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Unless the person has lost mental and physical functions and there are no longer options, everyone is more comfortable at home, and everyone is better taken care of by family (unless one is unfortunate enough to possess family that has mental issues, is psychotic, or whose intention is to cause harm).
While my dad has been at rehab (a place that has 2 sections: one being rehab and the other a nursing home), I've had a chance to see the workings of a nursing home up close and personal. I'm now terrified of nursing "homes."
First, at nursing homes (at least this one) there's understaffing. The few nurses employed are, for all intents and purposes, administrators of patients, and not hands-on treaters for the most part. The CNAs are hands-on, and very few are hired, so they have a load of patients they cannot possibly handle.
Second, I honestly think elderly patients require more staffing than they are provided at nursing homes. They're less able-bodied than ordinary patients, so they require more help, more often. They are unable to contain their bodily functions and need more help in that regard. They're afraid and need reassurance more frequently. Their physical condition can change in the blink of an eye, so they should be watched more often.
Third, nursing homes pay NO attention to the psychological well-being of the residents. A lot of this would automatically be resolved if these places were better staffed.
Fourth (and this might sound silly to some), I witnessed two of the staff members using colloquial street language of the sort one might hear on TV when gang members are portrayed. As a result, the elderly at the place could not understand what they were saying. Wrong for the workplace to hire people that cannot communicate. Further, neither my dad nor the other person in the room could understand them. It's best to hire people who can enunciate well so they can be understood by the elderly. This might create a problem with regard to individuals who have accents from other countries, and/or speak street slang, but if nursing homes are there to serve patients, they need to serve patients in every regard, including communication.
Fifth, at the end of the day, the major problems lurking behind nursing homes are the profit motive (corporations and insurance companies), and the budget cutters of Medicare and Medicaid, both of which are actually the same creature disguised as different creatures.
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Originally Posted by 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!
I was doing some research and found a list of the honor roll of nursing homes. I'm going to look into these and find out what they're doing so well that they're ranked so high:
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.
My father was moved from the hospital to hospice, he died 2 days later. The nurse told me that the last sense to go was hearing and that I should talk to him and when I was done, give him the right to die. I did and he died less than one hour later.
I was doing some research and found a list of the honor roll of nursing homes. I'm going to look into these and find out what they're doing so well that they're ranked so high:
We have one 5-star facility, that I know of, in the Las Vegas valley. But try to get in there if your family member isn't ambulatory, is a fall risk, or has special needs! Small wonder they can maintain their 5-star status, being extremely picky about who they admit to their facility. The facility is owned by doctors.
Another possibly way to judge the quality of a LTC/Rehab facility is to watch the Want Ads for the healthcare facilities in your city. If you see job openings week after week, month after month, for the same facility, what message does that send you?
Another way of getting more care from nursing home staff is ban smartphones, cellphones in the workplace. If I owned one of these facilities and caught someone using their smartphone, if not on break or at lunch, I wouldn't even give them a 2nd chance!
Yet, you'll see both Nurses and CNA's hiding out somewhere, or in plain view, attending to their smartphones, Iphones, whatever. But this is becoming an epidemic in any workforce today and how to control it, as they're so easy to conceal.
You just brought up something that really causes problems at work: cell phones. I agree re CNAs, nurses using their own personal phones. These take away time and focus from patients. Where patients are being cared for, these should not be allowed.
Also the same for going off to sleep when they think visitors will not show up. Someone told me that in the wee hours of the morning, when visitors are not around, the personnel at some facilities just go off to sleep, and the patients can press their call lights till they turn blue in the face, and no one will respond.
That's why I stormed in one day at 2:45 a.m., at the rehab my dad has been at - to make sure to catch them off-guard and let them know I was capable of showing up at any hour, and they should not let their guard down.
(I also reported the needs of other patients to the CNAs and nurses. I also reported incidents to the administration when there were serious communication issues, or what I interpreted as disrespect, and I asked the administrator point blank a couple of times if her facility was purposefully understaffed. Of course it is, and that's the owners' problem. If the bottom line were not one of the biggest problems always, things would be lots better in every area of life. Ultimately, it's the bottom line that is so destructive).
Quote:
Originally Posted by tijlover
We have one 5-star facility, that I know of, in the Las Vegas valley. But try to get in there if your family member isn't ambulatory, is a fall risk, or has special needs! Small wonder they can maintain their 5-star status, being extremely picky about who they admit to their facility. The facility is owned by doctors.
Another possibly way to judge the quality of a LTC/Rehab facility is to watch the Want Ads for the healthcare facilities in your city. If you see job openings week after week, month after month, for the same facility, what message does that send you?
Another way of getting more care from nursing home staff is ban smartphones, cellphones in the workplace. If I owned one of these facilities and caught someone using their smartphone, if not on break or at lunch, I wouldn't even give them a 2nd chance!
Yet, you'll see both Nurses and CNA's hiding out somewhere, or in plain view, attending to their smartphones, Iphones, whatever. But this is becoming an epidemic in any workforce today and how to control it, as they're so easy to conceal.
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?
You speak the truth. I've been reading your responses and you're absolutely spot on. As a nurse, the last place I worked kept promising more staff, oh they hired more...as promised, but as fast as they hired one, they let another go. The last 1-1/2 months I was up to 29 residents. At hiring, they said I would never have more than 20. I never had less than 22. They always used the excuse that they were looking for more nurses. As it turns out, the DNS and Administrator were issued bonuses for keeping the staff down to a bare minimum.
The very people who were promising to care for people's family members, were receiving bonuses as a reward for understaffing. It's not as if people who work in these places don't LOVE and care for people, most of them do, very deeply. Unfortunately, there's NOTHING the immediate caregivers can do to give more care to some, without neglecting others! The majority of the "caregivers" I worked with in these facilities cared very deeply for the people they were taking care of. Unfortunately, as I said, if you spend too much time with a few, or if family members are monopolizing the time of the caregivers with their constant harrassment and complaints, many other people are being neglected.
If you have family members in these places and you have complaints and concerns, make an appointment with the administration. Don't monopolize the time of the caregivers, who can do absolutely nothing about it. When you "waste their time", someone else's loved ones are not getting showered, cleaned up, toileted, changed, or otherwise attended to.
As for the original question as to why people die when they're sent to these places from the hospital..... many of them are SENT there to die! There is nothing more that the hospital can do for them, so beds are freed up at the hospital, by sending them to nursing homes, so that they can die there. It's not some mystery. It's just the way it is! In fact, some insurance companies INSIST on it!
It does sound as if the basic problem were understaffing by the management and owners of these places.
Business schools throughout the nation are training their students to go out into the world and make medical decisions (and bad ones always, since their medical decisions are based on the bottom line), by providing patients with the least and lowest possible care, and they do this via understaffing.
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Originally Posted by beachmel
You speak the truth. I've been reading your responses and you're absolutely spot on. As a nurse, the last place I worked kept promising more staff, oh they hired more...as promised, but as fast as they hired one, they let another go. The last 1-1/2 months I was up to 29 residents. At hiring, they said I would never have more than 20. I never had less than 22. They always used the excuse that they were looking for more nurses. As it turns out, the DNS and Administrator were issued bonuses for keeping the staff down to a bare minimum.
The very people who were promising to care for people's family members, were receiving bonuses as a reward for understaffing. It's not as if people who work in these places don't LOVE and care for people, most of them do, very deeply. Unfortunately, there's NOTHING the immediate caregivers can do to give more care to some, without neglecting others! The majority of the "caregivers" I worked with in these facilities cared very deeply for the people they were taking care of. Unfortunately, as I said, if you spend too much time with a few, or if family members are monopolizing the time of the caregivers with their constant harrassment and complaints, many other people are being neglected.
If you have family members in these places and you have complaints and concerns, make an appointment with the administration. Don't monopolize the time of the caregivers, who can do absolutely nothing about it. When you "waste their time", someone else's loved ones are not getting showered, cleaned up, toileted, changed, or otherwise attended to.
As for the original question as to why people die when they're sent to these places from the hospital..... many of them are SENT there to die! There is nothing more that the hospital can do for them, so beds are freed up at the hospital, by sending them to nursing homes, so that they can die there. It's not some mystery. It's just the way it is! In fact, some insurance companies INSIST on it!
I've worked in hospice and end-stage dementia comfort care only, and must say I see no correlations, but people do seem to find some comfort in seeing things that way.
I've worked in hospice and end-stage dementia comfort care only, and must say I see no correlations, but people do seem to find some comfort in seeing things that way.
brightdoglover...hospice is a whole 'nother story. Hospice care is generally excellent and above excellent, which would also include end-stage dementia. It's the run-of-the-mill patients who end up in nursing homes. As many have reported, nursing homes ARE indeed incredibly understaffed. I did my CNA clinicals in one and all of us students were shocked at how understaffed the care was in this particular nursing home. When an employee is assigned double or triple the amount of patient load, it makes it impossible to "care" because if they don't finish the patient load, they probably won't have a job. The pay for the nursing assistant staff is horrid.
In this particular facility, I worked in the end-stage Alzheimer's area. These patients seemed catatonic...then I noticed how they were all being given "medication". The better to control them so they would just sit and not be able to ask for anything. True, end-stage Alz can cause patients to be difficult to work with.
This was a real eye-opener for me as someone who wanted to work in healthcare. I decided to work in "homecare" instead where I took care of patients in their own homes. Homecare is radically different than a nursing home, IMHO. It is one-on-one care where all the patient's needs are met, with a loving attitude by the caregiver. Our patients are like "family". Homecare versus nursing home care is outrageously expensive, and usually is paid directly by the patient rather than insurance, but the care patients receive as a homecare patient is outstanding.
Nursing home administration is definitely something that needs to be overhauled. There may be a few outstanding facilities, but as a rule they are a dumping ground for the elderly and disabled. Once again, no wonder many of the elderly - the ones who know exactly what happens there - go to them kicking and screaming...because they know they are going to NoMan'sLand from which they will never return.
So glad to find this forum for caregiving because we need a place for cogitating on one of this country's most pressing needs for restoration of human dignity...for the patients and the workers.
It's good to hear from people in the medical field that are confirming the suspicions that understaffing is the #1 problem of nursing homes. Of course, with Medicare paying so little, that exacerbates the problem.
I agree that home care is far superior than nursing home care even at its best. Who wants to leave home? No one. But if there's understaffing, nursing homes become even worse places to be. I think everyone pretty much knows these things about nursing homes, and they have for all of us become a horror story. We're all scared of them.
Quote:
Originally Posted by 'M'
brightdoglover...hospice is a whole 'nother story. Hospice care is generally excellent and above excellent, which would also include end-stage dementia. It's the run-of-the-mill patients who end up in nursing homes. As many have reported, nursing homes ARE indeed incredibly understaffed. I did my CNA clinicals in one and all of us students were shocked at how understaffed the care was in this particular nursing home. When an employee is assigned double or triple the amount of patient load, it makes it impossible to "care" because if they don't finish the patient load, they probably won't have a job. The pay for the nursing assistant staff is horrid.
In this particular facility, I worked in the end-stage Alzheimer's area. These patients seemed catatonic...then I noticed how they were all being given "medication". The better to control them so they would just sit and not be able to ask for anything. True, end-stage Alz can cause patients to be difficult to work with.
This was a real eye-opener for me as someone who wanted to work in healthcare. I decided to work in "homecare" instead where I took care of patients in their own homes. Homecare is radically different than a nursing home, IMHO. It is one-on-one care where all the patient's needs are met, with a loving attitude by the caregiver. Our patients are like "family". Homecare versus nursing home care is outrageously expensive, and usually is paid directly by the patient rather than insurance, but the care patients receive as a homecare patient is outstanding.
Nursing home administration is definitely something that needs to be overhauled. There may be a few outstanding facilities, but as a rule they are a dumping ground for the elderly and disabled. Once again, no wonder many of the elderly - the ones who know exactly what happens there - go to them kicking and screaming...because they know they are going to NoMan'sLand from which they will never return.
So glad to find this forum for caregiving because we need a place for cogitating on one of this country's most pressing needs for restoration of human dignity...for the patients and the workers.
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