May 24, 2006

Adam and Eve - Part 3

As I said in earlier posts, I've been impressed to do this series of articles. I have no idea why, but the angel on my shoulder won't let me sleep until I've done this. Some events have been modified to protect identies. These stories are in no way a reflection on my present or past employment

Adam and Eve – Part 3
"The Adam and Eve Care Center"

There are many questions one should ask when anticipating nursing home placement. Just as importantly, the nursing home should be asking YOU some questions. If not, one should start to wonder if this is an appropriate placement for your loved one.

For many years I’ve wished I could whisper the honest responses to those who place their loved one in my care. Instead, I’m bound to uphold the policies and procedures of my employment. I am not in charge and I do not make the rules. If so, there are many things I would do and say differently.

I’d love to take all the experiences from my 30+ years of caring for the elderly and make one red-hot care center that people would flock to. Both staff and patients! But, instead I will create a make-believe place on this blog where perhaps some information will help you understand the concept of long term care and what it’s like to live the last days on earth in a no-name facility called a “Nursing Home.”

Lets call my care facility “The Adam and Eve Care Center”.

Let me introduce you to my staff. I have hired each employee. Each one has passed a background check, had at least two interviews in my office and one meal with me in a public place. My employees need to represent my personal standards so they must know what those are. I expect my staff to be good PR representatives, so I should know they understand that aspect of the job.

The Administrator: Each nursing home is required to have one but in Ohio, it does not have to be a full-time position. I hold this position in my Adam and Eve Center, but I also work as a nurse on every shift to keep my ear to the ground and in tune every resident and each employee.

The Administrator (ADM) holds the key to all aspects of the facility. Most leave the day-to-day running of the facility with the director of nursing. But, just so you know, the administrator can call the shots and can always make the final decision. The ADM can’t answer call lights unless they have medical training, but they can knock and enter a patient’s room to inquire how things are going.

I always watch the interaction between the Director of Nursing (DON) and ADM where ever I'm employeed. Sometimes the DON works closely with the ADM and other times, there’s conflict and distrust of each other. You should know who each person is and which one is the decision maker. When things go badly, you need to know who to turn to.

The Director of Nursing is always a RN. (This is why I have studied to become a RN and hope to someday be one.) Don’t expect a lot of “hands-on” from the DON because her desk is always piled high with paperwork, her voice mailbox is always full and her schedule is unpredictable. At best, she has a hard working and loyal Assistant Director of Nursing whom she can delegate day-to-day matters to.

The Staff Nurse is the nurse you see most often. He or she can be a LPN or RN. In this position, it doesn’t matter. They do the same thing unless the LPN is not IV Certified. Then the RN must do the IV meds.

Count on the staff nurse to have a regular med-pass every few hours and to be the supervisor of the unit. She is the heart of the unit and can make or break a good name. She is also the one most dumped on by the ADM, DON, ADON, the doctors and the nurse aides. He/she has to pass all the meds (on time), give pain meds (immediately), do the treatments, answer the phone, chart on the patients, take orders from the doctor, answer call lights, cater to family members and keep the aides running smoothly. Her patient ratio is anywhere from 20-40 patients.

My pet peeve is the perception that if the nurse is a male, he is god-like. It’s usually just the opposite, but I have never been able to figure out why it happens or how to change it. A
fter following a male nurse, I’m usualy stuck with accepting comments like, “George gave me a Tylenol PM” (when none was ordered) or, “Andy put a new catheter in” (when there was no order to do so), or, “Greg gave my meds right on time.” Oh well. Neither of us are doctors.

The Nurse Aides: My first question would be, “Are they state certified or not?” Each nursing home chooses what to hire, but they are all called the same regardless of the training. If they are not certified, they will not know how to give a good bed bath and they will have no CPR or First Aide training. They won’t know how to take blood pressures and have no training on how to properly transfer patients to and from bed.

So, it’s 4 a.m. and the aides go in teams of two to make rounds. They have five patients each, but work as a team. Turning on small bedside lamps, they have piles of clean laundry for each room and they supply each bathroom with fresh soft towels and fluffy washcloths. There’s warm soapy water and a soothing “good-morning” for each sleepy resident. Faces are gently wiped clean, dentures are slipped in and sweet skin lotions permeate the air. Soiled depends and messy diapers are placed in a small laundry basket to keep the floor clean and odor down.

No. That’s not right. This isn’t the Adam and Eve Place!

It’s 4 a.m. and the aides have 15 patients each. With lights blazing overhead, they start going from room to room (alone) quickly removing wet diapers, throwing them on the floor and snapping on dry depends. There’s not a washcloth in sight. At best, they will wipe the sensitive peri area with a cold “wet-wipe” (and throw that on the floor too). Some residents will be dressed and rolled out into a day chair (at 4 a.m.)because with so many residents to get up before breakfast, they don’t have time to start getting them up any later.

Now, it’s 8 a.m. and breakfast is being served in the dining room. The radio gives the morning news and weather forecast as residents are wheeled to their favorite table to greet their ‘table mate’. First, they are served warm cereal and fresh toast. They select butter, jelly or other favorite toppings for their toast and cereal. Each resident selects a favorite juice from the rolling cart and every resident is assisted one-on-one to assure the food is perfect. A few minutes later, smartly dressed young people pass out the main course, and dainty little hot sweet rolls complete an attractive and pleasant morning meal.

No. That’s not right. This isn’t the Adam and Eve Place!

It’s 8 a.m. and breakfast is late again. The cook didn’t show up to work, and the kitchen staff had to make a “cold breakfast”. They skipped the coffee, and all 50 pieces of toast burned in the oven. Mr. Smith over at table 8 has a cold and is sneezing all over his table. No one has a Kleenex and no one thinks to take him back to his room. Grandma Jones is still in her wet hospital gown and granny Jenny still has last night’s supper on her face. The staff nurse who should be monitoring the dining room is late passing her meds, and the extra “feeders” (staff who assist feeding the residents) are still getting patients out of bed.

Oh well, administration won’t be in for an hour and families never come in before 10 a.m. This is the No-Name Nursing Home in Anyplace, USA.

I exhausted thinking about my story. You have much to think about.
There will be an Adam and Eve – Part 4.

Take Care on the Journey,

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