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 also worked in an Assisted Living Unit as a companion. I am now a CNA and would not EVER lift as I had done in the past. Most of the times the staff were told to do the "Bear-Hug" lift to transfer. :angryfire One resident was a complete lift and one a partial. I worked night shift alone, so did not have any help on this shift. I blame the management in ASF for the greed of accepting residents that are beyond the care of the compansions. I know the resident is to be transfered into LTC, but the safe way to handle this is hire additional TRAINED staff to work one on one while the transfer is pending, with use of a hoyer. Not depending on untrained staff. Sometimes money stands in the way of caring for our elderly.
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.
This is exactly what I was thinking. There is no way on earth I would expect anyone to cause themselves permanent damage on account of what some may perceive as a dignity issue and even if it is because of skin breakdown, I believe efforts should be concentrated on skin care for incontinent patients.
The nursing home won't be any different. There will likely be even fewer workers to assist this person.
I agree with sending the patient to the hospital and then not accepting her back.
If your facility director will not agree to this, I would have her notify the family that they must provide home health aides around the clock who will be responsible for the patient's toileting needs as your staff are not trained to do this and it is outside of their job description. I would have them sign a statement saying that they had been notified of this and after 48 hours you would no longer see to her toileting needs.
At the same time, I would give a 30 day move out notice. Hopefully these provisions would get the family off their duffs and make them take care of this.
as a former cna - i have heard you have a depends. i would always try to get them on a bedpan. if they were an undependable transfer - i would do the bed pan. i threw my back out on a dependable 1 assist transfer because she dropped on me. so i am cautious on transferring patients in nursing homes.
you are right and that is why the family is looking for a new place that can offer her more than what assisted living does. However, until that is resolved we still have to take care of her the best that we can.
The best that you can also means taking care of yourself. If you hurt your back she is not going to pay your bills. She is the one who caused herself to be overweight you shouldn't have to suffer for that. I agree that if at all possible a bedpan should be utilized but I would not be pulling on her to get her onto a BSC. Don't flame me, I'm overweight and I likewise wouldn't want some one pulling on me, nor would I expect them to.
If the family is overly concerned they should take her home until they find appropriate care or they should rent a hoyer lift for the staff to use while she is there.
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?
Can you please offer some advice/feedback?
Thank You
As Someone who actually owned an Assisted Living Facility for 7 years; aka Personal Care Home, in the state of GA, if a client can not evacuate the home under their own power in case of an emergency they can NOT live there without a waiver from the state. The PCH must give them 30 days to find other accomendations, unless it is an emergency.
The PCH must under no circumstances do any "Nursing Care". I'm an LPN, and was told by state that my license wasn't worth the paper it was wrote on after I stepped into the facility. You can only do basic 1st Aid. A PCH is NOT a "skilled nursing facility".
If this client has skin breakdown they have to get Home Health to see about it. It sounds to me, but I don't know all the details, that the woman may not have been a good candidate for a PCH to begin with.
As far as telling someone to "pee in their depends" you can get fired for doing that. It is not only unsafe for the clients skin integrity, but not to mention degrading to the dignity of the client. The caregivers that are there with here need to be made aware of good body mechanics and double up with the client.
Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.
When safety is an issue to the patient and to the staff commonsense has to prevail.
If staff are not trained in lifting etc then they are opening themselves up for back injury.
Good pericare is a must so regular changing of adult incontinence wear is a must if they cannot get her on a pan or BSC.
I think of the other side too if that was my mother I would be looking at other avenues to get the assistance my mother would need. If that required moving to another facility so be it.
I hope this gets settled soon. What was the outcome?
As Someone who actually owned an Assisted Living Facility for 7 years; aka Personal Care Home, in the state of GA, if a client can not evacuate the home under their own power in case of an emergency they can NOT live there without a waiver from the state.
Good point; something I hadn't thought of in this case.
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?
Can you please offer some advice/feedback?
Thank You
this is not acceptable- there should be a way to get a gait belt which are easy to use and simple to learn that can be used- if she is really unable to move on her own an dthere is no way to do its safely there is no reason that the hospital can not make arrangements to have her ( where they do have those items) until a NH can be found- is the family allowing NH placemennt? i have seen hospitals take people in and get people in a NH within a day or maybe 2 - it may not be "convenient " for the family as tis not in the area but can be found even if a few cities away. perhaps the family is hindering the process refusing placement away from home - talk to your supervisor tell them what you have seen and heard - they should push it thruogh it is not only unsafe for the staff but not good for the patient either.
you are right and that is why the family is looking for a new place that can offer her more than what assisted living does. However, until that is resolved we still have to take care of her the best that we can.
this is an old post so hope they have resolved this issue- i do know that there is no reason a NH cant be found unless the family is not allowing placeent out of the area, sometimes we have had to utilize that option of going cities away for a short time but for the safety of workers and pt it is what is best. be sure your facilities are looking ALL over not just nearby.
meintheUSA
137 Posts
I also worked in an Assisted Living Unit as a companion. I am now a CNA and would not EVER lift as I had done in the past. Most of the times the staff were told to do the "Bear-Hug" lift to transfer. :angryfire One resident was a complete lift and one a partial. I worked night shift alone, so did not have any help on this shift. I blame the management in ASF for the greed of accepting residents that are beyond the care of the compansions.
I know the resident is to be transfered into LTC, but the safe way to handle this is hire additional TRAINED staff to work one on one while the transfer is pending, with use of a hoyer.
Not depending on untrained staff. Sometimes money stands in the way of caring for our elderly. 