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?
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.
You are so right about the luxury of time with the family because that is the impression I got from the resident that it was not a rush. I "think" we have to give them a 30 day notice if we want them to move. I sure wish something would happen before that. The resident is a sweetheart but she just needs more than what we can offer her.
I noticed recently some nursing facilities have a short waiting list so sometimes its hard to plan too far ahead
Specializes in Community Health, Med-Surg, Home Health.
if she is continent there is no need for her to pee herself
not even is it disgusting it is also not good for her skin, if she is already getting red...
also if i would be the patient i would be very disgusted with myself
to pee myself
nici
I made a mistake by placing thank you on the bottom of the post. The issue is that she is immobile, but is aware that she has to go to the bathroom. The problem is that she seems not to be able to move herself, and it is a safety issue. She may be disgusted with herself, but it is an issue that she can't help without moving. If the fire department has to be called each time she has to be moved, they will not be willing to move her just to go to the bathroom. There has to be a solution, may it be a foley, bedpan or a group effort.
Specializes in critical care; community health; psych.
This could be a case of a family not willing to go the distance to do the deed. Putting mom in a SNF is a hard decision and no one wants to be the bad guy or even admit that it's necessary. Maybe mom herself is what's holding up the works if she's competent. I can't blame her. I'm in my 50's and every time I visit one, I am reminded that this too could be my fate and I DON'T WANT TO GO!! Or it could be a situation of money talks in which case Administration is the culprit.
I'd be interested in what's transpiring on the case conference level.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
You are so right about the luxury of time with the family because that is the impression I got from the resident that it was not a rush. I "think" we have to give them a 30 day notice if we want them to move. I sure wish something would happen before that. The resident is a sweetheart but she just needs more than what we can offer her.
If the assisted living facility is obligated to give a notice, then someone in the facility needs to be diligent in making sure that declining residents are given that notice before they need the level of assistance this resident needs.
And I understand that a family may choose Nursing Home A for the resident and that A may not have a bed when it's needed. It's often possible to place someone in Nursing Home B or Nursing Home C until a bed comes available in Home A. That may be what this family has to do.
Specializes in icu, er, transplant, case management, ps.
In the summer of 2006 I had to be admitted to an assisted living facility. Before I was admitted, I had to meet with the nursing supervisor, as well as one of the assistant administrators. They went over with me, my needs, how much assistance did I require? Did I require assistance in transferring from my wheelchair to my bed, to the toilet? Did I require assistance in dressing, with my meals, with ,my medications, with my daily glucose monitoring. After talking, it was decided I was independent enough to live in the indpendent side of the facility, because I really did not need that much assistance. I'm sorry but I wonder who did her screening. And what the criteria was for their assisted living side. If this lady required that much assistance, why did someone not notice it prior to her moving in? And why was she allowed to move in, if she exceeded the limitations of the assisted living side? The assisted living side, where I live, had hoyer lifts to help move patients who required such assistance. And no one moved a resident without assistance, in an effort to prevent injuries.
I am sorry but I see this situation as a complete failure on the part of the facility. If they did not have the staff to assist this individual, they never should have accepted her. As for the family delaying her transfer until a bed is available in LTC A, tough. They never should have admitted her, in the first place, if they didn't have the staff.
Specializes in LTC, assisted living, med-surg, psych.
Here's another idea, albeit an act of desperation: I have, on two memorable occasions, called non-emergency transport and sent residents to the hospital for a medical evaluation, then notifed the ER personnel that we could not accept them back due to the fact that we could not care for them safely. Of course, I had to be willing to take a fair amount of verbal abuse from the paramedics and/or the ER physician, but sometimes there is NO OTHER WAY to get someone out of a facility.
Once the resident is at the hospital, the discharge planning team becomes involved, and they have ways of finding emergency placement for people who can't take care of themselves (or who can't be cared for in their current living situation). Obviously, this should only be done as a last resort, and I'm sure ER nurses will want to throttle me for even suggesting it! However, in both the cases I mentioned, it was imperative that the residents in question not return to what was essentially an unsafe environment, and good outcomes resulted from both transfers.
Again, I don't advocate misuse of emergency services, and I'm sorry that it's EVER necessary to do such a thing to secure the proper placement for a resident who is no longer appropriate for assisted living. But when you've tried everything else---the family is not cooperating, the resident him/herself doesn't want to move, the administration isn't listening, you've brought in additional resources to help with the situation, and it STILL doesn't work---you have to do whatever it takes to ensure the resident's needs can be met. That's the bottom line.
we had a large lady that slept in an electric recliner. She would lean forward on a sturdy walker while the chair lifted, then we could ease her back down with the bedpan in place. it worked very well as there was no pivoting involved and she had the walker to help bear the weight.
Here's another idea, albeit an act of desperation: I have, on two memorable occasions, called non-emergency transport and sent residents to the hospital for a medical evaluation, then notifed the ER personnel that we could not accept them back due to the fact that we could not care for them safely. Of course, I had to be willing to take a fair amount of verbal abuse from the paramedics and/or the ER physician, but sometimes there is NO OTHER WAY to get someone out of a facility.
Once the resident is at the hospital, the discharge planning team becomes involved, and they have ways of finding emergency placement for people who can't take care of themselves (or who can't be cared for in their current living situation). Obviously, this should only be done as a last resort, and I'm sure ER nurses will want to throttle me for even suggesting it! However, in both the cases I mentioned, it was imperative that the residents in question not return to what was essentially an unsafe environment, and good outcomes resulted from both transfers.
Again, I don't advocate misuse of emergency services, and I'm sorry that it's EVER necessary to do such a thing to secure the proper placement for a resident who is no longer appropriate for assisted living. But when you've tried everything else---the family is not cooperating, the resident him/herself doesn't want to move, the administration isn't listening, you've brought in additional resources to help with the situation, and it STILL doesn't work---you have to do whatever it takes to ensure the resident's needs can be met. That's the bottom line.
ER nurse here ... and you'll get no throttling from me. Your suggestion is exactly what I was thinking as I was reading the thread.
We do receive patients from personal care homes/ALFs who are clearly in need of a higher level of care. With everyone on board (family, PCP) they can be admitted for a day or two while a social worker busts his/her behind working with the family to find an available bed in an SNF.
Many facilities would do this in a heartbeat (and have done so) rather than risk the resident's safety as is clearly the unfortunate case here.
Here's what I would propose: Speak with your administration , the resident, the family, and the PCP re: the need to get the resident transferred to a higher level of care ASAP. Then call your local ambulance service (or a private service that you contract with) for transfer to the ER.
This is not an inappropriate use of the ER provided that a few courtesies are extended:
1. Don't do this at 3pm on a Friday afternoon, making an impossible job for the hospital social worker/case manager/discharge planner.
2. In your report to EMS, be clear & upfront about why the resident is being transferred to the ER. Don't offer vague complaints in an attempt to justify a medical emergency - a few that I've seen are "just not himself" or "not eating today."
3. Don't call 911 - find the appropriate number for the ambulance service to schedule a non-emergency transfer.
4. Even better yet, IF you can get the PCP to do this -- have the PCP directly admit the patient to the hospital. "Inability to ambulate" will do just fine for an admission dx.
I have no idea if there is a critical shortage of LTC beds in your area or if this resident's family are dragging their feet. But this person's safety is at risk, and IMO things need to happen now.
Edited to add: this happens all the time with the fragile elderly who are being cared for at home by family, until it becomes too much. They are sent to the ER, admitted for whatever appropriate diagnosis, and then moved to an ALF/PCH/SNF.
I think you need to read the policies for your facility. Many assisted living facilities have very clear policies about what a resident must be capable of doing for themselves in order to continue residing in the facility. There are continumum of care facilities that allow for an increase in care/need and will compensate for changing needs, but many that are labeled assisted living are very stringent in what they allow their staff to do, including transfers and medications. Checking the policies will also help your companions to know exactly what is expected of them.
Specializes in icu, er, transplant, case management, ps.
I think you need to read the policies for your facility. Many assisted living facilities have very clear policies about what a resident must be capable of doing for themselves in order to continue residing in the facility. There are continumum of care facilities that allow for an increase in care/need and will compensate for changing needs, but many that are labeled assisted living are very stringent in what they allow their staff to do, including transfers and medications. Checking the policies will also help your companions to know exactly what is expected of them.
I agree that both the residents and their family need to read the policy and what degree of independence is required by the assisted living facility. Having lived in one, for one year, I was very aware of what my facility provided. It provided transfer assistance from a wheelchair to a chair, a bed. For an additional amount of money, bathing assistance is given. Cleaning is done by the facility weekly. Medications are passed by an LPN. As a residents inabilities increase, their costs increase, to a point. When it is reaching the point that they need LTC assistance, they are notified, in writting, as is a family representative. Here in Florida, assisted living facilities, what they offer and what they charge vary from facility to facilty. It pays to investigate before moving in.
If this person is immobile and requires 5 people to lift her yet some staff still hurt their backs, when there have been times the fire department was called in to lift this person, when there are no mechanical lifts available ... what exactly do you propose they do?
It doesn't matter one bit if this woman is continent if she can't get to a toilet or BSC.
As I see it, she has three choices: bedpan, foley, or wet her depends. Sorry, I will not nor will I expect anyone else to harm themselves trying to lift a person as you describe.
I agree! I now suffer from 'old nurses back' syndrome from too many years of straining MY back because I didn't want to tell people 'no'.
dv0806
15 Posts
You are so right about the luxury of time with the family because that is the impression I got from the resident that it was not a rush. I "think" we have to give them a 30 day notice if we want them to move. I sure wish something would happen before that. The resident is a sweetheart but she just needs more than what we can offer her.
I noticed recently some nursing facilities have a short waiting list so sometimes its hard to plan too far ahead