Shouldn't ratios exist in LTC too?

Nascar nurse, ASN, RN · Oct 20, 2005

I've been a LTC nurse in the midwest for nearly 20 years. Yes, I think there should be some sort of mandate about staffing ratios in LTC. I also believe these ratios should be tied to the acuity of the facility. Example: An acute rehab/subacute unit would need a lower staffing ratio as opposed to a run of the mill ICF unit. This could easily be established by the MDS process already in place. I know that we are seeing people come in to us much "sicker" than ever before with a multitude of problems. BUT, along with this, the government is going to have to come up with a better reimbursement program to cover these added costs AND the corporate "BIG WIGS" are going to have to give up some of their personal (huge) profits. It would seem that we need a better lobby support in Washington to stick up for both the residents and the nurses in LTC, but I am not a political person and have no idea how to go about this. Unfortunately in this state, the reimbursement for prisoners per day is higher than the reimbursement for a LTC resident. That stinks all the way around. But then again we had a family member in today upset about the high cost of Mom's bill, but in the next breath was telling us how much he paid for White Sox tickets. (ie: Alright to pay a huge price to a sports player, but we bust are butt/backs and everything else and get relatively nothing) Get your piorities right dude! Ok, I think I'll get off my soapbox now. I love LTC, but I get so frustrated with how the whole system is setup.

dekatn · Oct 20, 2005

I agree. There is so much that needs change in LTC. I wish the people that make all these "rules" had to spend one month in LTC as a pt. (with current staffing, no special treatment). I could go on and on, but I won't. Any of you that work in LTC know all the pitfalls anyway. It's just so frustrating. I'm sick to death of it.

caroladybelle, BSN, RN · Oct 20, 2005

I've noticed a lot of hype here in california for the 1:5 ratio law requirement in hospitals, and wonder, why don't they enforce some sort of ratio in long term care? The patients often require a lot of needs in LTC, and it seems ridiculous to me for one nurse (LVN) to exist for over 50 patients. And then they're upset when you stay late!
I would not want a family member, or anyone I know ever in a LTC because of the lack of attention they have to recieve because there's only one nurse and a few CNA's.
I'm wondering if anyone else feels the same way that I do? and perhaps there's a way we can protest for change?
Thanks.

Of course!!!

But given how long that it has taken to get ratios passed in one state (and those ratios are currently under fire from Ahhhnooold), we will be waiting a while for any for LTC...especially given how bad medicare/medicaid reimbursement rates are.

LoriAlabamaRN · Oct 20, 2005

I most definately think ratios should exist. I am the Clinical Nurse Manager (11-7 shift) of a 165-bed LTC facility. During my shift, it is normal for us to have only 5 LPNs, and some nights we only have 4. 30 of our beds are also a higher-acuity rehab unit, so on that hall we have 2 LPNs, which means that on the "regular" halls, we usually have 1 LPN and 2 CNAs caring for 54 residents. I think it is ridiculous. For LTC I think that the ratio would be better 25-1 at the very most. But of course, that would cost money, and we can't have that... :uhoh3:

SouthernLPN2RN, MSN, RN, APRN, NP · Oct 20, 2005

My take on it (for my facility) is that first shift should have two med nurses, plus the charge nurse. Second should have two nurses and third could remain with one. We currently have two nurses on first, one is charge and doesn't pass meds, one nurse on second and one on third. Weekends is just one nurse per shift. This is for one 44 bed unit.

mistylou12 · Jan 24, 2006

Yes ,Yes,Yes nurse to patient ratios should be a major concern for LTC,I'm writing from Connecticut. Our LTC facilities have subacute units not just LTC. we have a 1 to 30 patient ratio. here is the problem....The patients in subacute are discharged from the hospitals on IVs,Capd,with extensive surgical incisions and need alot of nursing hours. We are working 12-16 hour shifts just to come home get a few hours sleep and return again. My supervisors are going insane and all we are asking for is two nurses to work the subacute unit not just ONE. One can't get it all done even if that nurse forfeits her breaks,lunch and denies emptying her own bladder.we are eating while we pass meds. We joke that we need a foley cath our selves and a leg bag. There has to be something that we can do..the patients are ultimatmatly who go without.

mistylou12 · Jan 24, 2006

My hat off to you , my nurse managers are wonderful but they spend so much time on the subacute unit that they neglect the other units that also need them. We are a 160 bed LTC with a 30 bed subacute/rehab. I love my supervisors they do all they can and are still frustrated.we need 2 nurses to carry the case load and to effectively nurse.

pickledpepperRN · Jan 24, 2006

Absolutely! It is appalling how patients are neglected in long term care.

Even skilled nursing facilities (SNF) associated with acute care hospitals staff poorly and they are better than the rest.

Too many are really med/surg patients with IV medications and unstable vital signs or blood sugars.

Even stable patients need lots of care. Lack of staff contributes to skin breakdown, pneumonia, dehydration, UTI, and worse

I think we have to get the big money out of politics before our elected officials do the right thing.

allele, LPN · Jan 24, 2006

Shouldn't ratios exist in LTC too?

YES!!!

I don't have much to say professionally.....only that I used to work per diem in a LTC facility and I left because I was scared for my license!! Too many laws and way too many residents! I would pass meds to roughly 30-40 residents, (better than some LTC facilities, I know) and I just couldn't handle it. Meds were late, they were missed, and I just couldn't handle it. I hope to someday see nurse to patient ratios in LTC, I think it would go a lond way in saving some of the LTC reputations out there and you'd probably see a LOT less deficiencies in the the state reviews. :twocents:

DusktilDawn · Jan 24, 2006

Another vote for ratios in LTC. I don't care how wonderful, compasionate, and dedicated a health care provider may be, they cannot effectively fulfill their roles if they are under staffed and overstreched.

1 LPN and 2 CNAs caring for 54 residents. I think it is ridiculous.

That is ridiculous.

dekatn · Jan 24, 2006

But, how do we go about change? It all boils down to the almighty dollar. Most LTC are businesses and the corporate bottom line is all that matters. As for government, state and federal are the ones that require all the paperwork and regulations. Please, I'm not saying LTC doesn't need regulations, I'm just saying, some of the things we have to adhere to are totally absurd. No siderails, give me a break, I'm not talking full length side rails, half rails that can catch a pt should they roll too close to the edge of one of these skinny beds. But no, they are considered a restraint. Continence and incontinence, our CNA's have 12 to 15 pt. each. This just happened the other day, 3 pt. were needing to go to the bathroom all at the same time, which do you decide to take first? Well, by the time the aid got to the others, because according to the rules, you can't leave a resident on the toilet and go off and leave them, they might fall, they had been incontinent, not by choice, but by circumstances, yet, the person in charge of the "toileting" program, jumps all over the aid because so and so was incontinent. Yes, technically they were, but given different circumstances, say, more aids on the floor, instead of sending 2 home that very day because the census was low and of course we don't want to pay them for having a fairly easy day at work. The whole system is screwed up and I like others know what I would like to see, but have no earthly idea of what to do about it. People say talk to your politicians, your nursing associations etc:, we all know that doesn't get us anywhere. Been there, done that. The associations are focused on education and retaining and new nurses, it's a vicious cycle, until things change, even the new nurses aren't going to stay in the profession. You can make more money doing other things that are less demanding physically and mentally and don't have to take the abuse we do. If the owners would be less greedy and allow the places to be staffed the way they should be, there would be less turnover, which in turn would actually save money in the long run. This is supposed to be the residents' home, but get real, the state and federal governments have us running these places like institutions, not homes, yet, when something happens we have either violated somebody's rights or broke the law by not following some guidline that some person that has never stepped foot in a nursing home has written. I get so steamed over this whole situation, and just when you think it can't get any worse, don't worry, it does. Where I am, there is no such thing as union, not that they would probably help, it's obvious they haven't helped anywhere else. The way things are going not only in healthcare, but in all areas of the economy, unions will be obsolete before too many more years. Now they are just closing unionized industries instead of making concessions. I worked in the clothing industry prior to becoming a nurse, the company I worked for, had a union, that didn't stop the owners from closing the company and moving out of the country where labor was cheaper. I am so sorry for the long rant, I just get to thinking about all this stuff and I don't know when to shut up. I appreciate the fact that there are others out there that at least understand where I'm coming from, thanks for listening.