Relative died within 24 hours of going into a Nursing Home- (Chance or on purpose)? (disabled, attention)

[birdinmigration]

Originally Posted by tijlover

Saritaschihuahua: Shortage of staff, at least you recognized it!

As an aide in one of these places, I now care for 25 patients at night, and God forbid if the 4th aide doesn't show up, and then we're looking at 33 each.

These owners of these facilities all know what's coming, and the staff as well, with increasing, expected cutbacks in Medicaid/Medicare, or the gradual elimination of funding.

5 years ago, there were 7 aides on the nightshift, now we're down to 4, next round of cutbacks? Do you really want to know? And the nurses, 7 to 4 as well!

And our mouths are sealed shut, or we'd get fired, if you even allude to any resident we're short of staff, as that creates fear in the resident.

And how are the owners preparing for these additional cutbacks? Get rid of the older higher paid workers, and they're being replaced with the lowest paid, and with that kind of pay, and reduced benefits, what would you expect!

I would love to carve out some time to sit and nurse/nurture some of these residents properly and help make their stays more pleasant. I curse every night I have to spend almost an hour every night just charting, all as a result of the litigious atmosphere of these places!

Documentation, nurses/aides alike, document everything to prevent a lawsuit!
And while being distracted with documenting, another potential lawsuit is brewing somewhere else in the building, someone else is being neglected!

Think about it! If you won the lottery, had the funds to buy one of these lawsuit-trigger-happy facilities, would you foolishly stick your $$ into one of these places?

Oh yeah, tijlover, I co-sign on this big-time.

Lest anyone thinks it's any better in for-profit health-care, think again. In for-profit, they only need to loosely follow the law, and are not subject to many of the same requirements and oversight as non-profits. I could tell some stories that would give you nightmares. Short version: it is all about the bottom line.

Our ratio of caregivers to resident is even worse than yours. Workers are costly, and the turnover is high, because nobody is paid what they are worth and they get fired right off the floor for any reason or no reason ("at will employment"). Training is summary or non-existent, and the hours are killers.

Almost every time, it's the aides/care-givers on duty that get to feel the family member's wrath -- but health-care decisions are never made on that level. The aide/nurse's job is to follow orders and keep her mouth shut. If she even alludes to issues being created by a supervisor or doctor, she will be fired, right off the floor and escorted out of the building.

Family members: the staff is overburdened, badly paid and under pressure from supervisors, family members, the State, and the sick people in beds and wheelchairs. She is trying to do her best.

(...if we try to start a union, we get fired...)

[Saritaschihuahua]

Absolutely, and you don't have to convince me. I've long since noticed that for-profit ventures are strictly that, for the profit of the owners, and little else. They don't necessarily provide better services or products, and often they provide MUCH WORSE. AND they are the enemies of unions precisely because of that, because they live ONLY to enrich the owners, and for no other reason. Private enterprise is a headless creature that exists only to enrich its owners, has no morality, has no compassion, and doesn't care a rat's *** about much else, least of all its employees.

Originally Posted by birdinmigration

Oh yeah, tijlover, I co-sign on this big-time.

Lest anyone thinks it's any better in for-profit health-care, think again. In for-profit, they only need to loosely follow the law, and are not subject to many of the same requirements and oversight as non-profits. I could tell some stories that would give you nightmares. Short version: it is all about the bottom line.

Our ratio of caregivers to resident is even worse than yours. Workers are costly, and the turnover is high, because nobody is paid what they are worth and they get fired right off the floor for any reason or no reason ("at will employment"). Training is summary or non-existent, and the hours are killers.

Almost every time, it's the aides/care-givers on duty that get to feel the family member's wrath -- but health-care decisions are never made on that level. The aide/nurse's job is to follow orders and keep her mouth shut. If she even alludes to issues being created by a supervisor or doctor, she will be fired, right off the floor and escorted out of the building.

Family members: the staff is overburdened, badly paid and under pressure from supervisors, family members, the State, and the sick people in beds and wheelchairs. She is trying to do her best.

(...if we try to start a union, we get fired...)

[Jukesgrrl]

Originally Posted by Saritaschihuahua

Absolutely, and you don't have to convince me. I've long since noticed that for-profit ventures are strictly that, for the profit of the owners, and little else. They don't necessarily provide better services or products, and often they provide MUCH WORSE. AND they are the enemies of unions precisely because of that, because they live ONLY to enrich the owners, and for no other reason. Private enterprise is a headless creature that exists only to enrich its owners, has no morality, has no compassion, and doesn't care a rat's *** about much else, least of all its employees.

And the same is true with for-profit prisons. People benefiting financially off those who are incarcerated, be it in a nursing home or a prison, is barbaric on a conceptual level. On a practical level it leads to a worse environment for the incarcerated and hideous work situations for the people who labor there.

[tijlover]

Being that 95% of the residents in the nursing home/rehab center, I work in, are funded by the government via Medicaid/Medicare, I've often thought if it would be any different if the goverment just took over these facilities, as far as care.

One of the biggest "lifesavers" a resident can have, in one of these facilities, is a copy of the Patient's Bill of Rights, which oftentimes gets ignored by bossy, do-as-I-say aides, nurses, administrators. I'm shocked, many times, when I talk to a resident about this "lifesaver" and they never received a copy of it upon admission. Nor the family members! They do have one posted on the wall near the nurse's desk, but you have to stand up to read it.

I've enlightened many a patient with the contents of this bill of rights.

Yes, a patient has a right to question any medication he's given, have the nurse explain why he/she is taking this or that. I had a patient who came in using 3 medications, and, before long, 20 medications. This patient stopped a nurse, dead in her tracks one night, demanding to know what was the purpose of each medication. Come to find out, a number of them should have been cancelled, and weren't.

Another patient fell, hit his head, was adamant he wasn't going to be sent back to the hospital. In come the bossy nurses, violating his patient's bill of rights, dictatorially saying: You A-R-E going to the hospital! But I had coached him earlier, not that he didn't already know, you have a right to refuse! He stubbornly refused, and stayed put!

Now that's one area, violation of a patient's bill of rights, that can warrant a lawsuit!

"The doctor and your family doesn't want you smoking! You can't smoke!"

Oh yeah? Violation of a patient's bill of rights! Call your attorney!

[MsAnnThrope]

My BFF is a registered nurse in an aged care home.

Basically the patients are too unwell to live at home, and are at the end of their lives.

She was dealing with a new admission - a feisty older lady who had been brought in by her daughter. Her kids obviously loved her and did this reluctantly, but could no longer care for her at home.

This lady was adamant she was NOT going to stay. It was all a big mistake. She refused to even take her coat off, or unpack her bag. My friend was trying to reason gently with her, opened her suitcase to get something comfortable out to wear. The lady said "I am NOT staying here" and slammed her suitcase shut - and fell backwards.

She hit the floor, right in front of my friend, and she was as dead as a doornail.

To make matters worse, my friend had to ring her daughter who HADN'T EVEN LEFT THE BUILDING, to tell her her mother had passed. The daughter had said "She will hate it here, I think it will kill her" and it did....no-one guessed it would only take 10 minutes!

Honestly...what a way to go.

[NCRNStudent]

I'm a third semester nursing student, and I assure you that the staff at the nursing home must have a physician's orders before doing much of anything. Sure, they can do some things without an order, but they can't administer medications or treatments without an order. As a nursing student, I can't say that I'm satisfied with the care given in most nursing homes, but I don't feel that they are, "killing" patients with unordered treatments or medications.

['M']

Having worked in both healthcare and homecare for a number of years, I've noticed that people in general do seem to have an extreme fear of going to a nursing home. This is why homecare is so wonderful because people are able to stay in their own homes and receive excellent personal care. Caregivers in these settings often become like "family" to the client/patient. They care. Some nursing homes don't cater to their clients personal or basic spiritual needs and they are left all alone every single day. Who wouldn't want to die if shut up in a place that is devoid of the close friends and family that many were accustomed to when they were younger. I read somewhere that this is why being elderly is so difficult for many...friends and family die, and you're the last one left. It gets horribly lonely for some. If their beds become soaked with urine, it may or may not get cleaned up, for example. In homecare, that would never happen. I think people see a nursing home as being put out to pasture...the last place they go on the way to dying. In fact, the expectation is that they will die there. I do not believe there are "mercy" killings due to morphone overdoses, etc. I do believe that it is just one of the side effects, if you will, from being given these meds. It is difficult to stop the cumulative effect of a respiratory depressant like morphine. So people often die because of this cumulative effect rather than "mercy" killings. So called "mercy killing" is illegal, you know.

['M']

Tijlover...kudos to you for your post. Good info to know. My reputation button hasn't worked for a while.

[Saritaschihuahua]

So true, Jukesgrrl. I see little difference between the people who have a callous attitude toward the ill and the old, and those who wish to make profits for corporations by using prisoners as free labor (or nearly free). It's all savagery. Some individuals just have a disregard for life and human beings.

Originally Posted by Jukesgrrl

And the same is true with for-profit prisons. People benefiting financially off those who are incarcerated, be it in a nursing home or a prison, is barbaric on a conceptual level. On a practical level it leads to a worse environment for the incarcerated and hideous work situations for the people who labor there.

[Briolat21]

Originally Posted by NCRNStudent

I'm a third semester nursing student, and I assure you that the staff at the nursing home must have a physician's orders before doing much of anything. Sure, they can do some things without an order, but they can't administer medications or treatments without an order. As a nursing student, I can't say that I'm satisfied with the care given in most nursing homes, but I don't feel that they are, "killing" patients with unordered treatments or medications.

I totally believe and agree with you that things in nursing homes aren't done without orders.

The problem is - in a number of homes, the doctor is nearly non-existant, and so the nurses are just left to implement outdated orders that really may not be appropriate.

In the nursing home my father was in - the doctor was there perhaps once a month. Did he do the sort of real evaluation that my father would have gotten from his own PCP? No. Was there any real attempt to get my father to specialists to take care of his severe bed sores? No. They just had a visiting wound nurse come once a week.

Which - as my father had medicare - doctors visits with specialists would have been covered. While the room and board at their facility was NOT and was private pay (after the first 100 days)

My father's sores (in a 24 hour care environment setting) remained unhealed for 1 year.

When I broke him out, I took him immediately to a wound care specialist facility (within 1 week of him getting established at my house).

They hospitalized him immediately for the bedsore on his heel -- ended up removing bone and tissue and he was in the hospital for nearly a month. Did a skin-graft, and after being sent home - the foot was healed in about another 2 months.

Sure - was that a good bit of effort? You bet.

But - once he got to the right people - it was a fairly straightforward process.

Nursing homes (in general) do not bother with the "right" doctors. Their doctor - whoever they are - takes care of everything. With the exception of dialysis which patients are usually sent out to.

When my mother had to briefly go into a nursing home (after they were already living with me) - we had her go to one that was only 5 miles from our home. She was simply there to get a little stronger before coming back home.

They did nothing with her. When I told them she had a cardiologist appointment (her cardiologist was approx. 2 miles away) - they said "oh - no -- she's a patient of Dr. Nursing Home Doctor now".

I said. "NO. She's a patient of Dr. Cardiologist, 2 miles from here - and she will be going to her appt.".

I had to "check her out" from the home for the afternoon, and get copies of the orders in triplicate and then fight to have them implemented.

And they still screwed her medicine up.

I really wish I didn't feel so badly about nursing homes. I promise you - I didn't until my parents went into them.

Also - I am pretty educated and fairly intelligent about medical issues. I think so many people put their family in a home and actually BELIEVE that the nursing home is giving the most appropriate medical care.

I know (in the case of the 3 homes we've had experience with) that is not true.

They are giving the easiest, and usually cheapest (and most profitable for them) care.

*sigh* End of rant.

I hate nursing homes.