and she does help with meal service. Yes, I was the RNAC for years prior- I can adequately judge the work load. I am also certified with AANAC so I understand the 3.0 side of things with the extra assessments. I believe it varies building to building and who are completing the assessments. I understand places out there have the RNAC complete the entire assessments including the care plans entirely.

We do not treat MRSA of the nares or give a private room. We just use good ole precautions like handwashing.

You have to work where your heart is- for me that is working in LTC. I have had multiple job offers at hospitals but have turned them down- it just didn't feel right. I have always worked in LTC- first as an aide, then as a LPN, then as a RN who even works in the dreaded word on these boards- management. Any position is what you make of it. I love LTC, including the residents I take care of and serve. I am sure there are facilities(and hospitals) out there that are not the best place to work- I guess I am fortunate. Currently my PPD's are running 4.60 to even in the low 5's. I work with an administration that really cares about the residents and staff. Do I have days that I want to run away screaming- yes, but then most jobs do. I want to make a difference and for me this is where I feel I belong. That is what makes nursing unique- we all receive the same degree (RN, LPN, NA), but there are many different venues to work in and what may be ideal for one is not ideal for the other. I guess what I am trying to say is you have to find what works best for yourself and where your niche is, not anyone elses. LTC is demanding(again as in the hospitals that have their own issues), but is also rewarding. I go home multiple nights realizing a small action I made was the difference in someone's day.

Sorry answering your question- I would probably say Yes. Since this is an Assistant Director of Resident Services I would compare it to a ADON. I hope the position is everything your looking for- Personal Care and Assisted Living are getting to be the long term care facilities of years ago- need caring people who want to make a difference. : ) Good luck!

I am from PA and it appears they are having you taking a Assisted Living Administrator exam- basically you would be able to practice as an Administrator in Assisted Living.

I also received my certification through AANAC. I took mine on-line by reading the material and taking the quizes and final at the end. The on-line learning is a self-taught course as you just read/study the materials and take the quizes/tests, but it worked for me. I too had been the RNAC for a few years before doing this course, so it helped for filling in the gaps.

Put a paper MDS in your admission packet and have the nurses fill out three items- name, date of entry and the ARD. They can pick any date up to day 8 for the 5 day that way you can say it is set. You can adjust the date when you come back to suit your needs.

Thanks for the information, much appreciated!

[color=#545556]we are looking at various types of oxygen (concentrators, portables, battery packs) for a skilled nursing facility. i have worked facilities that switch everyone over to tanks and others that have left them on the concentrator. the battery packs only hold a charge for a few hours and i am told they do not work for all residents. storage though is a concern with the tanks [color=#545556]what is everyone else doing and what do you like or dont like? please and thank you in advance- just trying to explore options.

Thanks! Are you combining your 5D with the sig change? I read in an AANAC newsletter that CMS is billing default rates if you combine these two assessments- due to a computer glitch. I wasn't sure if it was better to split the two apart and submit separately until they fix it or not. Curious to see what the say at the open forum on the 24th. Last I heard they had no resolution to the issue.

A resident goes out to the hospital on private pay and returns 3 days later as a Medicare Part A. She is admitted 3/27 and they complete a 5D assessment on 4/2/2012. Her 14D assessment was completed on 4/9/2012 and her 30D assessment was completed 4/24/2012. Sounds good so far..... Upon investigation it was determined that the 5D assessment was combined with an admission assessment versus a significant change in status as the reason for the assessment which means the HIPPS code is wrong. She was not a brand new admission she was re-admitted to the facility. So, do I have to inactivate this assessment and bill default despite the fact that the PPS assessment type is right(it is a 5D and should be). The ARD is also correct. If yes, how far do I bill default- to the 14D assessment kicks in or all the way till today? And last but not least do I just complete a new 5D with a sig change or do I also have to re-do the 14D and 30D if I am defaulting through those assessments. Sorry for my confusion- I am not the RNAC, just filling in. Thanks for the help in advance.

Congratulations!

We are in the middle of construction and are buying new equipment. I was curious to see what others were using and what they liked/didn't like. I am also interested in how they are holding up for you. The items we are looking at are beds and lifts. We are also looking at bed pan sanitizers- what are best practices with those these days and what do you like? I asked a few DON's in my area and no one seemed to know. Currently we just bleach everything and replace every 30 days. Thanks in advance for your help!

It depends on the area you live in- where I am nurses in the LTC setting make more then hospital nurses.

Most of my RNAC experience is with 2.0 and the billing person and I worked together to have the billing completed by around the 5th of the month. Now things happened and there was generally one or two assessments that had to be completed later based on the extensive services and rehab category. This was for the Medicare assessments. I recognize though you are still trying to do things based on the best reimbursement. Do people still use a projected cut off date for billing or is it anything goes. My billing person is getting upset with the current RNAC because she feels every month she gets later and later having assessments locked up and ready for her to bill. Thoughts? Thanks in advance,

We are looking at going with versatile workers. They spend 80 percent of their time in a designated role such as NA and then 20 percent of their time in a role of their choosing be it dietary, housekeeping, and activities(but will also have employees spending 80 percent of their time doing this). We are also going into a household model of 20 residents per household. I would have a 1:6 ratio for the aides. It will just allow the household team to understand each others responsibilities and "pitch in when needed" as more of a blended role. An aide would be able to assist in a cooking activity and a dietary aide could assist in a knitting class(if that is their gift). I have also seen the universal worker at a facility I visited in MN. They use the household model too and everyone is trained as a NA so they can help answer lights and provide resident care. It promoted team work as they would come in every morning and decide together who was going to complete what task or job for the day. Management didn't decide it for them. It promoted job satisfaction so you didn't feel like you just did the same thing day in and day out. We decided not to make everyone be trained as NA's which is why we are going with a blended role or versatile worker versus a universal worker. To me it's not about saving money, I am actually adding staff to do this. I think it is better for the resident, promotes staff decision making and satisfaction, and gives an all around improved quality of life. But that's just my opinion.

Let me hammer mine out and then I will share them with you- it may not work with your DOH, but I will share. Yeah- I have already told the administrator I am taking vacation when we implement all these programs on the SAME DAY(flexible medications, natural awakening, and open dining). I am going to need to stock up on something....lol :)

I knew of a RN that only wanted to pass medications as she only worked every other weekend which left the LPN in charge. This was a mutual agreement and the facility knew this. Something went horribly wrong one weekend which involved the state health department. When everything was finished the DOH turned the RN into the BON not the LPN, despite the fact the RN was "just passing medications". It has been said here before- it is not in the LPN scope of practice to perform assessments- notice that is missing in the ADPIE equation they learn. The LPN can not supervise a RN's clinical skill when it's not in their scope of practice.