I need some feedback on this matter. I work at an assisted living facility and this resident is already known to be too much for assisted living and family is looking for a LTC facility.
Here is the situation she is very immobile and VERY difficult with transfers. We have called paramedics/fire dept to help get her off the floor several times. She has good days and bad days with transfers. She alert and oriented and she is continent of bowel and bladder. She wears depends as a back up. She does have a small area of skin breakdown starting up. Well others have told her to just pee herself and they will change her then have to get her up to the bed side commade.
In assisted living they do not have CNA's that learn about tranfers. We don't have a hoyer lift or anything like that. So the "companions" think it is easier to change her every 2 hours. I understand they are concerned about hurting themselves with transfers but I am also thinking about the resident because if she is continent then why make her pee herself?
It may be different in your area, but where I live and work aides and staff in assisted living centers may ONLY be SBA for toileting and getting into out of bed. More than that is considered skilled nursing.
You may be required to lift a certain amount of weight but that requirement does not transfer to lifting a patient.
Since we seem to all agree this woman no can no longer eb safely cared for... what plan has been put in place by your employer to protect them selves legally and the patient and staff physically? Perhaps if you approach your supivisor that why it may get the ball rolling.
Ann, I have called my director who is a nurse about this situation. It just seems to be taking awhile. I want the best for her without putting us at risk of injury. Thank you for your feedback.
Everyones post comments are really helping me deal with this situation.
Can you check online or call the state to find out what your legal scope of practice is in an assisted living setting in your area?
I'm concerned that 3 staff actively lifting this client may not only be dangerous for all involved, but putting your licenses in jeopardy.
Someone mentioned a sit to stand recliner... is it possible for the family to rent one for the time being? At least you'd have mechanicla help on one end of toileting issue.
Can you check online or call the state to find out what your legal scope of practice is in an assisted living setting in your area?
I'm concerned that 3 staff actively lifting this client may not only be dangerous for all involved, but putting your licenses in jeopardy.
Someone mentioned a sit to stand recliner... is it possible for the family to rent one for the time being? At least you'd have mechanicla help on one end of toileting issue.
She has that recliner and a pole from ceiling to floor to help with transfers.
I just need to push the issue more of getting her moved to a facility that have lifts and more staff trained with transfers.
I don't know exactly what your governing body is, in assisted living, but if that were happening at a LTC facility (the pt being told to wet her depends, instead of using a bedpan/bsc, etc) it would mean a "site" and a huge fine.
It might just take mentioning that fact to the DON, whoever, to get the ball moving faster.
I dont agree with the comment of her pee'ing in her depends because of the difficult transfer. Last weekend right after the paramedics left she said I need to go to the restroom and I was so bummed but myself and her caregiver got her up. I am going to push this issue harder and stress why it is important to not handle it this way.
Well I tell ya: you know that this lady is a difficult transfer. She has a documented history of falls. Every time you and anyone else get her up without appropriate equipment or training, you are not only risking your backs but her life because a hip fx or a head injury due to a fall could finish her off. And you will have no defense because you knew that she could not always be transferred safely. I totally agree with your concerns about patient dignity and skin integrity. But you must prioritize: her safety trumps embarassment and/or a rash. I don't recommend that you try to get her up again.
I'm curious how you are changing her depends. Are you standing her up with the chair and then doing them quick? If so woudl it be posible to stand her up with the chair and put a bedpan under her and then sit her back down on top of it?
I'm curious how you are changing her depends. Are you standing her up with the chair and then doing them quick? If so woudl it be posible to stand her up with the chair and put a bedpan under her and then sit her back down on top of it?
Well I tell ya: you know that this lady is a difficult transfer. She has a documented history of falls. Every time you and anyone else get her up without appropriate equipment or training, you are not only risking your backs but her life because a hip fx or a head injury due to a fall could finish her off. And you will have no defense because you knew that she could not always be transferred safely. I totally agree with your concerns about patient dignity and skin integrity. But you must prioritize: her safety trumps embarassment and/or a rash. I don't recommend that you try to get her up again.
New view to this and thank you. This whole situation is new to me. I have worked with residents that are hard to transfer but have had trained coworkers or lifting devices. At this place I have neither.
Specializes in LTC, assisted living, med-surg, psych.
One thing I would suggest for the future is knowing what your facility's disclosure statement says. This is a state-mandated document given to residents and prospective residents to inform them of what services the facility provides, e.g., medication management, one-person transfers, bathing and dressing assistance etc. and what it does NOT provide, e.g., feeding tube care, sliding scale diabetes management (or whatever---each facility and each state is different). That way, you can hold your director's and administrator's feet to the fire when a resident has needs the facility cannot meet.
BTW, ditto to what SharonH said: safety trumps dignity every time, and I'm a huge supporter of residents' dignity. This poor woman needs a nursing home STAT.
I want to say thank you to everyone for their comments and feedback. I have written my director with my concerns and what I think needs to be done for the sake of the resident and our staff.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
I agree with someone lighting a fire under administration to get her out of there and into the appropriate facility.
The family may be "looking" for something else, but as long as your staff is going above and beyond, they probably aren't in any hurry.
The family needs a deadline, and probably some social sevices assistance as well. They need to understand that she has to go and that they don't have the luxury of time to find the perfect place for her.
I have a question for those who know more about this kind of situation than I do. Would it not be wise for anyone in assisted living to have a "Plan B" in case they get to the point that they need more skilled care? In other words, pick out a nursing home or two before there's a need for it. There might not ever bee a need for it, but then again, there might.
dv0806
15 Posts
Ann, I have called my director who is a nurse about this situation. It just seems to be taking awhile. I want the best for her without putting us at risk of injury. Thank you for your feedback.
Everyones post comments are really helping me deal with this situation.