So this is Infection Control?

Bird2 · Mar 25, 2006

so there are budget cuts and restraints (interpreted... we have to wait until the beginning of a new quarter in April) but please.. We nurses have been fighting and begging for supplies up to and including: spoons, drinking cups, straws.. yesterday we had no paper towels in either the employee bathroom nor at the nurses station. NONE to be found in the facility. Patients were lucky if they were served food at one meal.
This isn't some rural LTC facility, but one of the largest groups of LTC/Skilled facilities in the U.S. We are located in the HOME town, the "Flagship" if you will. The same company is building a new multi-million dollar independent living/assisted living facility adjoining the LTC/Skilled care facility. People are selling their homes across the country just to move into the new facility. (There is a wonderful marketing staff!)
Now, if management could only be convinced or held to task that the LTC patients/residents still have to eat and have nursing care around the clock...It seems patient care has been forgotten so rooms in the new facility can be filled. Same administrator for both facilities. Yes, the unit supervisor knows, yes central supply knows, the administrator knows, the dietary manager knows (she said they ran out of food in the kitchen). Oh, and as for the paper towels.. the Director of Enviromental Services said the truck would be in "tomorrow". Why is nursing staff expected to assume responsibility for dietary? central supply? environmental and housekeeping duties?
Any suggestions?

Literally ran out of food??? Call the Department of Public Health! The facility should have gone out and bought paper towels, food etc while they waited for the supplies. If I have read your post correctly all of your residents have been placed in a potentially dangerous situation.

FrustratedLPN · Mar 26, 2006

yes Bird2.. literally ran out of food!! My shift came in to discover this had happened. I'm a firm believer that any facility should be stocked with at least a 30 day supply of food. I agree that a run to WalMart was in order.. There has been more than one occasion when we completely exhausted the supply of "wipes" in our facility, and notified the "manager on call" when this happened. No one in management seems to take notice UNTIL there is another reported decub or illness or family members become involved (most family members rant at the floor nurse about problems even though we advise them to talk to management).

We make copies of all notifications we give, with dates and times noted. Otherwise, we caregivers are accused of being "troublemakers". It seems no one in management wants to assume responsibility when it's much too convenient to blame nursing staff for any and all issues that arise. Since many members of management are "hand picked" by the owner of the company (and believe me, he is one of the most respected members of our community) we're all frightened for our jobs if we go public.

I know I'm a patient advocate, that's why I'm so torn between going public or just finding another job. No one would believe the conditions we're expected to work under. We have no union representation, and no recourse it seems.

Thanks for your reply..

Bird2 · Mar 26, 2006

Your recourse if calling the Department of Public Health. If your are concerned about someone finding out that you called then tell no one. Not even your best friend. You do not have to give your name but help the DPH out by giving them specifics such as dates of when food and other supplies ran out, give names of managers that were given the notifications. I do not think that reporting your workplace in this situation if being nasty, you are just being a patient advocate. If you stress the seriousness of the situation they will arrive quicker to assess and remedy the situation. Places like this give all LTC's a bad name. Good luck to you. You are a caring person that can make a difference in the LTC world.

JLW,RN · Mar 26, 2006

This is the very thing I've hated the most...the nature of "for profit" long term care, especially in large publicly held companies. For a long time, I thought that long term care should be a non-profit profession, but realized that would never happen, since we're a capitalistic society (which is not bad per se, just has its dark side).

Unfortunately, there is little reward for giving good care (just give good enough to keep the beds filled and to keep out of serious trouble with the state), and little penalty for giving poor care.

I'm thinking now it would be better if nursing homes and companies were evaluted every year (say...using the annual survey, a customer satisfaction survey, and an employee satisfaction survey). The facilities in the state that were above the state average this year would get a "quality bonus" next year (20%?), the facilities that were below average would get a "quality penalty".

Be below average a couple of years running, and you'd be out of business. Be above average a couple of years running, and you'd make your stockholders happy.

What do you guys think? I've been working on a book proposing changes in long term care and would love to hear any ideas.

FrustratedLPN · Mar 26, 2006

A book or any type of public exposure would probably be beneficial, but as you and I both know, it will take sweeping changes in medicaid/medicare guidelines to force any change from the status quo. All the reports and exposes I've ever seen on television deal with potential abusers in long term care. I will say the caregivers I work with are deligent, loving, caring, and honest people who love their patients and what they do.

The retention rate and morale is low due to the conditions under which they are forced to work. Bonuses and appreciation awards are given to those in the front offices and managemenet, never to those on the front lines. Our administrator even made a statement to some cna's that she was more educated than they, and went so far as to call them "stupid". She has said more then once if we don't like the way things are run, "get off the bus".

Lawmakers and officials that visit are given the "red carpet" treatment by administrators and management, they never see "behind the scenes". If they did they would know changes are long overdue, but then again, if they saw it, that means they would have to do something about it.

When physical therapy decides Mrs. so and so needs therapy and exercise on a contracted arm she's had for years (and is 85) just so she remains under "skilled" care label, and a dialysis patient cries because having physical therapy and going out for dialysis on the same day is too taxing on her body (she was told she HAD too or would be discharged from the facility)... you know there is definately something wrong.

Agreed, LTC should be "Non Profit" if they are to receive funding from medicare/medicaid. No one should know when state inspectors are due. And for anyone who has a relative or loved one in a LTC facility, please let them know it's the "hands on" caregivers, the nursing staff that do the caring. All the fancy buildings... lush landscaping... smiling administration.. will never reveal the dark side of the LTC problems.

When a resident/patient slips into a coma or takes their last breath, it will be a floor/charge nurse or cna at the bedside holding their hand. I love these patients.. the frail and elderly, the confused. When we caregivers try our best to make them comfortable, we aren't focused on budgets or marketing.. we're focused on caring.

CoffeeRTC, BSN, RN · Mar 27, 2006

Just curious, what did they do when they ran out of food?

Getting the families involved normally helps these type of situations....squeeky wheel type of thing. What about the docs?

Jolie, BSN · Mar 27, 2006

I agree that your first call should be to the local Health Department.

Does your state have an Ombudsman for LTC? In IL, the state designates an Ombudsman for each county. When the Ombudsman is notified of an emergency complaint, s/he goes out and does an unannounced visit within 48 hours, and will get back to the person who filed the complaint and share the results of the visit, and the corrective action to be taken.

It is not a perfect system, but it is helpful to know that someone in a position of authority will look into the complaint promptly. I used it once with Auntie's nursing home, when staffing was so bad that call lights were going unanswered for literally hours at a time. They verified my complaint and let me know the corrective action to be taken. They DO NOT DISCLOSE THE ID of the person filing the complaint, so there is no reason for a staff member or family member to fear using the system.

Thank you for trying to improve the situation!

FrustratedLPN · Mar 27, 2006

In reply to what they did when they ran out of food.. as I said, I came onshift to hear of the situation, but it's my understanding that some residents only got mashed potatoes to eat. I did report it to my supervisor who, in turn, went to dietary managment with the complaint. That's when he was told they "ran out of food".

Employees have shared their meals, bought soft drinks and snacks for the residents, and scavanged up cereal. We don't have access to the kitchen after hours, so if milk and juice aren't brought to the floor prior to kitchen staff leaving, we're out of luck.

FrustratedLPN · Mar 27, 2006

Yes, there is an ombudsman designated for our county. I'm just beginning to feel that representatives and management work hand in hand on issues. They are aware when a state survey is due, and when state is to be expected. Management begins to appear at 7am the week State is due, and we see people on the floor we've never seen passing out meal trays and smiling.

As I said, I'm keeping dates and times of incidents such as this one. Should it happen again, I won't hesitate to begin calling.. whomever needs to be called.

Thanks for your response

Geeg · Mar 27, 2006

How about an anonymous call to the local TV station. They might care if it is a slow news day.

CoffeeRTC, BSN, RN · Mar 28, 2006

Yep...the news media can be helpfull in these type of situtations, but its best to try first with the ombudsman. Get the families involved in calling too.