Where I live in TX it is most common to have hall nurses & hall aides work either Mon-Fri in 3 different shifts i.e. 6am-2pm, 2pm-10pm & 10pm-6am. Those weekday people never work Sat-Sun. On Sat-Sun most of the NHs here have the hall nurse work 6am-10pm both Sat-Sun & one for overnight. Some of the aides pull a double shift also to make up for not being on during the week. This has been the case in the past 10 NHs I have experience with. The office staff meaning the DON, ADON, admissions, administrator, social worker & business office only work Mon-Fri 8-5. Now this means that none of the weekend hall staff immediately caring for the patient have ever met or talked to any of the the front office staff esp the DON. In addition to this the overnight nurses during the week never talk to or meet the front office staff or the people in charge of them & their jobs. This presents common problems & I am curious as to why this is a typical setup. There is a weekend supervisor in most facilities that also does not in reality really know anyone or coordinate or report to the DON or anyone else during the week. In dad's current facility she is a figurehead & is stuck behind a closed & locked door all weekend if she is even in house. Several weekends she is not present & unless dad is a serious med emer. you aren't even allowed to have her call you back after leaving a message for her. I am curious as to why the setup is that no one that is really in charge of hiring-firing-training is ever meeting or speaking with people responsible for patient care during several hours of the week. There is no layover of front line care staff & DON or ADON when the whole idea of a NH is to get round the clock care. Basically under the right or wrong weekend sup the weekends are open season on leaving patients in their beds all day & night, leaving them unchanged when it comes to diapers. And I have witnessed this frequently on dad with bed sores, skin breakdown. I have brought up the subject with DON but it doesn't matter because she has no communication with anyone in house when DON isn't there.
Anyway, my question is what is NH staffing like as in Weekday-Weekend staffing in your area of the country? Please I would like to know if this is unusual.
I don't know the current but for 2010, I'm remembering it was like 70% of NH residents were under TX Medicaid with avg cost of stay about 70K. Most die well within the 1st year too, so the political reality is that for most folks their concern with anything NH is only short-term so there will not be enough grassroots voters out there to keep on w/legislation to make change for the better for NH residents.
Wow, 10 NH is a lot. I'd like to suggest that perhaps you look at the next NH move somewhat different. My mom went from 3 years @ IL to a NH and totally bypassed the whole AL phase. At the time, I had no idea of just how uncommon this was. SInce then it has about 3 years & she has been in 2 NH. The move from NH # 1 to NH #2 was due to a whole set of issues from totally inept billing office, a revolving door of administrators, staff and the medical director's situation got changed (he had been affiliated with the geriatric program @ the medical school & his privilege hospital was too and all that changed and my mom had been seen by that group for ages) - I moved her out of there asap once she had cleared Medicaid approval and her first correct billing statement. Also Stark Law issues. Now no NH is ideal but for myself & for my mom, her 2nd NH is much much better. One of the key questions I had when looking for NH #2, was their % of long stay residents (beyond 18 months) and then those who are there on hospice and their length of stay till death & where death occurred. The % of long-stay is important in that the facility probably has great long-term staff who has actual relationships with their residents. Most at this NH are there 3 years before death, that is a really really long time for a NH stay. 3 staff have their own family as residents too although they are not on their floor for caregiving. When I was looking for the new NH, only 2 NH had % that were high enough & had it such that the hospice group actually died @ the NH and only 1 had a opening, so that is where she moved into. My mom is in her mid 90's and considered advanced elderly with no chronic diseases so in theory she is the type who could live to 100 so prolonged length of stay is mucho importante for us. She is now since June on hospice and it is good to know that she is somewhere who can provide the 24/7level of care for her and that can be consistent for her till her death. .
That said, there are always staff buzzing about, attending to residents and getting them into activities and the staff are wonderful - some have been there 30 years. There's also kitchen and laundry staff and cleaners, an activities director and a physio one or two mornings a week. There's an RN on duty all day and and two others on shift during the night. The admin office is open M-F 8-4 and the head honcho (owner, director or what you want to call him) is about or popping in and out, though from my observations he's just a figure head. The staff are the backbone of the place. Some members of the family that own it live in a house next door.
When looking for a NH I saw many that were larger, newer and fancier but, corporation run (chains mostly), I saw people parked in wheelchairs in the halls calling for help and staff just ignoring them.
If you're thinking of moving dad try to find a NH that is family owned and operated. They're rare but there just may be one in your neck of the woods.