Are all skilled nursing facilites for rehab the same?

Response to help2day: Joint Commission of Healthcare Organizations (JAHCO- but now they just call themselves the "Joint Commission" will certify that the facility meets their rigorous standards that are more detailed than the state or federal regulations. This is an OPTIONAL certification that costs the facility thousands of dollars to receive. If the facility is accredited by the Joint Commission, they will also investigate a complaint. I was an administrator in a JCAHO accredited facility for six years, but it didn't make any difference in how well we did in the state/federal surveys, nor did it make us a "better" facility regarding resident care. In my opinion, it was a great deal of extra paperwork without any real improved client services.
The threat to call the proper authorities may or may not be effective. You should check what state agency surveys the facility in your state. It will be the agency that issues the facility's license, which is posted in the lobby. (If you can't find it, ask.) This is the agency to call if you experience a problem, and you would be entirely justified to call them NOW. They can determine if this happened too long in the past for them to investigate. What you experienced was entirely wrong. What will happen when you call is they will take all relevant information and ask for your name and contact info so that they can call you back with their findings. They will send a surveyor out to the facility to investigate, within 48 hrs in many states, and issue citations if the complaint is substantiated. This is not what the administrative staff at any facility wants to go through, and if a family member does mention the possibility of calling "the state", I'm sure they would be more attentive and take your concern more seriously. But I hope that this new nursing home is willing to listen to you and will communicate changes in your mother's condition without you having to find them on your own. I have always considered families and staff as a "partnership" and most facilities do a much better job than you would gather from reading the responses above. We will never be as good as home, but many do have a mostly compassionate, if imperfect, staff.
May god bless you.

Babalou ~ Joint Commission of what??? What should I be saying to these people?

That has not been my experience at my mom's NH/rehab. They notice when she's ill when I think she's looking pretty good. Maybe that 's because I'm an idiot and don't see the symptoms.

I agree that the above scenario is totally unacceptable. I would document it and have a meeting with the DON and the director of the facility. And ask them why my next call shouldn't be to the Joint Commission. I said those words once, very quietly, in a care meeting. My mother has been getting phenomenal care ever since. It may be a coincidence. thanks to Pam S. for teaching them to me.

Christine73 ~ I hear your pain, sweetheart. We are living a nightmare and our poor mothers are bearing the brunt of poor quality care in such "5-star" facilities we have placed them in. Just this past weekend, my mother was admitted to the hospital from the rehab facility because I INSISTED on it! I went there one evening to check on her at dinner time last Thursday night and as I was entering the building I could see into the dining hall and there she was slumped over in her wheelchair, barely conscious, alone. Her "care plan" calls her being labeled as a "set up/feed" whereby an aide is supposed to be sitting with her helping her to eat. No one was around. I went to her room and waited. Approximately 1/2 hour later, an aide brought her back to her room and just pushed her inside the room in her wheelchair, said nothing to me and left. I tried to engage my mother in a conversation and she was delirious and not making any sense. She was practically unconscious. I walked down to the dining hall where she was sitting and found her entire tray of food UNTOUCHED. So she ate NOTHING. I continued to try to get my mother to speak and she was coughing and hacking up yellow phlegm (which she had been doing over the past 5 days). I asked her LPN (who basically only takes vitals and pushes meds) to PLEASE take her temp and when she did it was 101.8! Good God! She gave her 2 Tylenols and basically that was it. I had to find two aides to get her into bed because she is a 2-person lift. (Try to find ONE aide -- much less TWO -- so she sat in her wheelchair for another 1/2 hour.) It was unreal. I was really concerned but apparently they weren't.

So, the next morning I showed up bright and early at 8 AM to see if my mother was feeling any better and, again, as I was going into the facility, I passed by the windows of the dining hall. There she was AGAIN sitting alone in a wheelchair with NO food in front of her, head hanging down, practically unconscious. I put my things away and went down to the dining hall and asked the kitchen "staff" -- even lowly-er than the aides -- for her food because I felt her forehead and she was burning up. And they REFUSED to give me her food because family members are "not allowed" in the dining room with the residents. I was totally pissed at this point and demanded her food and took her out of the dining room to the common lounge area to try to get something in her as she hadn't eaten since lunch the day before! I managed to get some oatmeal into her but she was again barely responsive. The day LPN and Nursing Unit Supervisor appear along with the PT/OT people and I practically go commando on them! Do you not see what is happening with this frail old lady, for God's sake? I ask them to take her temp and it's now 102.6! Good God!!! At this point I DEMAND an ambulance to be called and transport her to the hospital (which they were happy to do because I was making all sorts of noise at this point).

After spending this past weekend in the EXCELLENT care of our local hospital, it was diagnosed that my Mom has an upper respiratory viral infection (that's apparently going around now). She spend the whole weekend getting phenomenal care in a hospital setting except now she has returned to the SAME rehab center to "continue" rehab.

Christine73 is correct. You can't just "move" them to another facility. They (these nursing home/rehab facilities) are able to refuse you for any such reason they deem. Oops, no, we don't have a bed right now. Well, they couldn't say that for my Mom because she was already "accepted" by them. Because my mother is very frail and has a broken leg and does not have a lot of financial resources, she is on the extreme end of rehab needs and most "decent" facilities don't want to touch her with a ten foot pole. My husband had connections and they agreed to take her. I shudder to think of the poor elderly who have no one to advocate for them. We are not wealthy and cannot just "take her home" and give home care. She has extreme needs at this point, needing a hoyer lift to get her in and out of bed, is totally incontinent (bladder and bowels), cannot have any weight bearing on her leg for at LEAST 2 more months, is mildly cognitively impaired and when lucid, is a ROYAL narcissistic demanding pain in the butt. There is no way I could take her home and "nurse" her back to health (bad that it started as). After the first 2 weeks of her being in this facility, I was going crazy with seeing all the things that weren't happening that should have been happening with regards to the care of patients. I was ready to throw my sofa out on the front lawn and get a hospital bed in my living room with a hoyer lift and spend the rest of my mother's life in servitude to her. Fortunately, my loving husband brought me back to reality before I made any such crazy moves. I am now calming down and basically going to the facility DAILY to check on her.

That's my advice for ANYONE CONSIDERING PUTTING SOMEONE IN REHAB OR A NURSING HOME: Show up DAILY and at different times (shifts) and keep the staff on their toes. Make them know you are watching them and hold them to the "glossy full color brochure" standards they give to the public when advertising these places. I sometimes think I'm demanding too much from people (aides, LPN, RNs), but come on, these are human beings, for God's sake! We treat our pets better. There for the grace of God go I. I hope these young kids who are crappy aides get the same treatment they're giving our elders someday when it's their turn to be in a nursing home.

Let me give you an example of one of the idiot aides in my mother's NH: A group of residents were in the common area watching TV. An aide had to be with them. They love those assignments because they involve no real work. One woman's nose was running, dripping past her chin. The aide did nothing. Another aide came to relieve from another floor, immediately asked for rubber gloves and a towel to take care of it. She then asked the aide assigned why *she hadn't taken care of it. Her reply? Loud enough to be heard across the floor, "It's boogers!" And this is the idiot they assigned to my mother. We're in one of the "nicest" nursing homes in one of the most affluent counties in the nation and, well, "it's boogers!" As I am already beaten down and tormented by the situation, it isn't a stretch to say that even now, I would love to slice the throat of that woman....

Furthermore, if you'll allow me this rant, I'm really tired of hearing people say, "you should move her." Guess what? You CAN'T just find this wonderful nursing home and "enroll" your parent. They have to be ACCEPTED! And if you have dementia and walk, or if you have a small social security check, no one wants you! And they will lie and say there are no openings so they don't have to take you. Those are the facts. So options are limited. Oh, and guess what? If you "complain" or try to report them, they trump up charges to get rid of your loved one, or they threaten to put your loved one in the nuthouse and falsify medical records to do so, or they just stop feeding and changing your parent until they're at death's door. I've experienced it myself and seen it happen to others.

Oh, and guess what else? You can't take your parent home because it's Alzheimer's and caring for them will kill you quicker than the disease kills them. So you just cry yourself to sleep and wish that one of you would die just to get some relief, and THOSE ARE THE FACTS. Welcome to my world. Thanks for listening.

Why are Nursing Homes so expensive? How do you justify $80,000-&100,000 a year in costs? I wonder if it would be such big business if Medicaid or Medicare refused to pay for NH care. Private pay is more than what Medicare/Medicaid pays. I just don't understand the need to profit so much on an aging population of babyboomers.

We're there 5 to 6 days a week. I shudder to think what my mom's care would be if we never came.

A lot cannot be doing their job and when the family shows up, the staff suddenly gets on their game.

Help2day, you are not alone. I'm right there with you, sometimes wanting my mom to die just to escape the indignity of it all. It kills me slowly to see the garbage "care" she is getting, but my mom is not rich, plus she has dementia and walks, so the few facilities that accept mobile people with dementia won't take she because of finances, and the ones that would are zoos, not fit for a dog. I hate her current place. I'm tormented. Yet I have no good option. Your post helped me to know that I am not alone and to feel less guilty because I probably AM doing all I can do. I'm so sorry for both of us.

Help2day, it sounds like your mother is in the NH from Hell! I've also done CNA work at a NH and in a hospital. That's one of the hardest jobs ever created. It may look like they're not doing anything and some of them really aren't, but for the most part, the aides are frustrated by the sheer number of patients to be bathed, dressed, sheets changed, patients diapers changed, meds given out, bedsores treated, etc. etc., and all the other chores they have to do. And, when they think they are done, the RNs are calling them asking why they are sitting down to rest for a moment. Why are they having coffee? Why are they taking 30 min. for lunch instead of 10 min.? I took as much as I could of it and finally threw the towel in. I walked away from my astronomical $9.00 an hour to go back to my old job of accounting that I had burnout from because I couldn't take any more of the never-ending "why aren't you .....? questions being asked. I even tried to set a plan for myself to bathe every other day so I would have the other days to change sheets, etc. but there was always someone else in a higher position who wanted a bath done on THEIR time, not my time. Everybody wants to be first, always. If you can find another place to transfer your mother to, please try to find it. She doesn't have much longer to live, especially with the bedsores beginning. sometimes, they will become gangrenous and she will get blood poisoning or some other infection. I can offer a suggestion if you can't get her out of that place though. I felt your pain when you were describing the aide saying "well, it's gonna hurt" when jerking the diaper out from under her. There is a decent way to do that which won't hurt and that aide doesn't need to be there if she's going to hurt the patients. I know it's a drastic measure but sometimes having a colostomy done on a temporary basis could help make things easier for her. The docs would put a stoma on the abdomen and attach a bag which would collect her feces. Having to empty the bag is much easier to clean than changing a diaper and hurting her. Most NHs receive federal money to operate and if you see definite abuse of any patient or your loved one, please inform the proper authorities. I believe the internet can help with that. I use the search engine ASK.com and ask a question like "how do I make a complaint against a nursing home in **state** (name your state). Once you have a list to choose from, look for either NH complaints, Bureau of Health Facilities Admin., (responsible for oversight) Dept of Health and Human Services, etc. There are many to choose from and from lawyers as well. I'm sure your mother will get the best care possible if they think there may be a complaint on the horizon if they don't take good care of her. Follow thru with any complaint with detailed notes of the day it took place, time, aide on duty, RN on duty at the time, what you complained about and what the end results were and by whom. If there is another bedsore, carry your phone camera with you and take a picture to back up your complaint. The more info you collect, the better the claim. Hopefully, you won't have to do any of that but it's good to know what to do if you see that you will need that information. Remember, if a judge can't see a picture of an injury, it may as well not have happened. I know my mother vowed that she would never go into a NH regardless of her situation because of all the rumors she had heard concerning their care or lack thereof. Many people feel like that, I do too. Good luck, Help2day and Lola8888.

Carieisgiving. I am so sorry that you are going through this horrible situation with your mom and God bless her. I know she is in a lot of pain.
The move from the hospital is horrendous. Especially as you describe it. Most people don't know this. Meds are seldom there when the patient arrives.
I went through many of the things you mentioned with my mother when she was sent from the hospital to a NH for rehab after a terrible fall. I lived within walking distance of the most prominent senior home in a major city which I erroneously thought would be the best place for my mother to rehab. It was awful. I was able to be there daily and for most of the day and it took constant vigilance to protect her from the system. An unexpected visit from myself one night found my mother screaming in her room for help. She was wet and could not get her call button to work. I saw her CNA giggling in a darkened dining room as I came in. She was on her cell phone. The next day my mother was back in the ER with a congestive heart failure episode. This time I insisted on her going to the SNF in the hospital. They accepted her and she went home after a month or so. The nursing home has your mom there with Medicare paying for rehab. That's why she is seeing the therapist. That's how they get paid the most. Some of the staff are caring. Some are not. Like anyplace. The good with the bad. I took Clorox wipes and cleaned my mothers room every day at the first place. I checked her meds each time they were distributed because they were wrong more than once. Never on time. Years ago a person would have stayed in the hospital if they were as ill as your mom. Get hospice in as soon as you can. Take her home if you can. My mother came through her ordeal but she didn't have dementia. A fractured back and CHF. Demand the bed sore be seen by the dr immediately. Find out his instructions so you can make sure it's followed. Hugs to you and your mom. You can't change the system but you can insist it be followed correctly. I see advertisements for the posh senior home on tv and I shudder in horror at the thought of winding up there. Oh yes. They had a top rating also.

What is one of the largest non-profit medical services combined with SNF in the United States? It's the VA system. Does anyone remember the VA scandal that came to light last year?? If not, Google it and educate yourself on the tragedy that happened there. Veterans were either purposely denied or delayed seeing their physician and/or receiving other much needed services, then eventually died - while the administrators pocketed thousands of dollars in bonuses. Some of the VAs became "lifers" in the SNF until their death, an example of keeping the beds filled for business. Are all facilities like this? No. Thank goodness! Does the staff in every single facility across the country all sit in the lunchroom with their feet kicked up, smoking cigars and drinking cognac while counting the all the single bills? No. But all medical operations, including SNFs, have a financial interest. It's well-known fact in the healthcare industry; for example, one of the nursing administrators told me on her last day that she quit her job because she was tired of what she saw was happening in the SNF my father was in; the new CEO was brought in to "transition the SNF into being more productive". What I learned later from the staff off the record was that he was CEO of another local well-known SNF (that traded on the stock exchange) who dramatically cut costs which then caused poor patient care while increasing profits for the company and dividends to its shareholders. I actually witnessed its upper administrators try to convince the family next my father's room that their loved needed to stay longer but the family said no because they wanted to take the family member, the father, home through hospice through it's palliative care program which offered PT. I heard the entire conversation between the family and administrators due to the pathetically thin walls. I saw the father walking but still needed assistance. The son told me later "we found a way to get my father outta here". This SNF was the only one that had a bed opening for my father at the time of hospital discharge. I didn't have the luxury of time to review others. This place was just bad. So bad. Thank goodness I worked on getting him out and home within one month of his admission. There are awful stories in all types of the larger SNFs - the star-rating doesn't matter. And that's why families need to visit often their loved ones in a SNF so the staff know can see that is family is watching to make sure their loved needs are being met. Get to know the nurses, CNAs, techs - because off the record they'll tell you their thoughts on the facility, the management, the doctors - and this can make a significant difference in how much of an advocate you want to be for your family member - or make you want to get your loved one better ASAP to get him/her out. Healthcare, profit or not, is buyer-beware. It's all relative. Some places/providers are great. Some are absolute crap and shouldn't be in the business.

I have been a professional caregiver for about 15 years now. What I have found, including after talking to many people from across the nation, people tend to get better care in states that are NOT: California, Arizona, Florida, because there are less people jumping into 'care' business just to make as much money off the misery and suffering of others as possible. Where older people have abandoned their family and moved to the 'sun belts' it is much more likely that they will find MOST facilities short staffed, unresponsive, and burned out. Like it or not, the people who are more self absorbed (don't care about others) are drawn to these place too. The result is young people who don't give a d*mn and old people with dementia (and not), who believe they should be able to treat caregivers like slaves, one client actually tried introduced me as her new maid, and I have had 'family' members try to claim I should be a family 'servant.' Yes, these were every high income people who inherited their wealth. It's not a pretty picture. The horror stories go BOTH ways. If you have family in these areas, I suggest you move them or become skilled yourself, because until this is all straightened out - this is YOUR future too. As was previously said, nonprofits usually do better, but just be sure the upper management isn't pulling hundreds of thousands or millions as 'salary,' in these 'nonprofits.'

My name is Don M. I havd been a Nursing Rehab Resident for 4 past years due to a Surgical Medical Accident which left me paralyzed. Before that in my career I rose thru the ranks as a highly skilled medical RT of a Trauma 1 Hospital. During my 4 years before escaping Nursing Rehab industry I was in 5 different Nursing Facilities from the Low End accept anyone facilities to Top End, private insurance type skilled care. So I had to enter this discussion to help out. Nursing Homes hire CNA's and LVN Nurses from the same Regional Area Labor pool of whoever or Whatever Staff is available for Hire. There is a Shortage of Nursing and not many want to be a CNA who does the most. Now that presents Another Problem,,, Keeping Staff to Show Up is the Trade-Off to Quality Care.., ANY BODY is better than NoBody.., So the business of NH Care will trade-off the Quality until they can find someone better and the Residents suffer during this time with a SLACKER.., or someone who is non-caring.., I Have Seen it ALL.., The BEST WAY to address this is to write REVIEWS to "Warn Smart Internet Families" about Poor Quality Care Issues because Often NH Management will Cover-Up woeful behaviors.., YOU can also go to the Dept of Disability (DADS) inspection review Website to get an idea.., of what is not being done properly. BUT LASTLY.., Visit Loved Ones many times in every week.., The More STAFF knows you will visit the better care is given,, at least until you leave.., FINAL ADVICE,, "KEEP MOMMA OR DAD AT HOME" and hire Nursing Homecare Service. Seriously..., DON

I am a retired nursing home administrator, who has worked in both non-profit and for-profit skilled nursing facilities of all sizes, and who started out in this profession as an aide. While most of the comments here provide some truth of the state of our nursing homes, the underlying assumptions made to try to explain why there is understaffing or apparently uncaring staff are dead wrong. The truth of the matter is that it will always be impossible to have perfect staff. There simply are not enough people with the right credentials and the right spirit of caring to fill the need. Speaking of CNAs, they are NOT "lazy" or "too stupid" as one commenter noted. Even the best can get burned out - caring for frail people takes all you got, whether working as a CNA, RN or administrator, and the resources are limited in both for-profit and not-for-profit homes. It is also not just a matter of more money. A facility with the highest pay scale in the area can still have very high CNA turnover. There are many factors involved in turnover and trying to pinpoint one factor is a fruitless endeavor. Government will not provide the solution, either. The federal regulations for skilled nursing homes are being revised this year. The proposed regulations sound like they are on the right track to make nursing homes more responsive to the individual needs of the residents but do absolutely nothing to help the systemic issues of improving the labor pool of good workers, offering a better physical environment, or more money to support better staffing ratios. My prediction is that these regs will increase costs but will not have a real effect on this fact: 90% of care in a nursing home is performed by non-professionals behind closed doors (to paraphrase Diane Brannon, PhD of Penn State Univ).

The best advice I can give is to remind family members of a nursing home resident that they are the best advocates for their loved one, as some commenters have come to realize. The staff should be responsive to your observations and realistic expectations. (Note that not all expectations are realistic, e.g. not every bed sore can be prevented; staff cannot provide one -on-one care to ensure 100% that the resident won't try to get out of bed on his own and fall.) If you find that your loved one is in a facility that has a staff who do not value your input, you need to find another home that will. My final note is that the Five Star rating found on nursinghomecompare.gov is only marginally helpful. It has no statistical relationship to how caring the staff is.

Standards can look the same on the official sites, but it's the staff that matters most.

Sadly, where we live matters, as well. In my community, most of the facilities are very good. I agree that most non-profit facilities tend to hire better and simply are more likely to be run with residents in mind. Faith based homes are often some of the best and your loved one needn't be of the faith that supports the home.

We have one local nursing home that was owned by a Lutheran based company, then a secular non-profit and then a Catholic foundation. It remained excellent the whole time, though the Catholic sisters that bought it seemed to do the best. Part of that may be that there is more general knowledge about good nursing home culture now, but part of it is their mission.

Over the 15 years that I was directly involved, I found the home excellent. Not perfect. Mistakes were made. Not every aide was an angel. However, in general, the staff was remarkable and in some cases they fall into my "prayers for life" category. I'll never forget them.

I feel terrible for the people who have little choice but to place their loved one in a poor facility. Caregivers must pressure members of congress and others for better senior care and that means better nursing homes for all.

My main point is that we can't paint them all with the same brush. Also - the age of the furniture matters far less than the caring of the staff. Ideally, a nice facility with good rooms and a wonderful staff - well, that's nearly perfect. However, I'll go for great staff first every time.

Take care,
Carol

Babalou, Amen!

Penny wise, pound foolish comes to mind.

Brief Rant ahead. Jude, I don't think it's hidden at all. "The State" has no intention of making care homes "more attractive" or paying any extra for care (I'm in America in what is called a conservative red state i.e. Republican). Our governor declined Medicaid expansion and fights almost any expansion of social services. We have a fund to entice businesses to come to Texas and offset corporate expenses in the millions of dollars. Education and affordable child care is chronically underfunded. We are building new toll roads, but the public aka "free" highways infrastructure is crumbling. Too many requests for too little money. And it will only get worse. In America, going on Medicaid is NEVER going to be as pleasant as being at home. Government is always going to push for family to take care of caregiving (I have a son with autism - talk to me about lack of respite sometime!). The best hope we have is to take care of health as much as we can and figure that we will only have care we can personally pay for or talk family into. Institutional care for profit substandard since The State doesn't want to pay ANY EXTRA, especially in the upcoming worldwide recession. Look at year-end sales reports from stores - we are NOT buying in America (and much of America is consumer based). China is slowing down. The flood of political and economic refugees is not slowing and people are clamoring for funding for refugee care. Just time to hunker down.

Jude, I've gotten cynical with age and sad experience, and I agree with you. Also, "Money Talks" and I'm sure we know the rest of the phrase.



What else can we do, though? Without a lot of individual $$$$$, I think our only way to make change is to band together into big groups to have some influence.

I have to say politically speaking I sometimes wonder whether the suits have a hidden agenda here and think that if the care homes are grim more family will do the care and thus relieve the state of the costs

I was a CNA for a short time,but it was a wonderful experience. My residents and their families were great! I lost 20 pounds on the job due to missing dinner most nights and hustling for eight hours. I learned what Made my residents happy. My one lady didn't want her bedding pulled back at the beginning of the shift because she always had visitors after dinner. My one lady was always cold when she came back from Dialysis. I knew what time she would approximately would be back, I would have the heat in her room turned up as high as it would go, and have her sandwich ordered that she liked . I was always appreciative when families wanted to help with the care.
As far as the call buttons being answered, I believe in NJ three minutes is the time allowed to answer. However, if we were in a room performing care we would not know about the call light . If we came out of the room to get something and saw the light, we went to the room, found out what they needed. We would let them know that care was being given to another resident and we would be back as soon as resident was completed. I know I gave my 110% every shift and then some,because for some residents, we were all they had.

As far as putting more time in my education to become a nurse, at 47 years old that wasn't going to happen. A few of the younger CNA's were going to school for nursing, our facility paid for it. Good for them I had no desire to be a nurse, ever.

My mother moved into Assisted a Living in July. It's a great place, it's not fancy. Mom didn't like the fancy places. She loves it there! The entire staff is very friendly. One gentleman who lives there, lived in the Independent Living for 20 years with his wife. His wife had passed away, and moved the Assisted Living. I know we made the right choice. My mom will stay in her apartment for as long she can even if her needs change. They will not move her unless it's absolutely necessary for her safety.

I think 12 hour shifts are in humane.

The aides at my Dad's brief stay at a rehab facility were kind (from what I could see) but over-whelmed, particularly after meals when everyone had to 'Go' at the same time.

I know things are overwhelming for caregivers, but please, try to get politically active. Goose your politicians, join big groups. If you can't do it now, when your journey is over don't forget what you've been through. As if you ever could forget, right?

Care sucks worldwide unless you have a lot of money and can afford private home care done by people of your own careful selection and even then there is always the odd bad apple. It is not the main reason I look after Mum but it is high on the list.

I think care for patients with severe dementia is not considered by the investors of companies that offer it and is particularly demanding and pestering for carers and family respectively.

That said really good care home managers can make such a difference IF THE BOARD OF DIRECTORS allow it. In one care home I visited the Care Manager was given 3 years to turn it round, during which time she got a lower wage and ratios weren't harshly considered - She made full use of that period and now runs a care home that is effective, caring, the dross has been weeded out, there are voice monitors in all the rooms and she would like to put in cameras too but isn't allowed to in all areas. She tapped into those monitors a lot in the formative months and that is how she weeded out the bad apples. There is no second chance with her at all. You abuse once you are out with no reference worth having. She meant business but her home doesn't smell at all. There is no fixed time for cleaning commodes, yes some homes only clean them once a day and use deeper commode pots to accommodate the quantity. All her staff undergo at least 30 hours of training every year and if they don't they are out...it is in their contract.

She now has an activities room and a light room for calming, an aromatic garden that is just wonderful in the summer but more importantly they now have a driving business with happy residents and a lot more income. She cannot accommodate all the people wanting to come there. Yes it is more expensive but not exceptionally so but that woman did good and I am proud of her, although I wouldn't like to think how many hours a week she puts into that role

While I wholeheartedly agree with both Careisgiving and Help2day, I am now terrified if anything should ever happen to my FIL, that he needs Skilled Nursing Home Care! I as yet, have never needed to actually look into such care for him, and he has lived with us in our home for the past 12 years, he is 86, and the potential for such in the future is almost undeniable. I have been investigating all day on the internet, for a way to get some respite care time off, but after reading the last few posts, I may well forget the whole darn thing! It Sucks to be Us!

I respect LauraO's comments as she's a very caring person who loved her job working with patients - but her comments are from the nursing side (the side that actually cares about the patient's wellbeing) and not from upper management who are constantly pressured to keep a business running. A SNF is no different than any other business. And the larger well-known SNFs need to consistently make their profit margin, make their P/E (price/earning) ratio to meet the demands of its shareholder and investors. They simply can't do that without filling beds. No way. They're not in the charitable business of being kind and thoughtful. Healthcare is a brutal business - all aspects of it - and it's going to get a lot worse in the next 20 years with aging population, along with healthcare businesses buying out other business to consolidate and monopolize the industry. I have no experience in a small SNF where the ratio of CNA to patient is 1 to 8 (or less); if you do - hold on to it - because that's golden(!) but so not the reality of many of the larger SNFs. It all has to do with what's available in your area and who will take you based on type of insurance and assets. There's no SNF in my area that has less than 1:15 ratio - during the daytime/normal business hours; nighttime is 1:24 in some facilities. I was with my father 19 hrs/day - yes, 19, when I cared for him full-time during his cancer battle and I observed both the five-star and three-star facilities - it doesn't matter the star, 90% of them are all absolute crap. Thank The Universe/God I was in a position to be with him and see and what I saw because I would've been terrified for his life otherwise. There are two reasons why the CNA patient ratio is very bad: (1) profit and (2) turnover. In a SNF, CNAs many make less than 12/hr - but are easily replaceable, easily dispensable compared to an LPN or Charge Nurse because LPNs and RNs have put more time into their education and training than a CNA. It's a lot cheaper to go through dozens of CNAs versus dozens of nurses for the CNA-type of job. I'm not trying to be condescending to LauraO or any other CNA - it's just the realities of doing business and how marketable your skillset is; if you don't keep up with your education, don't strive to want to better your skillset so you can move into an LPN or RN role, then you'll get crap pay with no respect - and get tremendously burned out which is the reason for the shortage. CNAs work their asses off and this is why they sadly bear the burden of nearly all the patient care; an LPN or an RN won't wipe the ass of a patient unless he/she is caring person or is told to. LPNs and RNs are too busy charting and getting meds ready for the CNA, checking inventory, drawing blood from the PICC line, attending "meetings". I learned A LOT by going through our healthcare system. It's very, very ugly.

help2day: My heart goes out to you. I know exactly what you've been through because I've seen it with my father (me being his advocate) and with other patients whose family had no clue what was going on until they did finally show up and had that "deer in the headlights/OMG" look on their face. It's just so awful, so dreadful what goes on in these larger SNFs (again, this is my experience). You're so NOT a bad daughter. You're just caught in a very difficult position. My recommendation is to see if you can get a hospice evaluation. The larger hospices, like the ones in our area, offer PT, OT, Speech services through their palliative care program. And she'll be in a much smaller environment with more one-on-care. As with all services, it all depends on what's available in her area. My elderly mother is not near the dire situation that your mother is in and, instead is a very slow decline from vascular dementia. I go to bed every night hoping she'll die in her sleep because her future is not a good one - and I don't feel guilty for wanting her die quickly and painlessly as possible.

While I appreciate LauraO's comments, I am grateful and hopeful that there are persons with her dedication and compassion being employed in rehab/nursing homes. However, from the last 2 weeks of my experience with the "5-star" rehab/nursing home my mother is in, I am discouraged, disgusted and fearful for my mother's general well being.

I have done my due diligence in researching nursing home/rehab places and I am convinced from talking to my husband's numerous colleagues/contacts in the health care/long term care field that you will get adequate or subpar care from these type of facilities. It just is what it is. For people who have commented that their loved one is in a wonderful nursing home with excellent care, I applaud them for find such a facility.

My 86-year old frail, hard of hearing (2 hearing aids), incontinent mother fell and broke her leg in her home the day after Christmas. She had to have emergency surgery on Sunday (Dec 27) to put a plate and screws in her femur. On the next Saturday (Jan 2) -- 6 days after surgery and on a holiday weekend which is a nightmare of understaffing in nursing/rehab homes -- she was transferred at 6 PM to the rehab/nursing home. I was appalled that they could release a frail old lady so quickly after surgery but the surgeon and attending physician at the hospital deemed her "ready for discharge".

Before being discharged, nursing home/rehab centers make you fill out their application/questionnaire relative to the patient's finances and what type of assets they have, because that's what determines if they want to accept you and how soon they will have to rely on Medicaid to support her. My mother has a small pension annuity from my deceased Dad, owns a small tri-level home, and very limited assets. The rehab place we chose did not want to accept her until my husband contacted the CEO/owner of the place and basically begged him to take her.

She has now been there 2 weeks in this "5 star" facility (according to Medicare.gov) and she's already developed a nasty bedsore. I agree wholeheartedly with Careisgiving's comments above. While I have found a "few" aides that give a damn, the majority seem uncaring and just going through the motions. My Mom is completely vulnerable -- she has a brace on her broken leg for support and due to her confusion and mild cognitive degeneration, she cannot use the call button to call for assistance. She is totally incontinent. She's unable to "know" when she's soiled herself. Her care plan states she must be changed and repositioned EVERY 2 hours but that is not happening. I've brought this to the attention of the Unit Nurse Supervisor and the Director of Nursing of the whole facility but nothing changes. I feel I have to be at the facility10 hours a day to make sure someone is responding to her needs.

She is a 2-person assist patient -- meaning they need a hoyer lift to lift her out of bed or a wheelchair to put her into bed, roll her over, change her diaper, then lift her back to the wheelchair. However, many times after they change her, they just leave her in bed laying on the same bedsore that she's developed because they don't put supports (they use pillows and not foam wedges) under her.

To take her home is not an option as she requires skilled nursing care 24/7. She (and we) have no money for private duty nurses/aides. To change facilities is also not realistic, as again, I have checked out all of them and they are either the same (short staffed with underpaid, undereducated aides) or worse. I had to complain vigorously to the Director of Nursing because while I was there, an aloof CNA (aide) was making my mother scream in pain just changing her diaper. The aide says to me, "Well it's gonna hurt" when she pulls the diaper out from underneath my Mom. Are you kidding me???? WTF???? Needless to say, this aide was written up and no longer assigned to my mother. However, I won't know if she ever gets reassigned to her because I can't be there 24/7 and the aides are "floaters" who go from facility to facility in this nursing home chain.

The care for the frail, vulnerable elderly in this country is atrocious. Careisgiving is correct: "some don't care and are lazy but are too stupid to want to better their skillset to get a higher paying job, so they're content with the low pay grade because unless they commit negligence they're guaranteed a job." I've heard horror stories from friends and family with loved ones in our local nursing homes from lack of responsiveness, bedsores, laying in urine/feces, being dropped in the shower room, lack of attention, etc. My observations from just a short 2 weeks is that RN's occupy the nurse's station to "supervise" the LPNs who are at the med cart in the hallway basically taking vitals and passing out pills. The bulk of the patient "care" is performed by the aides, many of which "call off" because they want a day off or miss the bus to the facility or whatever excuse, so whatever aides are left are frustrated and resentful that they now have double the patients to take care of. The turnover in aides is tremendous. My mother is reliant on them to change her soiled diaper every 2 hours but because she is so needy (needing 2 aides and a hoyer lift), she is the last one to be checked on. The aides to patient ratio is probably 1 aide for every 10-15 patients, so when my mother needs 2 aides, yikes! And again, she can't even push the call button to ask for help. I am beside myself. I don't think my Mom has any realistic chance for any meaningful "recovery" so her days will end here suffering at the hands of non-responsive staff. However, PT and OT will continue to do "rehab" per the surgeon's orders.

Again, Careisgiving is correct: "it's just that they want all beds filled - all the time - for business - so if there's an opportunity to keep a patient there due to development of another health condition or the patient's health condition declines, they'll keep running up the insurance." My mother is non-weight bearing on her leg for 3 months, THEN she's supposed to have more "rehab" to try to get her on her feet. This will put her into the Medicaid "status" at that point (when Medicare and her private insurance no longer will pay) and I'm sure they will determine at that point that no more rehab will help her and they will want to move her to the back of the nursing home for long term care. She's 86, frail, declined cognitively, has severe osteoporosis, osteoarthritis is both knees (bone on bone).

I feel so guilty that I can't do anything to make my mother's last days on this earth pleasant. I dread the thought of my Mom (or any elder person) having to die like this. I almost pray to God that she will die. I feel like a horrible daughter.

Hmmm, I can relate on both ends. Having parents go to rehab nursing facilities and working in one now.
When my mom was alive, she was in and out quite a bit. I helped with caring for her, my Dad kept her at home with our help until she passed away.
After she passed away, I felt lost. I felt like my purpose for existing was gone. After counseling, I decided to become a CNA (Certified Nursing Assistant) then also got my TMA (Trained Medication Aide). I love working in a Skilled Nursing Facility and Rehab. I love my residents. They are like my family also.
That being said, most facilities as I have learned are understaffed, not because they want to be but because there is a shortage of CNA's. I would do just about anything for my residents within reason. However, I am human. While I do my best, there are times I can't keep up with all the lights. I have done my best to take time with each resident when I am with them. I don't want them to feel rushed or that I don't care because I do. I answer the call lights as quickly as I can with that in mind. I answer them as I see them come on.
The problem being, each resident thinks they should be first, even if their light wasn't on first. I am only one person. I am not lazy and I do care. While they don't see this, I don't take breaks that I should even though they are taken out of my checks, because I put my residents needs before my wants. That is however, how burn out happens. I just feel that my residents are important. I love them. I know there are some who may not care and are only there for the paycheck. They give the rest of us a bad name. I am not one of those. I don't like being grouped in that. I can only do what I can do.
Just keep in mind, there is those of us that can't help being understaffed but love the people they care for.
No, we don't want to make your family permanent residents as much as it may seem that way. I have residents that have gotten better and went into a assisted living facility. I am happy for them, but make no mistake I do miss them. They become like family. That being said, I have seen some that left and shouldn't have because they weren't ready. My mom being one of those who signed herself out because she "thought" she was ready and wasn't, then ended up having to find another facility because they have waiting lists and filled her place when she checked herself out.
The point is, we don't want our beds to be full for the purpose of just being full. We are happy for residents that get to leave when they are ready. Sometimes people think they should be able to be on their own when truthfully, they just can't.
Important things to check on when looking into facilities is:
-Are they a "for profit" or "non-profit" facility?
-Are they a Christian facility? May not seem important, but trust me it is, Christian facilities are supported better and tend to hire as such).
-What is their Aide to resident quota?

Something else to think about is most full time aides are working 12 hour shifts, and with few breaks. Please give them the benefit of the doubt if you aren't sure.
Just my 2 cents. Sorry for rambling.

My mom is in a NH going on three years now. She was at death's door when she arrived and is now stable and content. Mom rings when she needs to go to the bathroom and staff is responsive. Her roomate rings for everything and is not ignored, but they don't come running.

im with freq .
the staff may be smarter than they look . my aunt was often left un alarmed in her bed or chair because unofficially the rehab team wanted her to use her muscles as much as possible even tho she was a fall risk . they werent far away and were listening intently . i cant say enough good about them .