erin21880

And what's even more concerning and frustrating is that when I was researching our toileting program and directed questions to the DON...her comment.." gee, I'm not really aware of how our program is set up...I wasn't a part of it!!" I think that's cause for concern

Agreed!! Thanks for the information...it's nice to be able reaffirm that maybe I'm not wrong about my facilities "programs". I have no choice but to go with the flow because now that I have brought up these questions and concerns I have quite a few people upset with me!! I guess we'll see what happens!!

I agree!! Off the ambulation subject...would you consider toileting every resident upon rising, before/after meals, HS, and PRN standard care or a "bladder and bowel program" in regards to RT program?

Thank you for your responses!! Now if I can only get my DON and RT aide to understand this in regards to the MDS...Unfortunately I'm only a substitute to do MDS and they don't seem to wanna hear me out! I'm just concerned on how our state surveyors will view this.

By cognitive I mean alert and oriented but I guess even residents who have Alzheimers or dementia that are ambulatory who want to wander or explore. If a resident is ambulatory, is steady, uses no mobility aide but just needs cueing and direction due to disease process would that qualify as walk and dine??

I agree...it's just confusing for me because some residents are fully capable of being independent and are but then therapy does this test and they want to have staff assist for all cares! There's always a risk for falls...I get that!! I also do MDS and I get frustrated because ADLs are coded as independent but then I'm having to code for walk and dine and half the time they ambulation alone anyways!! I probably make no sense...lol

Our professional therapy services performs a Tinetti on all our residents and if the test results indicate a high fall risk our RT aide initiates a walk and dine program on residents who are independent with cares and ambulation. The question I have is if a resident is a fall risk and environmental interventions and monitoring are implemented to prevent falls do we take away their independence to move freely or do we restrict their mobility and make them wait to use the bathroom or go to meals or elsewhere?? Especially if they are cognitive? I think this gets started quickly just to capture in RT to make money. What do you guys do??

I guess maybe I'm overthinking this!! I was just concerned that our toileting program is not individualized and resident-specific enough to code on the MDS as this is how we toilet every resident. If that makes sense!!

Our LTC facility MDS coordinator and RT CNA have started a toileting program which is toileting upon rising, before and after meals, at HS and PRN. They are coding this in section H as being on a bowel and bladder program. Is this ok?? The RT CNA tracks incontinent episodes and how many times they were toileted. They chart all this in the I-notes and say it is their toileting program. I just don't feel right about this...isn't this basic care for toileting, skin maintenance??

Hi...I am a RN in a LTC facility. I have worked there for 10 yrs now. Many of my co nurses have also been there this long, some even longer. We live in a small community and do enjoy working here. We want to take care of our community people. The problem we are facing is the lack of recognition we get. We had a meeting today and were told that we will now be taking turns being "on call" d/t the fact that we have a nurse or two who like to call in and our DON and nurse manager are tired of covering their shifts. Instead of correcting the problem, this is what they came up with. We have to be on call Fri thru Sun and holidays. Does anyone else do this?? They compared it to being on call like a hospital, but that is completely different. Also, we are always given the comment that we are always "replaceable"!! And might I mention that our CNA problems are out of control. Many of them will do the no call no show thing. When we bring this up with management, nothing gets done!! Do other nursing homes face these same problems too? Just want to get a feel for is going on.