What time does your LTC facililty start getting residents up?

BerryHappy · Aug 11, 2009

Find a different LTC!!! At ours we get the early birds up early (7ish), and the ones who sleep soundly through all the morning noise, get up when breakfast arrives (8:30ish).

I am horrified that anyone would wake someone with force, or in any unpleasant manner! Get out of that place!

donnasRN · Aug 11, 2009

I'm sorry you haven't been having a great experience in LTC, and thank goodness that CNA was fired. I don't work in LTC, but have worked in a facility similar to it and patients that did not get up on their own were usually woken up around 7am, 7:30am the latest to perform ADLs before 8am meds. The late sleepers were woken up around 8am to take meds, allowed to go back to bed, then woken up again @ 8:30am for breakfast. 4am is really early!

Why do you think the DON is skirting around the issue? Do you think they want them to go to sleep earlier so they wake them up earlier? Since she's not giving you an answer, during your shifts (if you are the Charge Nurse) tell the aides to leave the residents alone until YOU feel they should get up... I wonder how that would go over lol. Best of luck in your job search!

LoveMyBugs, BSN, CNA, RN · Aug 11, 2009

I did my clinicals at a LTC last year and they have a very relaxed morning routiune. Breakfast is served from 7am-10am and the residents can get up whenever they want. If they want to go to breakfast in thier PJs then it is accetptable, only breakfast though.

If they wanted to eat in thier rooms that was fine too. They could also choose what they wanted for breakfast. The kitchen would make a special for the day, but there was always avaible a varity of cereral, fruits, and breads and if they didn't like the "special" and just wanted eggs that was also an option. The other meals for the day were the standard this is the time and everyone gets the same thing. My clinical would start at 6:30 and maybe 2-3 residents would already be up, the rest would get up when they were ready. The aides were not to wake anyone up, only go and check on them and help them when they were ready. Which is why breakfast would go untill 10am for those residents who liked to sleep in. Needless to say I loved that place, if my mom ever needed to go to a LTC I would love for her to go there.

I have worked as an aide in another LTC and there the night shift was expected to have some of the residents dressed for day shift and have the clothes layed out the night before and they would start getting them up around 5am, but then they would put residents down for bed as early as 5pm!

KarynicaRN · Aug 11, 2009

Find a different LTC!!! At ours we get the early birds up early (7ish), and the ones who sleep soundly through all the morning noise, get up when breakfast arrives (8:30ish).
I am horrified that anyone would wake someone with force, or in any unpleasant manner! Get out of that place!

I hear you. This place that I am working at is just all over terrible. I have made several posts here concerning the fact that dressing changes aren't being done and the DON just tells me that "it happens". My orifice! State just came in and gave the place 7 violations and that didn't include the roach infestation. I have worked in several LTC facilities and this one tops them all as a huge mistake. I feel sorry for the residents and their families. I feel like I am just banging my head against a brick wall and no one will listen. I was also told that administration is just a clique of people that have been there for a very long time (very true) and that it's useless to complain.

I feel so bad for the residents, but my time there is short. I refuse to continue to watch the DON do nothing about nursing mistakes because she doesn't want to fire a nurse because we will end up short staffed. Better short staffed than having a nurse around that doesn't do her job.

cincymom96 · Aug 11, 2009

It is the same time for some of the residents in my LTC facility. We have 88 beds and three shifts. Third shift is required to get some residents up and first shift ( which starts at 6:30) get the other residents up. Third shifts start getting residents up @ 4am. Do I agree with this? No but I do understand the neccesity of it. If third shift started any later they wouldn't be able to finish there work and first shift does not have enough time between start time and breakfast to get everyone up. So what do you do? I don't know. Working in LTC is very fustrating just because you see what happens to people when there to ill to care for themselves and theres no one to do it. It's even more fustrating when you see individuals working in the feild simply because it's a job but don't care about the residents.

KarynicaRN · Aug 11, 2009

It is the same time for some of the residents in my LTC facility. We have 88 beds and three shifts. Third shift is required to get some residents up and first shift ( which starts at 6:30) get the other residents up. Third shifts start getting residents up @ 4am. Do I agree with this? No but I do understand the neccesity of it. If third shift started any later they wouldn't be able to finish there work and first shift does not have enough time between start time and breakfast to get everyone up. So what do you do? I don't know. Working in LTC is very fustrating just because you see what happens to people when there to ill to care for themselves and theres no one to do it. It's even more fustrating when you see individuals working in the feild simply because it's a job but don't care about the residents.

This is exactly what the facility tells me. We have to start getting them up at 4am or they won't be ready for breakfast at 7am. There are between 43-47 residents depending on if there is someone in the hospital/out with family, etc. The DON gave the night shift aides a list of residents whom she expects to be up by 6am. We have 2 halls and it just seems so unfair to start waking up someone at 4am, throwing their clothes on them and then pushing them into the hallway. Of course half the time they aren't even awake. They are sleeping in their wheelchairs and it's really sad.

Here in Illinois there is a new program that a few facilities are trying out. The residents get up when they want to get up. They get their medicines when they want, they can eat at whatever time they want to eat and get snacks whenever they want. I believe that a nursing facility should be run this way. Who wants to be shook out of bed at 4am, have some old dress thrown on and then placed in a wheelchair in the hallway? NOT ME!

florianslove · Aug 11, 2009

Res sleeping in the hallway is a heartbreaking site. When I became unit manager I stopped it. It wasn't easy, as the cna'S weren't used to it. I worked it out with our activities director to have our leisure center opened early, that way, the residents that are up early BY CHOICE, can go down there and socialize with other residents until it's time for breakfast. Believe it or not, some do like getting up early. For those who want to sleep, we let them sleep, we have what's called open dining, which means the resident can get something from the kitchen between the hrs of 8:00 A.M. and 7:00 P.M.. If someone wants to sleep in, they can get a bagel, toast, some cereal or a muffin when they get up.

I've been in my position since March and it is only now that the CNA's are starting to automatically take the residents to the leisure center instead of just parking them in the hallways. I do the same thing all day long, I don't want to see residents just parked in the hallways staring into space, in my opinion it is depressing and a dignity issue. We also got a facility dog (a puppy really) who the residents just love. I love my residents and for the most part work with good cna's and nurses, but it is a challenge every day to break bad habits.

Don't give up on LTC, it can be the most rewarding part of nursing. Good luck.

Roxann:heartbeat:nurse:

CapeCodMermaid, RN · Aug 11, 2009

I would write them all up for getting anyone out of bed and dressed at that unGodly hour! We have several residents who have always gotten up and dressed before sun rise. Mostly they were fishermen and have been getting up this early for decades. If it it THEIR choice to get up at 5:30 or 6 we get them up. Otherwise they sleep till 6:30 or 7. One facility I worked for got cited by the DPH for having the lab tech come in at 5 am. The residents complained that 5 was way too early to have some stranger stick a needle in their arm!!!

Here's my question for those embracing culture change: all the residents get up when they want. They get their meds when they want. So the regulation is still medications will be given an hour before or after the scheduled time. IF there are NO scheduled times, how do you get around the regs?

NotFlo · Aug 11, 2009

On my floor there are usually 3-4 early AM "get-ups". These are people who want to get up early and complain if they can't get washed, dressed and up with or before the sun. They get up around 6-6:30. Everyone else gets up around breakfast time, 8am (some before, some after. We try to meet the patient's preferences if possible.)

Moogie · Aug 11, 2009

At the LTC at which I worked, the policy stated that residents were supposed to be able to sleep as long as they liked, but the facility was having major problems with that culture change. If the noc CNAs didn't get "enough" residents up before day shift arrived, the day shift screamed at them and complained to the DON. The DON had her own issues with the culture change and she often sided with the day CNAs, causing most of the noc CNA staff to leave over a period of about eight months.

If culture change (e.g., letting residents choose their own bedtimes and wake times) everyone, from the DON to every CNA, has to be on board. Otherwise, there are too many conflicts between those who are trying to honor residents' rights and those who are still so task-oriented that they make sure things are done, on their schedule, not on the residents'.

I remember one woman who liked to be up around 4:30 AM. That was her habit, that was her choice. Another did not want to be disturbed before 10 AM. Again, her habit and her choice. Sadly, those who could not articulate a choice were gotten up as per the CNA's discretion, which meant that if a crabby day shift CNA was coming on, more residents would be up for the day than usual, whether they wanted to be or not.

NC29mom, ASN, LPN, RN · Aug 11, 2009

where i work, the cna's start about 5am. there are a few people (1 is a man with a horrible skin condition with horrible odor and other is an enteral feeding resident that lays in bed most of the day anyway) that go to the shower, and this really is the best time to take them. the other resdents that get showers take them after breakfast. our faciltiy gets about 10 residents up starting at 0500, mainly because these are the ones that have to be up to eat breakfast (can't be fed in the bed, won't eat well). it also helps decrease the load for the 7a nurses.

but, i have noticed that some of our night nurses will start at 0400 passing out 0630 scheduled medication. i think that is ridiculous!!! the nurse should be able to complete the med pass in 45 minutes (tops!!); therefore, shouldn't start until 0530 or 0600. when i work nights, i start the medpass at 0530 and complete it with no problem - and mind you, i don't work nights except every once in awhile (if somebody calls out)>

i agree with getting the residents up early (but not 0400) so they can be sitting up for breakfast. this helps with their eating and decreases the weight loss issues.

as far as a cna or nurse spraying a resident in the face with water---------she should have been fired on the spot!!! i have absolutely no tolerance for the mistreatment of our elderly - and this includes the tone of people's voices.

best of luck to you.

you may be one nurse, but you can set an example and you can make a difference.

above all, remember----we are our patients number one advocate!!!