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."
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.
Fascinating. Thank you for doing this job, and trying to do it well!