Okay as a nurse in a LTC facility, I have to respond to this post.
I work wkend baylor 7a-11p, my facility has 120 residents, and a staff of 1 RN, 4 LPNs and 8 CNAs, (however, with it being wkends, there are always call outs and the norm is 6 CNAs. I honestly can't recall when the last time we have been fully staffed for a full wkend... With that being said the LPNs are responsible for 30 Residents each, and the CNAs 20 Residents each.
Company policy is that each resident be changed, turned, cleaned, etc Q2/hrs. That gives the CNA 6 minutes per resident per 2 hours.
Keep in mind that in addition to the changing, turning, and cleaning, the CNAs also have take their residents to dining room, pass and set up meal trays, and feed the majority of their 20 residents. Also 1 of the CNAs has to stay in the main dining room during meal times, and another has to go to the "restorative" dining room and assist the "at risk" residents, this leaves 4 CNAs on the floor passing the trays and feeding residents.
In addition to the above the CNAs also have to pass ice, hydration, and snacks to their 20 residents. and if they are medicare, they also have to get a full set of vitals q8/hrs.
Please keep in mind that this is the wkend and Activities are abundant throughout the day and evenings, with church services both afternoons and evenings on Saturdays, and even an additional one thrown in on Sunday mornings right after breakfast. Yes.. 3 church services on Sunday. PLUS... we get all the FAMILY visits. Did I mention that company policy also states that we can not interrupt our residents during "activities" or "family visits" to do any care for them? It is considered a violation of their rights.
So if Ms Jones who is alert and oriented to name, demented and incontinent, decides to go to the dining room for breakfast, visit with family and stay there until the afternoon church service is over there is absolutely nothing that anyone can do about it. Now a good family member will bring her back and ask that she be changed, but that is not usually the case, as that cuts into their weekly 1 hour visit.
If Mr. Jones decides that he doesn't want to take a bath for a week...... He has a RIGHT TO REFUSE. We can send him to "behavioral" after a couple weeks of refusing, but they will send him back..... and the process starts again.
I could go on forever, but I think you all get the idea.... We at LTC facilities, KNOW that most of the residents are going to have a UTI, they wear briefs all day, and no they don't get changed as often as they should, with state guidelines on adequate staffing being what they are it is IMPOSSIBLE to change all the residents every 2 hours. WE CAN CHECK FOR UTIs at the facility... That is NOT what we are sending them to you for. We are sending the to you because WE KNOW THAT SOMETHING IS WRONG but can't diagnose it. Just because they are 92 doesn't mean for you to check their urine, and send them back to us, only to have them returned to you the next day throwing up blood due to a GI bleed. (happens all the time)
There truly are good LTC nurses and we try to get them to you ASAP, because we do know them so well, and we do know if something isn't right but we can't exactly put our finger on it or we know and can't do anything about it.
I honestly believe that "most" LTC try to be the absolute best that they can do with the staff that they have. The expectations, rules, regulations that are placed on the staff of these places are mind boggling and I often say the only way to make them better is for every one to set a date and just up and quit and open the eyes of the powers that be but we love our residents and that is the only reason most of us work under such conditions.