Staff eating with residents

[Inquisitive one]

How are CNA supper breaks scheduled in other facilities? At mine, residents supper is from 5p-6p. After their meal, residents then want to be toileted, changed, put to bed etc..... Many alarms sound and falls happen. CNA 30 minute supper breaks start at 6 pm so typically the units are running with less staff at this crunch time. Changing CNA supper time would impact the kitchen staff since most CNA's opt to buy their meal from the facility and kitchen staff need to punch out by 8 pm. Have any facilities tried having CNA's eat their meal with the residents and then take their actual breaks later in the shift? If so, how does this work out? How does staff, residents and their families feel about this? Are their infection control issues? Any input/ ideas appreciated.

[CapeCodMermaid, RN]

We are fortunate to have several dining areas so that we are able to group like-mannered residents together!

We had a main dining room....mostly the more alert longterm residents who don't need too much help go there if they want, Each nursing unit had one or two dining rooms....but there were some long term residents on the short term floor who just plain refused to move...so there they are in the floor dining room because they need to be fed. One of them "hawks loogies" on the floor. Thank goodness there were no other 'like mannered residents'.

[ktwlpn, LPN]

State regs here in Pa in ltc have stated for years that we can NOT seperate residents according to their levels of care,behaviors or any other reason.We can have specialized secure units and Dementia care units but every one else gets thrown together.Years ago we had one floor that had all of our tube feeders and trachs-then we had to mainstream them through out the facilty.The surveyors reasoned that if a resident had a turn for the worse they had the right to stay in the room they had been living in.Today we have alert and oriented residents in LTC as young as their 40's.It's a county facility-we only have a few private rooms (for medical neccessity) Can you imagine lying next to a trach pt? Or lying in bed,npo with a TF while your roomate eats ? Or listening to a screamer 24/7? It gets on my nerves and I'm only their for 8hrs.....I also worked in a private facility that was moving towards the Eden type of program.I worked in the Alzheimer's unit-we had a kitchen-a resident pooped in it....You can only do so much with these people-I have learned that there comes a time when they need security in a calm and quiet environment......You want them to maintain their highest level of functioning for as long as possible but with a census of 21 in that unit 2 cna's on day shift we were pretty much just getting through the day...But we had a kitchen and birds and a therapy dog....The birds all died because no-one fed them...Forget activities-everything ended in a fight between residents-we had one that smacked a child in the face...I'm getting long winnded-my POINT is-making things "pretty" is not always the best for the residents-or their families....And no-I prefer to get away for a break and NOT to eat with snotters and pickers-as much as I love some of them....

[nurse100]

I truly did not mean to imply that I wanted to make a facility "look pretty". It was unfortunate that the Eden program failed to do what it was intended to do for LTC. Hopefull, the greenhouse projects will succeed.

Each facility serves a different type resident whether the difference is social, cultural, etc. therefore there can not be a set "cultural change program" that works for all facilities. It must be individualized based on who the facility is serving. For instance, I care for residents who are private pay, most have lots of money. They do not want to sit at a table together and "pass the mashed potatoes", they want to be served. However, some residents miss that family connection of socializing around a large table. They miss that family connection that they associate with mealtime. And they do consider staff their family.

What works for my facility may not work for yours and vice versa, but what should work for both of our facilities is that those residents are not levels of care or diseases. They are people and our care should be focused on treating them as such. Instead of living out the rest of their lives in "institutions" they should be in homes living out the last of their lives as close as possible to how they always lived.

I understand that LTC is heavily regulated in all states. But I believe that most states are willing to work with the LTC industry in the area of cultural change as long as the end result is better care.

Also, I never meant to imply that staff should have to take their lunch breaks eating with the residents, if they eat with residents they should still get their breaks.

[PANurseRN1]

And I don't think they should be expected to eat with the residents on paid time, either.

It's very telling that your facility has mostly wealthy pts. who want what they want when they want it, and get what they want when they want it. This isn't a personal criticism; I just find it interesting to what lengths administrators will go when $$$ are involved.

[donmomofnine]

I am in PA and have not encountered those issues. We do have a wing where we try to keep our dementia residents. We try to put folks with appropriate room mates. We can place residents in whichever dining room we feel is best for their abilities. This has never been an issue. It is a quality of life concern for all of our residents. I can't wait till we have all private rooms so many of these issues will disappear. As Nurse 100 states, all facilities are different! We do have a beautiful facility. Our residents enjoy that. They also enjoy the great care we provide as well. You can have both!:)

[weirdRN, RN]

Okay, Maybe I have started to change my mind. I have recently been exposed to a different kind of nursing home through a job interview. I called and asked for a tour and more information about the nurisng home, and the DON gave me a tour.

I have seen a facility where the residents are allowed to "Age in Place" That is, they go in while they are still able to mostly take care of themselves. They are in private rooms, and so as they age or loose their independance, there is little violation of privacy, and few dignity issues. I am not sure who owns the facility, but, they have done a wonderful job of allowing their residents to live as close to a normal life as possible. Excellent activities, excursions, shopping trips for thsoe who care to go. While they do not allow them to cook, they do have an accessible microwave and refrigerator stand in their rooms. They have family style dining for the residents that choose to share their meals. The folks that have to be assisted in eating are brought to a separate dining area and the staff sits all together with them and it is more like a social hour than a "feeding" The downside is that most of the people who need help eating do not talk much. I was told that the staff try to find out as much as possible about the resident and try to have a conversation with the resident during meal times.

I have also seen a completely different side of the nursing home industry where the nursing facility is managed by larger corporations who only care about the money. It is a serious problem that is only going to be exacerbated as more and more nursing homes move toward being rehab facilities and extensions of hospitals instead of true long term care facilities.

I still disagree with allowing staff and residents to eat together. I still think it is an infection control issue. I think it is hard to enjoy your food when you are supposed to be paying attention to the residents in case they need me for anything.