Trachs and vents at LTC

Nascar nurse, ASN, RN · Sep 4, 2012

I think this will vary greatly depending on the facilities. I am lucky to see one trach a year and my facility does not accept vents. There are 2 facilities nearby that have a dedicated vent unit.

RNBearColumbus, BSN · Sep 4, 2012

We might see 2-3 trachs a year at our facility, but I expect that number to rise as the quest for higher reimbursement rates intensifies.

Facilities in most states are reimbursed for care based on the care needs of the patient. For example, a patient who needs IV ATBs will earn a facility more money than a patient who has had a knee replacement without complications who just needs a few days of PT / OT before returning home.

Trach patients earn a facility one of the higher per-diem rates. Facilities are going to find it difficult to turn down these higher reimbursement rates.

Reigen · Sep 4, 2012

I haven't worked in LTC for awhile. I have heard that some LTC's now have patients with trachs and vents. Is this true? How many trach and or vent patients do you usually have?
Thanks.

My facility has Trach Residents and also has Vent Residents... Vented Residents are on one unit/hall and there are 10 however we also have a round the clock Respiratory Therapist on duty. There is one nurse for all 10 of those to do treatments medications etc. The RT nd Nurse work closely together, as the Vented Residents are take off the vent and "bagged" during a shower....

The Trach Residents are "scattered" over four units/halls through the whole building. Each Unit has one Medication/Treatment Nurse, who is also responsilble for the Trach care, and suctioning (which must be done every 4 hours) and PRN as well, on assigned Trach Residents. This assignment of Trach Residents can be one to 3 depending on how many the hall/unit has at any given time.

imintrouble, BSN, RN · Sep 4, 2012

I worked on a trach/vent unit in LTC almost 20 yrs ago as a new grad.

I think they've always been out there, just concentrated in certain facilities. As one poster said, maybe facilities are changing their criteria for admission r/t money.

TheCommuter, BSN, RN · Sep 4, 2012

I first started seeing trachs and vents in LTC back in 2005, when I was a student in an LVN program while completing clinical rotations at an LTC facility.

When I worked in LTC, one or two of my residents might have had trachs out of the entire patient load. I have not taken care of a vent patient yet. They frequently developed infections and were sent out to the hospital. Management at the places where I've worked would not keep adequate respiratory supplies on hand, so staff was forced to reuse things that should have been disposed after one single use. Hence, the infections. . .

However, as Medicare reimbursements dwindle, LTC facilities are going to make up for the money shortfall by admitting more trachs and vents because these residents are highly lucrative to the bottom line.

Esme12, ASN, BSN, RN · Sep 4, 2012

There are facilities now that are called LTAC or LTACH Long Term Acute Care Hospitals....they have vents, traches and some of them even have ICU's. We have an LTAC forum.

roseonye · Sep 4, 2012

i work in a LTC facility and we have a 40 bed cent and trach unit. it was scary at 1st with all the bells going off but you get used to it once you understand what the bells mean. its also great experience. we also have other floors that have trach only. where the nurses do trach care, suction etc. the facility makes big bucks. medicare reimbusement.

SarcasticLVN · Sep 5, 2012

The only trach and vent patients I have seen in my county were at one hospital that had a sub acute unit specifically for them that I did a clinical rotation in.. There have beeb rumors about our facility wanting to do a trach/vent unit but I don't think it's going to happen. I was lucky enough to get to experience taking care of these residents.. The nurses were assigned 6-8 patients a shift.

IdianaCNA1993 · Sep 5, 2012

I worked in a vent facility that was poorly managed and very unorganized. I understand that in the nursing field they expect you to have super human abilities but when at night it came to 1 to 3 aides and 2 nurses and when we were lucky an RT that did there job for the whole entire building of 60-70 resident it was pure misery. mostly because the residents didnt keep normal sleeping hours management was on us about call light times. we had residents reporting us for not getting to them in time or not being able to do what they wanted becuase we werent given enough supplies and mind you that some of these residents wieghed in at 500lbs no joke and couldnt roll on there own. we the aides were forced to do things we werent trained or even aloud to do by state law like ambu bag or unhook the vent tubing to get them dressed. I dont think that I ever want to go back to working in vent care again unless its at a hospital. it was very overwhelming and draining but I know that if I can survive that place and still want to go in to nursing I can survive anything! I think that too there should be state laws for vent facilities like so many nurses/aides/rts to residents and experience levels and degree types. I myself would rather hire the LPN with 10 years experience over the BSN with no experience to work around vents.

AngelRN27 · Sep 5, 2012

My facility is SNF plus one hall of ALF, and we do not have any trachs or vents atm. We do accept trachs but no vents. I personally feel very comfortable with trachs as one of my longest clinical experiences was on a Neuro-surg floor where about 80% of pt's had a closed system trach. After that clinical experience I could suction a trach, provide trach care and replace a disposable canula without a wince.

Blackcat99 · Sep 7, 2012

Thanks to all for your comments. I appreciate your help.