Help2, I totally agree with you. One example I have of this type of spaced out lack of urgency was when an aide got my Mom ready for bed, put her in her nightgown and put her on the bed without covers, left the curtains to the ground floor window of Mom's room open. Aide walked out and closed the door and left Mom on top of the bed shivering in her night gown for 2 hours. When I complained to the NH director she told me it was only one hour that poor exposed, cold Mom was left on the bed. Gee...that makes it better??!!
I had a very rude awakening with these experiences with nursing homes and I hope I never end up in one. I have had depression issues ever since.
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ChrisA1 is so right except that it's more like a 1 to 12 ratio for CNAs. Home family caregivers are the only way our elderly will receive one on one care. You have to be an especially caring and empathetic person to take care of the elderly, especially those with Alzheimer's or many other physical and cognitive impairment.

The majority of CNAs are barely out of high school and have barely experienced life so it's no wonder they don't last long in these jobs.

As ChrisA1 stated, seniors need IMMEDIATE assistance. Not "I'll be there in a minute honey" responses and then don't come back for over a 1/2 hour. In the meantime, the senior has to hold it (which doesn't happen) and so the resident has to sit in their feces for who knows how long. Young people do not last in these jobs and those that do get burned out and go through the motions. I've observed MANY staff in various nursing homes and it's all the same. Never any urgency to see what the resident needs. It's sad and pathetic.

More and more baby boomers are living longer and longer. If they haven't visited their loved ones regularly in nursing homes, they are in for a rude awakening when the time comes for THEM to live in these facilities. And it will happen -- 70% of the elderly end their days in nursing facilities or hospitals. I pray I will get hit by a mack truck and die instantaneously instead of ending up at the mercy of a social media, facebooking, snapchatting, selfie-taking, self-involved 19-year old. Ugh. Sorry to vent.
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Nursing home staff must be one-to-one to be effective with your love one because when a senior has a problem they need Johnny on the spot to help them. How many senior have problems in assisted care homes and pass away because the staff did not get to them in time. Staff ratio to patient is generally one staff to eight seniors ? Health inspections are good, but generally the care home is aware of the inspection and are ready for the inspector. This does not mean the the home is meeting the health standards when the inspectors are not there. Quality is measured in many ways. Quality for a patient is that the staff care, the staff show compassion for the senior and the senior will receive assistance when immediately. I have had relatives in these homes and I have a number of friends who have had relatives in these homes. Watch the staff when they are not helping patients, are they critical or catty about the seniors. When a senior needs help, does a staff member respond or do they go about their routine duties or take a coffee brake. Seniors need one-on-one care and caring staff. This is the opinion of every person I have spoken with who has a relative in a home
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Maybe bad PR from previous patients really sad part is seeing and hearing the verbage. Staff scheaming inc DON. He is suspose to be on TNT formula peptide based . they don't want him there so they change Dr orders with fired by him prior to facility admission he told doctor if he touched him he would sue him.I had sent letter to hospital firing all involved and hospital and requesting transfer thechospital discharged him didnt wait for me to get there put him in a cab. He told me the dr shocked him. Against his advance dirrectives and me as durable and generalpoa hcs and mental hcs drs got judge to override me and control sovthey could give electroshock therapy to someone with tbi and encelopathy. His problem was meds they put him on making him paranoid and afraid of everyone. Nursing homefacility put that doctors name on as primary. He has his own TEAM of primary and specialists for his health problems. Mainly HCV causing KAOS. They seemed to give him jevity which he won't take causes bloat and he was determined by several times Dr team hospitalist to need peptide based total nutrition HCV messing with production of b vit for production and storage of amalayes and formation of food into peptide in body so they changed him to liquid peptide formula for chronic HCV malabsorption.malnutrition FTT. Heard them say because they let him refuse. Any kid will say no to the person who brings the medicine. He has dementia but drs says he can be rationalized with.just cannot walk up to him and push meds or a feeding to him. Hell balk. Everything has to be an outing. Then he follows. He tries to be autonomous. So like a little kid make out he decided to do what ever is needed doing. Then no problem he will remind you once he is in routine. Its the routine that calms him. Fortunately his encelopathy is stable but HCV ftt and infection are the variable. They are making things harder upon themselves because with the peptide he is much pleasenter and more cooperative and wants to be helpful once he is in a routine. The peptide gave him a functioning kidney. Hopefully wont go down before I get the other stuff done he needs to get the HCV antiviral. He's not even gettingvhis respiratory meds or nebulizer treatments. I'm contacting the parent company when my ducks are in a row for him and requesting transfer to different one of their facilities with a report to the Facility certification and liscinging board. I just can't show my hand or they will block me from him to CYA themselves. I was to the place needed to be reported and cleaned up. They are trying to change name of "memory unit" I thought he would get some cognitive therapy there. They put on music and movies. Don't understand why they dont run any of old game shows like jeopardy. They do have TVs in the room but when I got they are always turned off. He won't turn on himself without remote. Positive did bump into eye Dr there his broken glases getting redone. Hopefully they will get the other referrals done save me some legwork like podiatrist to fix his toenail for his toes.That was part of idea he being there was things I didn't have to be there for. Because case mgr didn't set up for me to be paid by ltc for hrs. I wanted it that way to give me greater flexibility we have Manny appts. And he doesn't like to stay on property.aid has 4 hour incraments .his attention span isn't that long.and he wants to leave for a walk or ride. I need a 6 ft fence. His fear of losing control makes him anxious and he hurts moving he says makes pain better. On peptide he has snignifiant pain relies and anxiety relief.why facility is cutting own throat. But looking at stock piling jevity they use for pts. By him refusing 4 a day.
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Beckytodd1 Your story is do typical. Too typical. And so sad. Especially when there is no accountability. Changing status code is a serios ptoblem. Advamce directives require two witnesses, not relatives, and notarized. I share your emotions. And fear the day when I am not the advocate or caregiver but a patient at their mercy.
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aseeding rat allowed spouse to be moved to facility that fire alarm didn't go off when door pushed on. Big problem when have person who seriously can NOT smoke. I have an issue when outdoor activity time is included with smoking time. Out of sight out of mind weaning will work with him ( he quit of his own volition for year and half until a person from past came in and declared him a smoker.) but, not when the main patio smells like an ash can. Spouse has post traumatic encelopathy that is stable. On feeding g tube FTT HCV. spent about 6 wk in hospital stabilizing. I had to stay beside. A lot of issues behind in addressing and Dr appts reach due to freq hospitalizations. Praise the hospitalist went to batt to prove theory HCV 85% culprit of spouses health. Mal absorption. Immune suppression. On Vital peptide. Gtube malfunctioned so replaced consult was GI Dr previous familiar. Prior colon sx. Changed to High Protein Vital and greatly increased feeding rate. at 3rd day he was pleasant and amazingly pain free. Possibly does not need low back pain block now I think. Move to this NSG home changed all orders took of Vital (predigested peptide)case mgr HMO saysNH probably changed because of cost of Vital.( Nurse there documented only (grazes) in po meals). Has dysphasia due to salivitary nerve damage dry mouth. I told them has to have a broth, sauce or gravy on food. NH wants me tried to force me to take home. I contacted LTC case mgr she set them straight on that. Still trying to make me take home by not acknowledging his Dr.. Gets upset with changes. Inappropriate Verbage. Animation. I cannot follow or run after anymore and don't have a fence. Cannot move now because health HCV problem needs attended to. Want to cry when see scalded area around g tube. Cradle cap same clothes over a week on. He has shoulder prosthetic Jan. can barely move it now and complaining of pain. Today in bed except up for lunch the straight back complain pain all over. What a difference without the vital. I offered to set w him during feedings. Now thy changed to 3bolus jevity pm. won't take the jevity disagrees and gives him bloat and GI distress. Has gastric and duodnal gastritis and diverticulosious...... Doesn't try to remember now makes head ache more hurts all over to bad to think says. I tried to insist w the home care for 1/2 companion hrs and rest to agency wouldn't be still and walked(I got walking and put speed on it) so would dip on me then follow stalk while I'm looking. I have to sleep some time more than 15 min.. Idea was to be safe place Would be at when I came back me get some rest.Do paperwork NEC. still have Dr referrals never got to . readdress HCV app. for Harvoni. With new renal and status due to vital would not need dialysis on remaining kidney and kidney would be OK keep up same routine.... Cannot NH changed the turn around of the dying kidney to one that he could live with other atrophied out the Renal hypertension was WNL. Still have COPD.... and spot on lung watching for 1 1/4 yr. etc.. Other referrals to psychoneurologist and neuropsychiatrist at university. Arrange transport (I don't drive).cross fingers he's stays good on bus no old tricks. Other transport takes 4 days prior arrangement. When one gets rescheduled it sets all off. Play catch up using bus in W/C and crossed fingers for luck. Urges for smoke now asking for beer because hurting. All almost went away as before. Goal . get all appts set HCV in motion and hope no more infection pneumonia CHF before can get back on Vital. He will have to fail. Then I turn them all in. Previously he fired the Dr they have as attending I heard Dr say Not my Patient when was on Dr list as intake exam for NH and Dr was discharged from pt when did rotation at hospital and changed the senior hospitalist orders whom appointed his staff in charge anytime comes to hospital.Saved the kidney in the process best function ever. Still some more tweaking for nephrologists but a considered and praised wonder to behold. Well this is listed as 4 + star and memory specialty unit. Has orders pt of cognitive. He's had none and even if said no Why I'm Gpoa And Dpoa and HCS and primary terms facilitator to facilitate his needs and care. Primary terms care very complex healthcare needs.with the Vital peptide base TNT his immune system would follow suite of his kidney and the liver failure wouldn't have to fight the HCV. Couldn't qualify on only the HCV chirrosis. Have misdiagnosis have to deal with to clear up. Just trying to get GI Dr put gtube in get a gander at the wound around it. Not would back if will follow for gtube care. If not got to find one. Just the paperwork trail is exhausting anymore. This is a conceire health care affiliate. The other place transfered from much better management. Even though got cigarette there less than 20 min and aid bought 2 packs and gave to spouse. To me this was unacceptable esp since was on one to one. Not the first time. Another place was buying picks and to me I would have to buy some like 5 packs a day. Sorry to me totally unacceptable.ended up they lost my spouse gone 4 1/2 hours I looked for 3 he's to convince not there then found out from other residence was done at store2 1/2 hrsbfore I arrived for visit . sheriff found about 3-4 mi away at Wendy's eating burger. Sorry I don't have good luck. Put father in facility to keep hydrated throat tumor uti due to prostate prostate sx scheduled died dehydration tongue Swollen sticking out throat day prior to prostate sx if out for 4 days no water to bedside. full code just signed 6 day prior er for severe dehydration told Dr wanted full code by blinking one eye then the other. Dr ordered if then he could talk when swollen tongue went down. Kept him 24 he's and sch sx. My sister removed the IV. A associate was to follow for hydration at NSG home that was right next to a hospital. Told to press charges would not be worth it. Was told same when other husband was oded by nurse. I only wanted accountability I would be held to.
Sorry state of affairs when couldn't trust a co worker. A people who need the care really are shirked. I kept wondering why so many sick people out wandering the streets. Americas healthcare system is a major problem In underserved and in homelessness
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Oh, and I forgot to add that the open wound and exposed bone led to osteomylitis. My Mom finally found peace from all this in January. To me, nursing homes are the most evil places on earth because of what they are supposed to do and really don't for tons of money.
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Nursing homes may provide enough staff in ratio to residents, but there is nothing that can be done if the aides won't work and cut so many corners the residents are neglected. One woman I spoke to who used to be a consciencious aide told me her co workers would get mad when she did a good job as it put pressure on them to work harder. The star rating means nothing to me after dealing with two 5 star rated homes for rehab...one let my Mom lie there so long she developed a stage IV bedsore in which her tailbone was visible. To add to the hurt of that, the nursing home did NOT tell me about the wound...it was discovered by an intake nurse at the hospital my Mom was rushed to with a raging UTI and delirium. I was stunned. The second 5 star home was a bit better...they only dropped my poor Mom while transferring her to a wheelchair and broke her lower leg. They always had dismayed looks on their faces when family would visit any patients. These people must have a real hatred for poor, helpless old people to treat them and their families in such a manner. If these were 5 star facilities I hate to think of what is being done to seniors in lower rated NHs. The 5 star rating is a farce as far as I am concerned. The attitude seems to be that " the old people are going to die anyway, so why make an effort?" It was a horrible, eye opening experience. Would you even send your pets to be treated this way?
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Looking4lulu ~ My sincerest condolences for the loss of your husband. And you are correct -- caring, competent, and attentive staff makes all the difference. It is absolutely true that the CNAs do all the hands on patient care. There are NEVER enough of them on a given shift. So if your loved one needs to be repositioned (and God forbid they need 2 aides because you're a 2-person hoyer lift) every 2 hours, good luck. My Mom got a pressure sore in less than 2 weeks when she entered the rehab/nursing for a broken leg. This was a 5-star nursing home according to Medicare.gov. She was taken to the ER twice while in rehab: once for a bronchial infection (no staff noticed she had a 101° temp and was delirious) and the 2nd time because it took them 4 days to recognize she was having a stroke. She didn't last 3 months in a nursing home. She died at the end of March 2016. I miss my Mom.
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Be very careful of the "pretty" facility . . . looks do NOT mean there is quality care within. Medicare.gov/nursinghomecompare is the place to check out the quality of the care. I relied on a referral from a friend whose husband had been treated "well" at a specific nursing home several years before our need. "It's pretty," she said. The care was lousy, and I later saw on the Medicare compare site that it was rated a low #2 across the board. Our doctor said it "should be closed down!"
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Any nursing home is only as good as the oeople actually caring for the elderly. That would be CNAs for most part. There is long term care and short term for those recovering and hoping to return home. No matter how many stars, it are these people who can actually make difference of life and death. A neglected sore can lead to sepsis. Inmobility can lead to blood clots. Not remembering to drink can result in dehydration and UTIs. All three happened to my husband in a 5 star facility. He had used the facility before and it was great. Different staff made the difference and now he is dead.
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Wonderful article for any caregiver or those entering those so called, 'Golden Years.' Thanks.
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I found this tool very helpful when trying to narrow down facilities to look at for mom. Thank you for sharing
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It troubles me that Sandyt3, the first person to respond to this article, had no idea how the star rating system was calculated. Either Sandy is being somewhat disingenuous and posing as a grateful responder, or she has no business describing herself as a Personal Senior Advocate.

And the 3 factors to help us compare Nursing Home Care? They're a start; but they're only a start and not much of one at that. Let's think this through. Nursing Home A scores more highly than Nursing Home B on, say, pressure sore management. Now that could be because they are actually better staffed and more conscientious about checking skin integrity. Or it could be because they reject applicants with existing skin integrity issues or who are likely to develop them: at which point this measure becomes counterproductive because it makes it increasingly difficult for families to source good care for their really frail, really elderly or really ill loved ones.

As consumers of these services, we need to demonstrate that we're using the quality ratings wisely. Otherwise providers will focus defensively on their tick-box scores and turn away service users who are really hard to care for - precisely the people who most need their help.
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Thanks for the new link, it worked...
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Link did not work???
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Great article! One thing I've found is that an in-person visit to each facility is crucial and talk to the residents (& visitors) who are there. Just like anything else, take the ratings as a "guide" - I've seen some facilities that are rated a 4 (instead of a 5 star) but they are wonderful. Likewise, a 5-star might not be a good fit for you.
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I always thought my grandpa would be slow to want to live in a nursing home, but he was actually quite willing when it came time. I think he just didn't want to put extra burdens on his family, and he wanted to be with other people his age. I agree that the staff is very important. You don't want people at nursing home who are just doing their job. You want people who care about the people they're caring for. Thanks for sharing the advice!
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Excellent article! I had no idea how the star rating system was calculated. This was really helpful.

Thank you,

Sandy
Personal Senior Advocates
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