National Nursing Home Week

National Nursing Home Week is celebrated every year by nursing homes across the US. It is a week to celebrate the residents in nursing homes. Over the past 23 years I have worked with nursing homes in a variety of positions.I would like to share some of the things that I have seen done and recognize the staff that pulls off these events. None of these events could happen without the hard work and dedication of the facility staff. Staff donate their time and talents to make these things happen.The following is a list of events: Balloon lift off Pic nics Bean dinners Ice cream socials Cash Cab Jeopardy Talent shows Carnivals Brunch Tea party Dog Show Car show Pet visits Sock hops Senior proms Music of all types Crazy hat contest Wheel chair races Wheel chair decorating Baby contest Cake walk Casino night Pie eating contest

Staffing The On Going Problem

It amazes me how badly people want a job yet once they have it do not seem to want to work. I use a standard interview form when I interview people. I always tell them the same things and ask the same questions. The 1 thing I make sure I tell them is that I expect them to give their employer notice if currently working and to give me 2 weeks notice when leaving. Of course every single one says that they will. I have had 41 people in just over 3 years quit without notice. These are not just nursing assistants but nurses as well.I have tried to call most of them to ask why and they will not even return phone calls. This really makes a huge impact on a facility. 1. confuses the residents, usually they have just got to know them when they are no longer there 2. leaves there co workers to pick up the hours they left opened There are many reasons people leave a job and I will be the first to congradulate them if they are bettering themselves but even then they should show enough professionalism to give a notice. I personally feel that licensed and certified nursing staff that fail to give notice should be reported to the board of nursing and nurse aide regisrty.

Person Centered Care Update

Person centered care has made a positive impact on the faciltiy I work at. The following are some examples: 1. Residents that ate alone in their room are now coming out to the dinning room at lunch time to eat 2. One resident that was having pain at meal time is now being layed down even if it is meal time and meal is served later when she is feeling betted and she is eating better and we have actually discontinued one of her narcotics and her pain has not increased. Before person centered care we were encouraging her to stay up untill after the meal and she just didn't eat well.We were more focused on the meal than the resident. 3. Residents that were refusing showers are now taking them because they don't have to worry about it being done on a day or time they don't prefer 4. The biggest impact is the reduction in falls. I did not expect this and I am not sure why it has happened but the number of falls has actually improved. Over the last 2 years our goal has been to have 5 or fewer falls per month. We have not met that goal until the first quarter this year. Last year there was a total of 7.6 falls per month on average and the first quarter this year we had 5 each month for April we only had 1 fall. I will need to do some further study to try and determine why but the one thing that stands out is that we started Person Centered Care on January 1 this year.

Person Centered Care Part 2

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.

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.

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.

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.