Those that have 15 residents in a LTC facility

[havehope]

Where I work there are three different units: nursing home part, assisted living, and a rehab section. I have always worked on the rehab unit and had at most 10 residents (most are content and able to respond to me). However, yesterday I was pulled to the nursing home part and had 15 residents. How do you all do it everyday? I drove home crying after I left because I knew I could not give each and everyone the care they deserved. All 15 residents were incontinent meaning I did not have to the check each resident every two hours, while obtaining vitals and weights. I truly look up to you all that work in nursing home! I admire each and everyone of you!

I also have one other question for you all...being that most nursing home facilities have a shower schedule, do you all wash each resident up every morning? If I were pulled to that unit again do any of you have any insight or routine you would recommend?

Sorry for the long post, but again I admire each and everyone of you! :-)

[thelittledoe]

I thought this was an astronomical number too when I first heard it. By me (NJ) they have a tough time finding caring CNAs so that is why the aide-patient ratio is so skewed here. Everyone wants a hospital or rehab position and not LTC. LTC facilities tend to pay less here which is why it is harder to find motivated workers. I found that a lot of the CNAs I worked with during my clinical would skip what they deemed "unimportant" steps to get their jobs done quicker. It really is sad but it makes me so happy that their are caring CNAs out their who try their hardest to provide the best care despite having so many patients.

[TheCommuter, BSN, RN]

With 15+ residents, you cut corners to get it all done. You do not really have much time to talk to the residents or do anything extra for them.

Most of the LTC facilities in my area have a shower schedule: 'A' beds are showered on Mondays, Wednesdays and Fridays while 'B' beds get showers on Tuesdays, Thursdays and Saturdays. There's not enough time in the world to shower every resident on every single day of the week.

Generally, the facilities where I've worked do not weigh LTC residents daily. They get weighed weekly. Also, there's no reason to check the vital signs of LTC residents on a daily basis unless they're on BP medications or on Medicare.

All of your patients in the rehab section will need vital signs because they're all on Medicare and private insurance, since Medicare requires vital sign checks at least once every 24 hours. However, most LTC residents are on Medicaid, and therefore, do not need constant vital signs unless there's a specific reason (cardioactive medication, specific signs and symptoms, not feeling well, etc.).

[funtimes]

What shift is this? 15 residents for day shift is craaazy. Even for evening shift. For the NOC shift thats probably a light load.

If this place has one cna taking care of 15 residents on a regular basis, I feel sorry for the residents. They are recieving the absolute minimum of care, if that. Sounds like a situation ripe for abuse and neglect. I normally took care of 7 people when I worked on day shift in LTC, with one, and sometimes 2 showers per shift, and I was lucky if I barely had time to go to the bathroom all shift. I cant imagine 15.

[havehope]

Funtimes- It was day shift 7-3. I totally agree that it basically is abuse and neglect, because I was unable to make sure every resident was dry every two hours being that all 15 were incontinent. I'm not sure if it is like that everyday, but if I had to take care of 15 residents that are LTC I would quit, because I know I couldn't provide the quality care each deserve. It was by far my worst day of work.

[esand]

15 incontinent patients and not enough time to care for them = not a good time.

That sounds terrible, I'm so sorry.

[lillymom]

Sounds about right to me as far as a nursing home is concerned. We keep two CNA's per hall and there are about 26 residents on each hall but most of the time there is only one of us on the floor at a time between breaks and showers. We usually have 5 showers per day.

We don't necessarily wash everyone off everyday because there isn't time. We do wash the face, pits, and privates on everyone daily though. We also leave the patient in bed on their shower day until we can get them showered right after breakfast. We only do this if they don't object or the nurse doesn't mind though.

Every minute of working there is taken by something that must be done, unfortunately I would love to spend more time with my residents and talk to them. I try to talk to them as much as possible though while providing their care.

As far as routing goes we get everyone up and change them, breakfast for residents, our breaks after residents are done eating, baths, change everyone, pass ice/vitals, lunch break, document, residents lunch, lay residents down and toilet the ones who don't, last break, document, any showers not done, then last round.

After working with the same residents for a while you get to know them and their schedules and it becomes a little easier as you can mostly anticipate things and build a more refined schedule.

Good luck!!

[havehope]

lillymom- I have to say…hats off to you and all the other CNA's that work with 15+ residents. I admire each one of you.