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momofIAndT

momofIAndT

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momofIAndT's Latest Activity

  1. momofIAndT

    Barriers to SNF and ALF improvements

    Another point to note, the company that owns the nursing home when faced with the low reimbursement rates will just end up selling off the home. There’s a reason Kindred Healthcare sold off their entire Nursing Center Division. Reimbursement rates from Medicaid and Medicare were so low, it was not at all a sustainable system. So they shut down their entire Nursing Home enterprise. The government is SHADY AF with reimbursement. Just ask any MDS nurse in Massachusetts right now about our reimbursement for having patients in “Isolation”. They’re making all of the Nursing Homes eat the cost saying that we were already paid because of the “COVID money” that we had to jump through hoops to get in the first place and spent it on whatever price gauged PPE and $200 apiece COVID tests we could finally get in May.
  2. momofIAndT

    Barriers to SNF and ALF improvements

    I think most people don’t understand that your DON and Administrator have absolutely NO SAY in what the staffing level is of the facility they work in. It’s dictated by the company that owns the facility, based on the census and how much money is coming in from Medicare and Medicaid that pay for the “heads in beds”. You need those MDS nurses because if you screw up the MDS, all of the money you billed has to be paid back to Medicaid or Medicare. The root cause of low staffing levels in long term care is because the reimbursement levels for a patient in a nursing home covered by Medicaid is less money than a night at a Best Western. $150/night. In my area, almost 95% of the nursing home patient population have Medicaid as their payor source. For about 2 years I worked as a DON in a very wealthy private pay building where it cost about $600 a night. I had PLENTY of staff, was able to put 1:1 care in place for behavior issues and could order whatever supplies I needed. It was glorious. Sadly the building was sold so that the attached Assisted/Independent living center could install an indoor pool with a gym on the second floor. 🤷‍♀️ It’s all about reimbursement for services.
  3. momofIAndT

    Tired

    Let me preface this with the statement that I just need to vent. I’m now a Staff Development Coordinator/ADON, Infection Preventionist, wound nurse in LTC. I’m tired and I’m actually scared. Our facility got hit HARD by COVID. Things are better now, but I’m scared to death we’re going to get hit again. The hospitals refuse to test patients before they come to us, And their staff aren’t tested with any regularity. We had one staff member test positive and now I have to test the entire facility for 2 weeks until we have 14 days with no positives. Now we have to open up for indoor family visitation and the area we are in, the public believes that COVID is no big deal. We’ve had multiple families break the rules during outdoor visitation. We lost 14 residents and multiple staff got sick. Even though those staff members recovered, some have continuing problems, cardiac, vascular, nerve damage. I wear a N95 everyday that I purchased for myself under my facility mask. I don’t think any of us can deal with going through this again. And I’m TIRED of us being portrayed in the media as the “negligent” places, dirty and uncaring. It seems like when people lost their lives in the hospital they “died of COVID”, but in the nursing homes they were “killed”. Folks who don’t know what we went through say, “Everything will be alright.” But WE KNOW it won’t be alright for a lot of people. Images of people dying with air hunger haunt me, and I’m afraid we’re going backwards again. We KNEW this was airborne. But we weren’t equipped to handle an airborne virus and we still aren’t. I’m scared for my team, I’m scared for my patients and I’m scared for my family and myself. And I’m TIRED. Now they want to restart the annual DPH Survey process. Ugh. Thank you for reading.
  4. momofIAndT

    Survey Rant

    I work in a small building, my census is under 60, and I have 2 of the most INCOMPETANT jerks as surveyors. One of them wants to give me MULTIPLE tags because my pharmacy wrote the wrong concentration of lactobacillus on our med sheets! The dose the patients are getting matches the original order, no harm has been done, and she wants to tag me for 4 categories on it! Are you freaking kidding me?! And I just found out that a complete dump down the street from us that's over crowded, produces more in house acquired pressure sores than you can imagine got DEFICIENCY FREE!!!!! ***!? Oh yeah, and they will be there FOR A WEEK!
  5. momofIAndT

    Nurses who can't give out narcotics

    As a hiring manager, I can tell you that it's rather slim pickings right now for any LTC nurses. I've been BEGGING for staff for months. As a DON, I'd rather hire a couple of nurses with restrictions than to burn out my own staff and run short. The unit manager/charge nurse should be looking at the assignment and making it more even. it's also possible that it wasn't Known that there was a restriction. Once you say someone is hired, you can't take it back because of addiction. That's considered discrimination.
  6. momofIAndT

    Anyone else tired of LTC?

    I feel your pain. I crossed-over into LTC management. It's really rough. I don't love it. Sometimes I don't even like it. I work with a very entitled wealthy clientele. Some days I feel like their demands are sucking the life right out of me. I miss being a Hospice Nurse. Unfortunately it doesn't pay very well. And I have a family to support. I really hope someday I can go back to it. I miss it terribly.
  7. momofIAndT

    DON salary

    Goodness. I'm moving to Canada. But seriously. Remember that as DON you are salary. You are on call 24 hours a day, 7 days a week. YOU are responsible for EVERYTHING that nursing does. And you cannot take vacation time during survey window, and that's about 4-6 months out of the year. Make sure it's a path you really want to go down. Most DONS only last 2-3 years in long term care at one facility. Burnout rate is HIGH.
  8. momofIAndT

    "State's Here!": Demystifying the Long-Term Care Survey

    You can't staff if you can't pay them. Surveyors don't say anything because it's a problem with medicare and Medicaid reimbursement. Your managers help out during survey because they know it's going to take you longer to do your job than normal because in order to follow the 25 kazillion regulations you're following (with a surveyor looking over your shoulder) it'll take you a half hour to do a dressing instead of 15 minutes. Next time you want to ***** about your DON or nurse manager not helping out on the unit, why don't you offer to help her with the safety device audit or maybe a few family meetings, or those grievances, or that Medicare/care plan/ID meeting. Or maybe those staff reviews, those write ups or even the QA meetings. How about a pharmacy audit or dealing with the errors the staff nurses make on the lab slips? How about if you give her a hand with the CNA meeting since she's exhausted from the staff calling her 4 times throughout the night on her time at home because a nurse didn't use a gait belt and a patient fell and went to the hospital. Oh yeah. You can't. The DON/CCO is qualified to do everyone else's job, but nobody else can do theirs.
  9. momofIAndT

    "State's Here!": Demystifying the Long-Term Care Survey

    This is a complete load of crap. Survey is a joke. I've seen the worst dumps get "deficiency free" and then a really well run place take 4 tags (yes I said 4 TAGS) because a surveyor didn't like a doctors handwriting. State surveyors are condescending, overpaid (one that works in my state makes over 111,000 dollars a year) and they're SNEAKY! They are absolutely there to intimidate, insult, and abuse you. If you're in management they will make you WISH you never went into that line of work in the first place. I was once berated for over an hour about a mistake in transcription for a pro biotic order and the error didn't even reach the patient! She actually made me feel so bad about it I cried later on in the bathroom because we missed the mistake on edits! A pro biotic for goodness sake! State surveyors exist to belittle, insult and intimidate nursing home workers. And if the surveyors know the management team and like them, then the surveyor will look the other way. It's even more unfair now that CMS has the 5 star rating. They want me to discontinue antipsychotic medications for people who have been on them and therapeutic for years! I'm sorry but call a spade a shovel; DPH surveyors are *******s. It's just another example of a corrupt government system.