The face of LTC is changing????

Youre right. Ugh, for every skilled pt, there is a list of high points you need to chart on in order to get reimbursement. I wish that the new requirements translated into better pt care, but for now it looks like its more about what you said you did

Right! I was always told you would do more charting & less patient care but this is crazy. I try to see my patients as much as possible but this has became so difficult.

Nope. It was that way years ago too. If everything pertaining to the skilled case wasn't documented just so, no money for you.

I have been a marketer for a SNF for a year now, almost 3 years working for them total and I can tell you, ITS ALL ABOUT THE MONEY!!! Now I am a nursing student and, speaking only from my experience, in the city I live, I will never work for a nursing home once I get my license. Truth is, they dont care about your license in a bad way. I have seen a DON walk out, an Administrator going into the chart herself (she is not a nurse) and LPN's and RN's just flat out leave when asked to purposely document something to either get paid or discharge a patient that they were not getting paid for. If you refuse, you get fired (they find a way). I tell my girlfriend all the time, I CANT WAIT TO BECOME A NURSE and get out. Patient to nurse ratio is ridiculous, 25-1 or more at times if someone calls out. Personally I think Skilled Nursing is going to hell in a hand basket and fast, again I am speaking just from my experiences.

You are so right because where I work the ration is 30:1. And it is VERY stressful. It seems to be going down real fast.

Agreed that there is a lot of charting. Thankfully where I work we have computerized charting. We have a lot of "assessments" to select from that we complete that capture all the required elements. Once I realized that completing the required assessments saved from writing a whole lot progress notes, it changed my perspective on having to complete assessments.

It's not unreasonable for reimbursing entities to require certain services to be performed and documented to justify the payment. The real problem is the staffing -- the de facto "normal" ratio of 25-30 patients in a SNF that is accepted and somehow managed. Ideally, nurses would be really monitoring the daily rehab activities and noting progress, and doing all the necessary assessments. But the ratio is forcing nurses to barely manage med-pass alone and end up fabricating everything else.

I wish I knew what it will take for the SNF industry to realize the potential of what it could be if they would staff appropriately and allow nurses do what we're actually trained to do.

25:1? Last job was at least 35:1 on Pm's when getting 2 or admits was not unusual.

Oh wow!