SNF

KatieMI, BSN, MSN, RN · Jun 23, 2017

I think that we need to get the elderly back to the place they occupied not so long ago. Keepers of traditions and wisdom. Backbones of families. Unquestionable support and loyalty.

I am traveling now in Four Corners region and do many archeological tours, and so meet with a lot of Navajo Native Americans. I am amazed to see their dedication to their roots, their traditions and the World as they see it. They treat their kids AND their elders as the most precious things. They honor elders beyond words. And, yes, sometimes they have to arrange care for them, but it is a care literally to die for.

amoLucia · Jun 24, 2017

Maybe if the elderly populations that require advanced healthcare and LTC/SNF were to have outspoken advocates things would be better.

AARP opens its membership up at age 50. AARP does great securing discount coupons and services for those relatively healthy with reasonably active lifestyles. Terrific if you want to rent a car or get a meal discount coupon for Happy Time Breakfast House. You're young enough, healthy enough, and prob wealthy enough to find some use for those benefits.

Just imagine if they were to get better involved with the aging populations in need of assistance.They must have a tremendous budget to advertise in printed media and TV. Couldn't they redirect some of that budget to a population that is older with heath issues and in need of other services that would make maintaining their community lifestyles healthier and easier? That, rather than having to consider NH placement or living in horrendous home conditions.

To benefit, the advocate would have to have far-reaching clout and the financial base to face opposing factors. A national chain of horrid NHs would most likely have the support of its legal eagles and the NH industry to support its operational deficits. Not to mention the federal, state & local government regulations that govern operations.

I think there are just too many forces out there that seek to maintain the status quo in order to protect their own interests. I'm thinking Big Pharm and Insurance.

LovingLife123 · Jun 25, 2017

I think SNFs need to hire appropriately and not expect nurses to care for 30+ patients at a time. It's mainly a for profit business and a terrible business model at that.

I won't touch those places with a ten foot pole. I like actually being able to care for my patients. That does not occur there. It's trying to pass meds for all those patients and document. The elderly end up losing out and it's so sad. I feel for them, I really do. But until the industry changes.........

caffeinatednurse, BSN, RN · Jun 25, 2017

I'm actually really proud of the SNF I work for. Several of our supervisors and floor nurses have come from acute care environments and they're always saying that our facility is the best one in the area and that they didn't know an SNF facility could operate the way that we do. We are a 5 star facility and deficiency free. We have a 1:15 nurse to patient ratio and we usually keep 1 nurse and 2 CNAs on each hall. (This ratio works seems much more manageable to me, considering I came from an acute care environment where I had 9 acutely ill patients and no CNA.) However, I know that not all SNF facilities operate this way, and it makes me sad when I think about the conditions that our geriatric population may be enduring. I am proud of the care that I provide, though, and I do wish that SNF would receive more recognition and have less stigma attached to it.

purplegal · Jun 25, 2017

I think SNFs need to hire appropriately and not expect nurses to care for 30+ patients at a time. It's mainly a for profit business and a terrible business model at that.
I won't touch those places with a ten foot pole. I like actually being able to care for my patients. That does not occur there. It's trying to pass meds for all those patients and document. The elderly end up losing out and it's so sad. I feel for them, I really do. But until the industry changes.........

That's right. Sometimes we're so understaffed that, at night, there is a sole nurse for 56 residents. However, that has even started occurring during the day, which is even worse considering all of the chaos that occurs during the day such as sending patients to appointments, admitting and discharging patients, at least three med passes, etc.

purplegal · Jun 25, 2017

I'm actually really proud of the SNF I work for. Several of our supervisors and floor nurses have come from acute care environments and they're always saying that our facility is the best one in the area and that they didn't know an SNF facility could operate the way that we do. We are a 5 star facility and deficiency free. We have a 1:15 nurse to patient ratio and we usually keep 1 nurse and 2 CNAs on each hall. (This ratio works seems much more manageable to me, considering I came from an acute care environment where I had 9 acutely ill patients and no CNA.) However, I know that not all SNF facilities operate this way, and it makes me sad when I think about the conditions that our geriatric population may be enduring. I am proud of the care that I provide, though, and I do wish that SNF would receive more recognition and have less stigma attached to it.

While 1:15 ratio is much better than the 1:56 ratio we sometimes have, even that can be too much at times. I found that, in the ideal situation, we have 1:8 or 1:10 or so, with most of them at least being relatively stable. Things were a lot more efficient when we had two nurses on each wing of 20 patients. Each person got the individualized attention that needed and we actually got to know our residents. Now, I would pretty much have to bring up a person's chart if I needed to call an on-call doctor, because sometimes the ratio is too high to remember all of every person's diagnoses.

SaltySarcasticSally, LPN, RN · Jun 25, 2017

Unless there are state mandated patient to nurse ratios then nothing will change. LTC skilled rehab is essentially long term step-down care in my area, 9 years ago you never would have seen patients as sick as they are now in LTC facilities but the patient ratio is still the same.

I worked PRN in LTC as an LPN while I was finish up my RN last year. We were a low acuity LTC which is why we supposedly had a 1:25 ratio. The rehab beds weren't pulling in money for lower acuity patient so the facility decided to take on more complex patients.

I resigned after a shift where I had 10 rehab patients, 15 LTC. My rehab patients consisted of a pt w/ sepsis & IV ATB (he had a PICC which I was only licensed to clean/flush as an LPN at the time), 3 days post op hip repair hemoglobin at 8 and trending down, CHF patient w/ dehydration so bad pt needed fluids but also had low potassium, pt w/ stage 3 coccyx wound, incontinent, & c diff, and a very confused newly admitted patient with no PRN anxiety meds and family that didn't believe in them. They rest were stable but that was just my rehab patients and I had 15 more LTC pts that got 5-20 meds 2x in a second shift. That didn't even include the breathing treatments, wound care, weekly assessments, the skin checks, the admissions, the discharges, the family, the dr, the OT/PT, managing CNAs, charting, calling pharmacy, etc etc. And all this to be done in 8 hours....its just insanity.

I loved my LTC patients and treated them with respect because they deserved it. But I put my two weeks in and will never go back to LTC after that. It's a crime how we care for our elderly in this country and it's not the nurses and CNAs, its the business owner's that run them.

caffeinatednurse, BSN, RN · Jun 26, 2017

Now, I would pretty much have to bring up a person's chart if I needed to call an on-call doctor, because sometimes the ratio is too high to remember all of every person's diagnoses.

I always end up bringing up the patients chart when I have to call on-call. Not because I don't know the patient, although that is sometimes the case if they are a new short term rehab admit...but because I need quick and easy access to their code status, allergies, recent orders, MAR, etc. Especially since we have one on-call provider that loves to "hang up" if she doesn't get an answer to her question within 20 seconds. :banghead:

caffeinatednurse, BSN, RN · Jun 26, 2017

Unless there are state mandated patient to nurse ratios then nothing will change. LTC skilled rehab is essentially long term step-down care in my area, 9 years ago you never would have seen patients as sick as they are now in LTC facilities but the patient ratio is still the same.
I worked PRN in LTC as an LPN while I was finish up my RN last year. We were a low acuity LTC which is why we supposedly had a 1:25 ratio. The rehab beds weren't pulling in money for lower acuity patient so the facility decided to take on more complex patients.
I resigned after a shift where I had 10 rehab patients, 15 LTC. My rehab patients consisted of a pt w/ sepsis & IV ATB (he had a PICC which I was only licensed to clean/flush as an LPN at the time), 3 days post op hip repair hemoglobin at 8 and trending down, CHF patient w/ dehydration so bad pt needed fluids but also had low potassium, pt w/ stage 3 coccyx wound, incontinent, & c diff, and a very confused newly admitted patient with no PRN anxiety meds and family that didn't believe in them. They rest were stable but that was just my rehab patients and I had 15 more LTC pts that got 5-20 meds 2x in a second shift. That didn't even include the breathing treatments, wound care, weekly assessments, the skin checks, the admissions, the discharges, the family, the dr, the OT/PT, managing CNAs, charting, calling pharmacy, etc etc. And all this to be done in 8 hours....its just insanity.
I loved my LTC patients and treated them with respect because they deserved it. But I put my two weeks in and will never go back to LTC after that. It's a crime how we care for our elderly in this country and it's not the nurses and CNAs, its the business owner's that run them.

You had 10 rehab patients and 15 LTC residents? Where was your charge nurse? As a supervisor, I would have planted my butt right next to you and helped get the deteriorating patients sent out, called in extra help in the form of another nurse to help with treatments and assessments, maybe a med aide to pass medications, and I would have double checked new orders, argued with pharmacy and taken care of the new admit and discharges. Tough times call for teamwork. It sounds like you had very little to no support in that environment, which is a shame.

Orion81RN · Jul 2, 2017

I'm actually really proud of the SNF I work for. Several of our supervisors and floor nurses have come from acute care environments and they're always saying that our facility is the best one in the area and that they didn't know an SNF facility could operate the way that we do. We are a 5 star facility and deficiency free. We have a 1:15 nurse to patient ratio and we usually keep 1 nurse and 2 CNAs on each hall. (This ratio works seems much more manageable to me, considering I came from an acute care environment where I had 9 acutely ill patients and no CNA.) However, I know that not all SNF facilities operate this way, and it makes me sad when I think about the conditions that our geriatric population may be enduring. I am proud of the care that I provide, though, and I do wish that SNF would receive more recognition and have less stigma attached to it.

Where do you work, and can I get an interview? ;-)