Posted on 02/17/2004 5:53:39 AM PST by mrustow
In that sense then, it would hardly be "poetic justice," rather an injustice as well as a monumental setback as we returned to a system infinitely better off left dead.
Seems we're doomed to repeat history, yet again.
...& too stupid to realize it.
Things don't look too good, Mr. L. If nursing home owners can't turn a profit, they'll get out of the business. And it looks like the constant litigation will make the business unprofitable.
Could you be more specific? I'm all ears. And what do we do about runaway litigation?
Well there're states where some of the nation's largest LTC Corporations have alread sold their operations because of the bloodsuckers.
FL is but one, CA isn't that far from finding themselves without LTC facilities, too.
If AhhhnOOOed thinks he "crisis" now, he ain't seen nothing yet should the LTC corps leave CA because of over regulation & a pay plan for Medicare patients -- & that's just about everyone now days -- that's already below the break-even point it costs to house these people.
...such as is the case right now.
You might very well be correct, at least partially, explaining the horrific conditions in state hospitals -- across the country -- were found guilty of.
Modern meds aside, there's human nature component to care too, eh?
The possibility of a psycho state employee who actually likes the idea of helpless people & all that that implies?
Those cases were all too common in the past, y'know.
And *who* was going to inspect a state run facility for compliance?
Another state bureacratic agency?
In any event, if [we] continue on as we are we're all going to find out who's right & who's wrong; because, the corps in LTC will simplt get out of the business & you know what that means, right?
We're right back to state run/managed institutions, again.
Because one thing's for certain, the children of our elderly who're willing to take care of their parents are indeed God Blessed in all ways; but, are also in such a minority as to almost not merit mention.
As a boomer a lot closer to my time in a LTC facility now than ever before, a state hellhole's a prospect I don't look forward to & neither should you.
...no sane person w/should.
It's unrealistic for the company to find enough RN's just to medicate a hundred patients 3 to 5 times a day so they gave us all a two-week class. Every time there was a new med to be given, a RN would be present to watch us give it for the first time to make sure we had it straight. Actually, it was almost overkill, but I could see why they had such strict guidelines. If there were any problems, we called the on-call RN, who would come over to handle the situation. We handled everything from adults with birth defects, severe brain damage to old age. Both agencys I'm familiar with are privately owned and state funded. It's my understanding that most places have similar systems. (We couldn't give injections, IV's or tube feedings. Just oral and topical.)
I have to respond to this thread because I am a Certified Nursing Aid and work at a local nursing home. I work 40 hours a week from 3:00pm to 11:30pm. I have 13 female residents on my assignment.
Let me tell you about my typical day.
At 3:00 myself and 2 other aids (1 of them also has 13 residents, the other has 14) get report, which can take anywhere from 15 minutes to a half hour. We'll use 15 minutes. Then I get to work.
(The names I use are fictitious.) Here's how my assignment is laid out. I take care of 3 rooms with 4 residents each in them. The other resident is also in a room with 3 other residents that are taken care of by aid Mary. Of course, if Mary isn't around and I walk in to take care of my resident, the other three are making requests of me to do something for them.
The average restorative care I am supposed to perform on each resident lasts about 30 minutes. That's 3 hours and 10 minutes. Before dinner I also have first rounds I am supposed to complete, taking continent residents to the bathroom, and changing the diapers on the incontinent ones. That takes about 10-15 minutes each due to their slowness and use of lifters to put the resident in bed, change them and use the lifter again to get them out. 13 residents times 10 minutes equals 2 hours. Then comes the dinner hour which lasts an hour and a half.
After dinner, put residents to bed. The average PM care is 15 minutes. 15 minutes times 13 equals 3 hours and 35 minutes.
After everyone is in bed, I do third rounds which takes about 30 minutes. Then I have my books (Activities of Daily Living charts) to do which takes about a half hour.
How much time have I spent on my assignment this day? About 11 hours.
Think this nursing home wants me to clock in 3 hours every day in overtime. No way!!!! And what I have described is a day without any problems.
The author brought out the restrictions on restraints. No one wants to go back to the dark days of binding people in their beds all day, but reason has flown out the window. The residents we call fall risks are protected by a little alarm box with a string that attaches to their clothes. If that resident pulls or stands up and walks away, the string pulls out of the alarm and the alarm rings loudly so all can hear it. First of all, if the alarm sounds, it's conceivable that that resident has already fallen, by the time we get there. Brittle bones, broken bones. Then the alarm is so piercingly loud when you are next to it that it hurts your ears and panics the other residents in the room. This is all in the name of dignity for the resident.
Another wonderful state regulation is that residents should no longer be sequestered because of their diagnosis. So Alzheimer's and dementia patients are roomed with helpless but mentally alert stroke and crippled arthritis residents. I wish I had a nickel for every time I've had to answer bells because an Alzheimer's resident (and many of them can walk just fine without assistance) has wandered into another room and started taking things and getting into the resident's belongings.
Some residents with dementia yell and cry and make alot of noise especially at night because they don't sleep peacefully through the night. I guess we could load the noisy ones up with sleeping pills but there are severe restrictions on medicating people to keep the peace. This is dignity for the other residents? To me it's torture. If homes could provide wards for these residents, they could still have room to wander but stay safe.
As far as keeping our eyes on the residents who may wander up to the roof, well if I'm in one room taking care of a resident (with the other 4 demanding some attention for this or that), how can I keep my eye on Betty who wanders all over the place. And family members who visit can be unreasonable also. I've experienced times when I'm taking care of a resident and some family member will let me know Mother needs something. I'll tell them that as soon as I'm done with Mrs. Smith I'll be right over. I get mean glares from the family member. Sometimes I'll be in the middle of a complete bed change because Mrs. Smith who has dementia tends to play with her bowel movements and gets it all over her hands, the bed linens, the curtains,the bed, her face, the floor, whatever she can touch. That's a good half hour of work there, I can tell you. Then when concerned family member comes back again to remind me sternly that Mother needs more water in her water pitcher, it takes all of my patience not to tell family member to go to hell.
To get back to my point, my unit has 40 residents and 3 aids. We are on our feet the full 8 hours of work. We take shortcuts. We have to. Restorative goes first - i.e., I lifted residents arms to take clothes off - I completed restorative on my resident.
Change and potty 13 residents before dinner? I get my 6 residents pottied; I don't have time to change wet diapers on the rest as you need to use lifters on most of them and can't use a lifter without a spotter and if I take the time to find another aid who is in the middle of her work and is trying to accomplish so much in 8 hours also and then wait till she is done with her work to come over to my area - well you get the point.
I haven't even begun to address taking care of combative residents. I've had my hair pulled, my face slapped, one resident whipped her call bell wire across my face, kicked, punched at, spit at, had them sink their nails into my skin as they grab me with a death grip. After dinner all of the residents want to go to bed at once and are quite rude when you explain that you will get to them as soon as you can.
By the end of my shift I am drained, physically and emotionally. And throughout the work day, I have to constantly keep in mind that when I explain to a resident that I will get to them as soon as I can and they keep nagging me and after a few rounds of that, I ignore their pleadings, that someone won't overhear that and consider that abuse.
Why am I working in job like this. I'm taking classes to be a nurse and when I decided this course of action, I believed that working in a health care setting would supplement my education.
Also my father is at the nursing home I work at. Despite all the daily struggles, I still have the desire to provide the care to these residents that I want my father to have.
Yes, there are direct health care workers who don't have a nice bone in their body and that is most definitely uncalled for abuse. But in 9 cases out of 10, when abuse is charged, it's because of the unrealistic expectations put upon a group of workers who are trying to provide good, quality care for the elderly and have the rug pulled out from under their feet because of outdated minimum staffing levels, insane state regulations, family members who think the aids are private nurses for their relatives and the higher ups who actually are doing the most abuse by trying to keep their profits high and shortchanging the residents with low quality food, bandaid maintenance and low staffing levels.
And next time there is a story in the papers about nursing home abuse, remember that there is a "rest of the story."
Exactly. My friend's father drove his Mercedes through the plate glass front window of their ranch house while in early Alzheimers. He became so agitated when they removed the car from the premises that they brought it back & put it in the driveway (without a few critical inner workings.)
They had money for round-the-clock aides (3 shifts.) Not everyone is so lucky.
God preserve me from having to experience it but from what I hear, it can be a terrible time for the family *and* the afflicted person.
As I mentioned above, my friend's father had sufficient wealth to provide for three shifts of aides (round the clock.) Lest anyone think that my friend "did nothing," it wasn't the case - for starters, supervising three people when you live 45 minutes away and have young children of your own is "something" in and of itself. Further, she had to manage all his financial affairs, take care of the home he was living in, etc. It was a monumental task, but the entire family was committed to keeping him out of a nursing home.
Given his condition, I don't see how he could have been cared for in any of the grown childrens' homes.
What people don't realize, as well, is that in the "good old days" of at-home care, when people became very frail and very demented, they simply stopped eating and *died.* We don't consider that an "acceptable" outcome anymore - we initiate RTC care, tube feeding, etc. All this care comes with a price.
She's certainly not getting any monetary support from the drug addict and has to work full-time so she will have health care benefits.
I have no one but myself to rely on so I have to work full-time.
Oh, get an aid to care for him at home while I'm at work? Get real. What do I do if he's abused? Or I get robbed? How often can I call in to work to say I can't come in or will be in late because my dad's aid called off sick and the agency is still trying to find someone to replace her and I still get to keep my job? And Dad can't get aid for home care from the state because with his social security and 2 retirement checks a month, he makes $200.00 more than the top tier for assistance. In other words no financial help to pay for an aid to watch him 40 hours + a week. (40 times $10-20 an hour - do the math.)
We don't have the money to remodel the house (widen doors, completely enlarge and redo the bedroom, add ramps outside) for a handicapped adult who is wheelchair bound.
For those who are able to care for their loved ones at home and have gazillion resources so that the caregiver doesn't die an early death from insanity and stress, god bless you. For the rest of us who are strapped with the stresses of just trying to get through life, to lay a guilt trip on us for sticking Mom and Pop in a nursing home, is unkind.
All he has left is the house that I'm living in but I've got to sell it sooner or later because I can't keep up with the taxes. Once I sell it, the nursing home gets all the proceeds. If he dies and there are still proceeds left over, the nursing home gets half and me and my sister get the other half.
For those of you clueless so far about the financial aspects of nursing homes, the resident has to use up all their assets before medical assistance can kick in. I'm talking all investments, iRA's, even have to liquidate their life insurance policies. Mom and Pop are allowed to keep $2400.00 for funeral expense. I don't think you can buy a pine box for $2400.00 any more.
And when it's time to apply for medical assistance, get ready to go through and provide financial records for the past 3 years. I mean every sheet of paper with a dollar sign on it.
Have fun!
Most people are on the public dole, I'm afraid to have to say.
In the "old days," having the taxpayer flip for anything used to be called, "Welfare."
But not anymore, not in this day & age of thinkspeak.
"My dad's monthly rent at the nursing home is $4800.00 a month. Ate up his savings many, many moons ago."
I'm sure it did; but, this also tells me a whole bunch about what kind of a man your father is, too.
He's an honest man, one who lived his entire life by working hard while never taking a handout.
~eh?
Without becoming enmeshed in a debate beyond the scope of what this article tries to point out, let me say given how your father lived his life, and, according to your own words?
You must be one hellova fine, decent, and honest person, yourself.
One of the few truths in life says, "The apple doesn't fall far from the tree."
Also, one other thing.
It may be just semantics butttt, your father wasn't paying, "rent."
What he was paying for was a clean heated room with staffed 24&7 nursing care, 3 squares a day, clean bedding, clothes & other assorted accessories and of course meals & medical treatment, PRn.
Moreover, I can assure you whatever state you live made damned sure he recieved what he was paying for -- via -- periodic suprise inspections from the Health Dept and at least one thorough survey per year from the Feds on every aspect of the business ranging from soup to nuts.
The surveyors leave no stone unturned.
Expensive?
You bet it is, make no mistake about it.
So what you're saying doesn't fall on deaf ears, you can bank on that.
"All he has left is the house that I'm living in but I've got to sell it sooner or later because I can't keep up with the taxes. Once I sell it, the nursing home gets all the proceeds. If he dies and there are still proceeds left over, the nursing home gets half and me and my sister get the other half."
So how do you feel about those elderly who cleverly divested themselves of all their assets & then, throw themselves at the public's [read: you & I] mercy while the kids enjoy the finest in housing, food & transportation -- in accordance to their "windfall" & YUPI lifestyle -- when there were honest men like your good father who played "the game" according to the rules & paid his fair share?
Feel screwed?
I sure do.
"For those of you clueless so far about the financial aspects of nursing homes, the resident has to use up all their assets before medical assistance can kick in. I'm talking all investments, iRA's, even have to liquidate their life insurance policies. Mom and Pop are allowed to keep $2400.00 for funeral expense. I don't think you can buy a pine box for $2400.00 any more.
And when it's time to apply for medical assistance, get ready to go through and provide financial records for the past 3 years. I mean every sheet of paper with a dollar sign on it."
Yup.
And that "Past 3 year rule" is a relatively new law, too.
The Feds want their money, first, then, they disperse said money according to what they say they're going to pay, & not a dime more.
Now whether the nursing home loses money or not, the government couldn't care less as their position is, "That's your problem."
Some "business," huh.
Having said that, may I ask you who you believe wrote everey word of the existing rules?
Fact is, the nursing home your father's in -- & just about every other elderly patient -- is probably running in the red; UNLESS, they've a preponderance of "Private Pay" residents.
PP's are a scenario which is becoming more & more rare with every passing day too, I might add.
"Have fun!"
...that's life, I'm afraid.
And usually the nursing homes have their own doctors that come in to check the residents. These doctors never, ever voluntarily consult with family members - you have to do the legwork to find out why and what medicine and care Mom is getting.
True and a World War II vet to boot.
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