From what I have been seeing where I work now as a nurse compared to other places that I have worked at when I was a CNA, is that the people who are being admitted are sicker, more unstable than I have seen in the past. Where I work we are a 100 bed facility with half of our building being long term and the other half short term rehab. On all of our units now we have trach patients, currently 5 in the building. Out of those 5 only 2 are stable. One of the trach patients that I did the admission on about two week ago requires extensive care, is a quadriplegic with a stage 4 decubitus sacral ulcer that has a wound vac, and is receiving antibiotic therapy for MRSA. They were placed on a unit where the nurse working that hall usually has 20-25 patients depending if all the beds are full. The rest of the patient load includes another trach, several others with CHF, COPD, a young stroke patient that has had about half a dozen falls and so on. This is suppose to be the area that is considered long term, with more stable patients, unfortunately is not the current reality.
We we have had agency nurses who have come in, that don't return saying that it is the worse experience they have ever had. We have a lot of patients that in reality need to be in the hospital still, at least in an LTACH floor where the nurse to patient ratio is lower and closer monitoring can be done.
The problem stems from a few different areas, I believe. The first is the insurance companies that we only pay for a person to stay in a hospital for so long, many patients I think are being moved out of the hospital before they should because the insurance company will only give a person so much time. Another issue is that at least where I am at, is that the building had not been making money for so long (changes in company running the building, and changes in management) they lower the standards of what they will take into the building, allowing sicker patients to come in. The companies running these nursing facilities continue to staff the way you would staff a long term care unit, the problem is that we are no longer representing what LTC facilities use to look like, and we are starting to look more and more like what you would see in a med-surg floor or an LTACH floor, however with less staff and higher nurse to patient ratios.