Step Four:
Determined goals to work on
1. make lunch time dining restaurant style
2. provide bathing time based on the residents choice
3. minimal over head paging
4. reduce over time
5. increase staff retention
6. STNA's to attend care conferences
7. provide medications and treatments based on resident choice
8. set up an activity closet where residents can go and get items to read, work on or games to play by themselves
Restaurant style dining
We started this the first Monday in February. The following are some of the thins that were put into place
a. list of restaurants to sit in each dining room
b. named the dining rooms and placed signs over doors
c. developed menu's to be filled out daily with options for food choices
d. developed policy and procedure for staff to follow
e. got input from staff, residents and responsible parties
d. linen table cloths and napkins
e. drinks served when given menu
f. new dishes obtained
g. dining rooms organized, cleaned and new paper, paint ect.
Wednesday, February 15, 2012
Thursday, January 26, 2012
Person Centered Care
We are beginning the journey to impliment person centered care in our facility. I plan to document our progress. This project is anticipated to take 6 months to complete. There are several reasons for doing this in long term care:
1. improve resident and responsible party satisfaction
2. improve satff satisfaction and retention
3. improve the facilities bottom line through a better Medicaid rate
The definition of person centered care is basically providing care and services to a nursing home resident in a maner that takes into consideration their values and choices.
Nursing homes currently practice a medical model that is based on routines and treatments and a plan develoiped by the facility for what is best for the resident.
As well as the Person Centered Care the Centers for Medicare and Medicaid have expanded the quality program to include 20 areas that are for the most part the same as the Person Cenetered care goals. Facilities Medicaid rate will be increased by over $16.00 for achieving 5 of these goals.
The Area Agency on Aging has chosen 10 facilities in Sounthern Ohio to be a part of their Person Centered Care program. They are providing education and assigning an ombudsman to the facility for support.
Step One:
Some of the members of our team leadrs went to a Person Centered care Meeting at the Portsmouth Area Agency on Aging office and recieved the beginning education and were assigned our Ombudsman leader. We were given the assignment to choose 2 goals and read a book they passed out on Person Centered Care.
Step Two:
The entire team was educated on what Person Centered Care is and given the list of goals and asked to choose the top 5 they would like to impliment.We decided to call the department managers the team leaders and to have captains from each department to be a part of the development team for Person Centered Care.
Step Three:
Reviewed the definition and goals of Person Centered Care with all staff and asked them to choose the top 5 areas theywould like to work on. Team captains were choosen as well. We chose one person from each department and additional nursing staff from each shift.
1. improve resident and responsible party satisfaction
2. improve satff satisfaction and retention
3. improve the facilities bottom line through a better Medicaid rate
The definition of person centered care is basically providing care and services to a nursing home resident in a maner that takes into consideration their values and choices.
Nursing homes currently practice a medical model that is based on routines and treatments and a plan develoiped by the facility for what is best for the resident.
As well as the Person Centered Care the Centers for Medicare and Medicaid have expanded the quality program to include 20 areas that are for the most part the same as the Person Cenetered care goals. Facilities Medicaid rate will be increased by over $16.00 for achieving 5 of these goals.
The Area Agency on Aging has chosen 10 facilities in Sounthern Ohio to be a part of their Person Centered Care program. They are providing education and assigning an ombudsman to the facility for support.
Step One:
Some of the members of our team leadrs went to a Person Centered care Meeting at the Portsmouth Area Agency on Aging office and recieved the beginning education and were assigned our Ombudsman leader. We were given the assignment to choose 2 goals and read a book they passed out on Person Centered Care.
Step Two:
The entire team was educated on what Person Centered Care is and given the list of goals and asked to choose the top 5 they would like to impliment.We decided to call the department managers the team leaders and to have captains from each department to be a part of the development team for Person Centered Care.
Step Three:
Reviewed the definition and goals of Person Centered Care with all staff and asked them to choose the top 5 areas theywould like to work on. Team captains were choosen as well. We chose one person from each department and additional nursing staff from each shift.
Sunday, May 30, 2010
A Day In The Life of a Nursing Assistant
A typical day started out by getting up at 8AM and planting some flowers in my yard and then cleaning the carpet in my living room and dinind room. Took a shower and went through the drive through for a sandwich on the way to work at 12:30PM because I hadn't eaten all day. I get to work and the off going shift tells me that it has been a pretty good day no big problems. The first thing I do is pass 2PM snacks. No one seems to want what I have so I go back and get everyone chocolate icecream. I only have 12 residents on my side and I am working with a nurse. During snacks one of my residents is yelling and confused and wants to go home. Nothing I do changes her mind so I place her in a wheelchair and put her in the lobby where I can see her and give her the news paper. Another resident is yelling nurse take me to the toilet. I do this and then pass my ice water. I take 3 pitchers out of a residents room and give her fresh ice water in a clean pitcher and she follos me around telling me someone took her glasses. No showers tonight so I go around emptying the trash and wiping off stands. The lady that was upset earlier is brought to me by the nurse and I am told she needs changed but she won't let the nurse take her. I take her to the bath room and she tells me she doesn't need to go she can do it her self. I assist her to the toilet where she does go to the toilet and I wash her and take her to her loung chair. In the mean time a resident is yelling nurse again and he wants fed. ( He is unable to eat he has a tube. The nurse feeds him and I take him to the couch and play ball with him. I then pass supper trays. After super I pick up trays and again the lady that was confused is scooting off her chair. One of the nurses volunters to sit with her outside. I also take out a couple of other residents. I then check the bathrooms and mop 2 of them because the floors are dirty. It is now 6:30PM and I am relieved by another NA because this is my day off. I am also the director of nursing and administrator and in between all the above met with a family about possible placement, did a residents treatment and fed a resident their tube feed before I went home. I only added this part because I want to point out that as I have said in earlier posts nursing homes do not work short. They make sure that all the care is provided and more regardless of what a persons title is. True team work can only happen if everyone in a facility is willing to help when needed. I am proud to work in a nursing home and I am very proud of the people I work with.
Monday, May 24, 2010
Attendance
I do not understand why people cannot just come to work when they are scheduled. Today I already had 1 hole in the schedule for a nursing assistant and I had 3 additional call offs,1 nurse and 2 other NA's.That is 28% of the daily nursing staff.I do understand that people and their families get sick and I don't expect people to work when they are. What I do expect is communicating that you will need to be off so that schedules can be covered and for staff to schedule appointments when they are scheduled off. I had one person call and tell me they couldn't come because their car was being worked on. I told that person to try and find a ride and to call me if they could not come in. Of course they did not come in or call and will propably try to say they thought they were to call if they could come in. Well what ever. I tried to call that person 4 times and left 2 messages on their cell phone. Don't tell me they didn't get the message. Another problem is not having correct phone numbers or answering calls or not returning calls. I don't know what the answer is I just know I am tired and frustrated with all the stress that this causes.
If people would only follow the rules set up there would be no staffing issues
1. put in requests timely
2. schedule appointments when off unless it is an emergency
3. call in in advance at least 2 hours
4. call back when called to let someone know that you can or can't work
5. don't tell your employer maybe you can work say yes or know
6. if you need time off ask someone to trade
I feel that these few rules for working will make the work place better for everyone.
If people would only follow the rules set up there would be no staffing issues
1. put in requests timely
2. schedule appointments when off unless it is an emergency
3. call in in advance at least 2 hours
4. call back when called to let someone know that you can or can't work
5. don't tell your employer maybe you can work say yes or know
6. if you need time off ask someone to trade
I feel that these few rules for working will make the work place better for everyone.
Thursday, May 20, 2010
Information Available to the Public
There are several ways to learn about a nursing home.
1. call numbers in the phone book
2. ask a friend
3. ask your doctor
4. ask your pastor
5. look on the internet
The problem is that there are 2 sides to every story. All of those ways will give you information. The information will probably be accurate. The only thing is that the information is not always complete. The reason I am saying this is mostly due to what you can find on the internet. You can look up several pieces of information about a nursing home including
1. state survey results
2. 5 star rating
3. resident satisfaction surveys
I would like for you to make sure that you get all of the information. First of all if you do not understand how a survey deficiency is rated you can be misled. A facility can have a lot of deficiencies but still be a good facility.What people don't understand is the scope (number of people effected) and severity (if there is actual harm) of the results. What they should look at is if the letter by the deficiency is a G or higher. This means that there was actual harm. A letter A,B or C doesen't even require a follow up visit. A D or E means that more residents coud have been effected but there was no harm. If you look up a survey call the facility and ask them about it. Better yet visit the facility and ask to read the survey. It is public information.
Second the state has set up a 5 star system to rate nursing homes. The areas that are looked at are as follows:
1. survey results
2. staffing
3. quality indicators
The survey results are misleading as stated above. A good facility may have 15 deficiencies while a poor facility could have much less. Staffing is based on the state and federal requirements and the QI's. The quality indicators are determined by an assessment completed by the facility and sent into the state. These scores are being looked at and hopefully will be improved upon.
Third there are the resident satisfaction surveys that are completed annually. These are conducted by people not associated with any facility which is very good. The only problem is that they are scored on by an average. Therfore a small facility with a 2 or 3 unhappy residents can score very low. They also interview all residents regardless of ability to comprehend. A facility that has a lot of behavior and or dementia patients can have a very low resident satisfaction score even though the families are very happy and satisfied.
Please be sure that before you make a decision to choose a facility you look at everything. Talk to the staff, take a tour on the weekend or in the evening to see how things are going. Check for odors and poorly kept residents as indicators of a poor facility not just new carpet and furniture.
1. call numbers in the phone book
2. ask a friend
3. ask your doctor
4. ask your pastor
5. look on the internet
The problem is that there are 2 sides to every story. All of those ways will give you information. The information will probably be accurate. The only thing is that the information is not always complete. The reason I am saying this is mostly due to what you can find on the internet. You can look up several pieces of information about a nursing home including
1. state survey results
2. 5 star rating
3. resident satisfaction surveys
I would like for you to make sure that you get all of the information. First of all if you do not understand how a survey deficiency is rated you can be misled. A facility can have a lot of deficiencies but still be a good facility.What people don't understand is the scope (number of people effected) and severity (if there is actual harm) of the results. What they should look at is if the letter by the deficiency is a G or higher. This means that there was actual harm. A letter A,B or C doesen't even require a follow up visit. A D or E means that more residents coud have been effected but there was no harm. If you look up a survey call the facility and ask them about it. Better yet visit the facility and ask to read the survey. It is public information.
Second the state has set up a 5 star system to rate nursing homes. The areas that are looked at are as follows:
1. survey results
2. staffing
3. quality indicators
The survey results are misleading as stated above. A good facility may have 15 deficiencies while a poor facility could have much less. Staffing is based on the state and federal requirements and the QI's. The quality indicators are determined by an assessment completed by the facility and sent into the state. These scores are being looked at and hopefully will be improved upon.
Third there are the resident satisfaction surveys that are completed annually. These are conducted by people not associated with any facility which is very good. The only problem is that they are scored on by an average. Therfore a small facility with a 2 or 3 unhappy residents can score very low. They also interview all residents regardless of ability to comprehend. A facility that has a lot of behavior and or dementia patients can have a very low resident satisfaction score even though the families are very happy and satisfied.
Please be sure that before you make a decision to choose a facility you look at everything. Talk to the staff, take a tour on the weekend or in the evening to see how things are going. Check for odors and poorly kept residents as indicators of a poor facility not just new carpet and furniture.
The staffing saga continues
OK, I met with another hiring stumbling block today. I was unable to verify a nurses license on line. The medical records person called the board for me and they told her that the nurse did have a valid license and it was not on the web site. Fortunately I am inquisitive so I called the board back. I told them that I needed something from them to show that she was indeed not on the web site but had a valid license. I was asked where this person had told me she worked last and why. I told them and they told me that she had had an additional job since then and I might want to ask why the license was not on the web site. They were unable to give me any additional information and asked me to fax a copy of the application that was filled out. I called the other facility and fortunately was told that this person was let go do to an investigation into missing medications. Of cource I am not hiring that person but if I had not been dilligent I could have hired this person and been put in a bad situation. I don't know the answer but health care facilities need to be honest with each other and not pass around unacceptable health care providers.
Wednesday, May 19, 2010
Hiring
Well this week has been interesting. I need 1 FT nursing assistant and 1 PT licensed practical nurse. I have interviewed 3 people this week. 1 positive thing is that they showed up for the interview on time and dressed appropriately.Once again trying to get references has been like pulling teeth. 2 said they didn't keep their records on site, 1 said they worked there but that was all. After this I hired 1 person that could not pass the physical and was sent to their own physician who still did not pass them. I did manage to get 1 hired with promise, but once again no information except they did work there. I have my fingers crossed that this will work out. Another one's license is not on the board of nursing web site and she told us she knew this and just to call the board????? Ok maybe next week will be better. My staff is tired of working overtime. I'm tired of interviewing and the residents desirve better. It is time that health care managers start being truthful with each other and stop these people from getting jobs they won't keep and or can't do.
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