Why I'm against a culture change in nursing homes?

LoveNeverDies · Jul 15, 2013

I didn't really know that they were trying to mix the two. I work in an assisted living facility as an Aide and we are not permitted to accept anyone who is not mostly able to care for themselves. (Mostly dementia, or people whose children feel safer with them there.) It is private pay and is very very much a home. It is very sad when someone cannot afford a place like this and must go to a much more crammed and understaffed facility. I fully agree that any extra money should be placed into staffing and supplies. However, I think smaller, more home like facilities can also help the problem.

silverbat · Jul 15, 2013

I disagree.

I have worked in LTC for several years and have worked with both Alzheimer's and skilled(rehab) residents. In my opinion (FWIW), I feel that a more homelike environment helps the short timers to feel less instituationalized and they heal quicker in a more home like setting, and it is a well documented fact that Alzheimers or other dementia residents thrive better in a homelike, familiar environment.

I do agree that staffing and equipment needs to be a priority.

Making an enviroment more homelike does not have to involve large sums of money. For instance... Families could bring items from home: pictures, chairs, blankets/quilts/keepsake items that can be placed in a room. In some instances, floor rugs or wall hangings may be appropriate. No cost involved if family brings and minimal cost if facility purchases from thrift stores, garage sales, etc. Then add a fresh coat of pretty paint in the room and wow... it is more homelike for very little $$.

The big time renovations such as changing floorplans, etc., will cost a ton, and will occur at some homes. Some of these homes may have needed remodeling for years, so it will be good. And, yes, some of the renovation $$ should go to staffing/equipment as well.

I do think it is difficult at best to maintain a unit with both alzheimers/dementia residents and rehab resi., but some homes are small, and cant seperate the two out. Then staff needs to be creative in making a more homelike environment.

Culture change may also involve simply recognizing the diversity of residents/staff and celebrating that. Such as Hispanic, East Indian, German, Irish, Native American, (etc.) celebrations, foods-music-decorations that recognize each different culture, etc.

Don't give up on Culture change, encourage it, embrace it, and help it to prosper in your facility. You will enjoy it.

ktwlpn, LPN · Jul 17, 2013

Well I been trading that done magical way nursing homes are trying to go less medical and home like with communities. I truly disagree with this for a variety of reasons.
1. With all the hospital like medical facility regulations this would be nearly impossible.
2. With an industry that's going broke and struggling, how can they possibly afford to transfer to this kind of layout, and cut there resident census.
3. A Nursing home today is a Skilled Nursing and Rehab facility. Too many many residents its not a home, it's a medical resedential facility, that many residents they there 3 months of rehab and nursing and go home today.
4. There might be 10-15 residents in the whole faculty who can walk, talk, and perform total care on themselves and don't really need to be there. The other 90 plus or either vegetative tube feeders, or far along dementia residents.
In my opinion it's time we separate Assisted Living Facilities from Nursing Facilities, and save Nursing Homes aka Skilled Nursing Facilities for residents for residents who really have te medical need. And I also think the federal programs should start participating in assigned living and home care for the people with the minimal custodial need.
I'm. Not saying because sow ones a bed bound tube feeder, or lost with dementia, doesn't deserve a nice home like environment but we really have to take care of necessities first. Right now the quality of care is so poor in LTC all money needs to go towards hiring more frontline care staff to help our overwhelmed caregivers (Nurses and Aides) . I think before facilities would even think about spending 100,000 of thousands on remodeling they could have 3 Aides on a hall of 30 resided a rather than 2. Or Have 1 Nurse per ball instead of one Nurse handling two halls of 30 plus. It can only be improved by improving the quirky of the frontline l. Not by looks of the building And fancy chandeliers

There are numerous aspects of the more institutional LTC's that can be changed to be more "home-like". For instance on my locked dementia unit the meals can be served in a "home- like manner", table cloths can be laid on each table, the plates can be removed from the trays and placed in front of each resident. I have several residents who prefer to sleep late-this is respected. We admin the majority of their meds later in the day. Those are just a few things that can be done.

It does not mean that we will cut beds . I work in a 100% Medicaid certified home and the total number of Medicaid beds in the state is regulated by the feds.I'm a little hazy on how this all works but I know you can't just decide to take a bed from a room for s& g's.

We have 250 beds and are gradually opening a SNF (rehab unit) We have two rooms ready for admits right now but the rest of our folks are true LTC- they have been been there for years and will die there.

Just because someone can "walk and talk" and wash and dress themselves does not mean they can live alone successfully. We see the results of that time after time. They look good compared to some of the others but still have cognitive issues. As for case mix we are seeing very few tubefeeders -there's a big culture change and it seems that in my area people are more likely to educate themselves about their loved ones condition and are more realistic then 20 yrs ago. Back then we had 2 or 3 units of tube feeders, today we have 2 throughout the entire facility.

As far as I know assisted living and LTC are separate entities with completely different rules and regulations . Long term care is not the same as rehab or skilled care but they can all be in a nursing home . I do agree that Medicaid/medicare should also help fund assisted living. We have a waiver program in our county that provides services to help someone age in place at home but there is a waiting list.

The quality of care is not poor in every LTC but they are businesses and these companies want to turn a profit and they want to look pretty so they can attract clients who can pay there way.Staffing is not top on their list of priorities.The folks in my county run, Medicaid certified "poor house" get much better care then in any of the pretty private places in this area because we are better staffed.The department of Health inspection process seems to be much harder on us then any I ever saw at the other places I've worked and our residents get excellent care.

adventure780, BSN, MSN, RN, APN · Jul 17, 2013

families are sometimes anxious to leave their relatives with us because of the poor staffing which leads to longer response times making them think their father or mother is sitting in a dirty diaper for an hour, or not getting their needs met overall. Organization, and ways to motivate staff and residents alike will improve the situation, What I don't get is when they spend so much money on improving the layout of the units why don't they make the rooms bigger so there is room for a few people to visit with the patient? Also they need room for their things. Most importantly in the places I have worked at we need decent staff and supplies so we all can do our jobs right.