I have been wanting to write this article for a very long time! I have always wanted the general public to know what I know in regards to long term care and rehab.
A Real Nurses view; what you need to know before placing your Mom in long term care or rehab.
First of all... NO nurses talk about this for fear of our careers. I have gotten to the point where I believe the general public deserves to know. I took an oath. An oath to serve and protect patients. This oath means NOTHING in the medical field anymore.
1. Your mom is money. Period. Just like any other corporation in the world, your mom will now be a means of profit. Private insurance equals $$$$$.... The facility will indeed promise you the world. They'll even promise you the cure to Alzheimer's disease!
"Sure you're mom will have a private room, her medications on time, heat and hot water, showers, clean laundry."
Reality is; mom will be sharing a room with someone else that requires completely different needs. You're moms medications may or may not be given on time, if they even have her meds.. Depending on the staffing of nurses, patient acuity, and the pharmacy.
Moms laundry will be thrown into gigantic machines full of other patients fecal matter, but because the water is "hot" it kills germs/bacteria.
Hot water is always a concern, depending on the facilities requirements. Sometimes they're will be 12 hour periods of no hot water.
2. Most facilities do not have adequate staff!! Period! One nurse can NOT give medications to 30 patients on time! Ever!
Simple math.. But let's say all 30 patients get 7 meds a piece. 5 patients require IV medications infused at certain times. 2 have G-tubes and require a half an hour a piece to infuse meds. 20 out of the 30 require their meds to be crushed,( requires more time). 18 have swallowing problems and require their fluids to be thickened to a certain level. 7 require various forms of eye drops given in timed increments and 11 require breathing treatments in timed increments. Traditionally in an 8 hour shift, there's two medication passes. Per state law, nurses have 3 hour window to pass their meds. If it takes a total of 6 hours to pass meds, it leaves only 2 hours for everything else.
Out of 30 patients, 20 require a form of skin treatment or wound treatment. There is the other two hours.
What if your mom suddenly got sick and required instant help and hospitalization? What if mom fell and got seriously hurt? What if mom had a sudden health change? What if it wasn't just your mom, but 4 other patients on the same shift?
That leaves your nurse very backed up.
And because your nurse works for a corporation, your nurse punches out at the 8 hour mark and continues working an extra 3 hours... Because she still needs to document, which is state required and the corporation doesn't get paid! Your nurse works on an average of 10-15 unpaid hours weekly. Illegal? Yes.. But most nurses fear losing their jobs and say nothing!
3. Why do nurses fear their jobs? Because we pay a LOT of money to get an education in a field "we love". We owe lotsa money in student loans. We are moms and wives and heads of households. We are predominantly women, and as a female field we lack most benefits as most fields. No pensions, it takes us 5 years to get 3 weeks of combined sick and vacation time. Corporations barely contribute to 401ks.
We have licenses to maintain and any fault or point on our license equals no job..
Most tenured or seasoned nurses make a bit more hourly wages than new grads. Nurses are disposable. Why would a corporation pay $45/hr to a seasoned nurse with 3 weeks paid vacation time, when they can pay $28/hr to a new grad with no benefits?
Speaking of benefits.. It costs us a lot to have medical insurance..
Corporations don't care how knowledgeable their nurses are, they care about how much money they can save. Think about that the next time you want to drop mom off at a facility.
We don't get raises. The economy sucks and the cost of living goes up, but my paycheck gets less and less yearly. My pay raise is really dependent on Medicare and the state and the cut the corporation takes. In the last 5 years, I received 30 cents!!! 30 cent raise people!!!!! Yet, my paycheck has almost $200.00 more a week less than 5 years ago.. Thank you taxes!
4. Most of upper management will watch their staff drown as they count their stars.
5. Facility rating is a star system, stars are a mathematical equation given to them by state inspectors and Medicare. The ONLy thing they care about is the Stars and state surveys. The higher the star rating, the better.. And they will kill their staff around the clock to obtain them.
Here's a secret; the stars don't mean shit with the facility. You can have mom in the shittiest 5 star facility around! Those 5 stars just means the staff is more worked and haggard, around the clock. For free!
I'd rather put mom in a 2 star facility with less haggard staff, then a 5 star with staff that's worked to death!!
6. Rn's and LPN's do the same thing in a facility.The only difference is that a RN is more "points" towards the facilities ratings . I have worked side by side with some of the best LPN's and some of the worse RN's.. When you see a facility full of RN's.. There's usually a problem.. It screams "new grads"!!!
7. Most DNS or Director of nurses haven't worked as an actual nurse in years!! Most lack basic physiologic knowledge. They'll talk a big game and promise you the world...
HINT:: if you tour a facility and meet the DNS and she's wearing scrubs and her hair is a mess and her nails aren't done, her hands dry and raw and she's wearing sneakers..... Put mom there!! It means she's a real nurse and knows her building inside and out!
8. Awards on a wall are almost always paid for.. Because they look pretty.
9. Some facilities hide shit, like falls and injuries. Infections, infestations and contamination.They fudge state documents and pressure staff to do the same.
9. Things to look for in a facility;
Does it smell?
Do they have an actual certified infection control and wound nurse?
Stop in on a 7-3 shift and then again at 8pm.. Do you still see the same nurses?
Do that twice in one week. If you continuously see the same faces at different times, their staffing sucks...
See what the patient nurse ratio is, anything more than 20... Mom isn't getting anything on time..
Look at the night shift ratio, typically the night shift has no staff at all..
Tour the laundry department..does it smell like fecal matter?
Observe how many lights are on and how often they are answered. Look at the expressions on the CNA and nurses faces. Ask about staff longevity and what the average employment is there.
How acute are the patients? Remember the more acute the more time they require. This includes feeding them too! How many beds are in a room?