How long should it take someone to answer the nurse call button in a NH?

I am an RN and a Regional nurse consultant. I have worked in long term care since 1994 and have been in more facilities than I can count. I have been there all hours of the day and night and often am in an office where I can see and here most things going on. Many of the aids on the floor have done the job for many years also and they are in the trenchs every day doing a dirty and un appreciated job. There are a few who have become so jaded in their work that they no longer get enjoyment from it and do this simply because they dont know what else to do. When I see this I encourage them to find something else. I see staff show lack of compassion and consideration to the residents, Ive never myself visually observed deliberate abuse. Ive overheard some insensitive statements made to family and residents but no physical abuse from staff, not saying it may not happen. I have though seen and heard many abuses from familly and residents toward these staff members who have the hardest job in the facility. Ive seen staff hit, kicked, cussed, called stupid, spit on, etc. Ive see family members be unrealistic in there family members care and be so rude and hateful to staff that they leave in tears swearing never to do this job again. Overall I see more abuse toward staff that anything and most of them are paid minimum wage and work two jobs to make it.
There can be some consideration on both sides, believe me, the better you treat staff and thank them for the care and help the more they will respond and try to please it is so nice to be treated kindly for a change.
There are times 2 staff members are assigned to 30 residents to clean, bathe, shower, feed, etc. Then you get an admission that the family is feeling a lot of guilt for not being able to take them home and take care of them and having to rely on a facility and strangers that they have unrealistic expectations and time seems longer than it its. They will turn on a call light for family to be assisted to bed and no one comes, more that likely you will not see one of them in the hallway, you may find them in a room helping get someone off the floor who had fallen, they may be feeding someone or something. In all the homes I have been to you would not find an administrator or DON or floor nurse who would not respond and investigate the issue. Sometimes actions are taken from the investigation that all are not aware of if they determine an infraction was done.

I just finished up a case with a patient in a NH. It was one of the finest if not the finest facility I have ever been in. Because I was private duty, per the facility's policy, I was not to transfer my patient. Only staff could do that. I was there on a regular basis to assess her and to make sure she was getting everything she needed from the NH and from her caregivers. The family hired me.

A half hour call light time sounds like a luxury to me. I'd use the call light and someone would come in after 30 minutes or so and turn the call light off and leave the room and it was anyone's guess as to when someone would come back.

The staff ratio was 1:13 and if any resident needed anything during the dinner hour it was tough luck because the aides were in the dining room feeding patients who couldn't feed themselves. I knew better than to use the call light during the dinner hour. Sometimes my patient would mess herself waiting for help until the dinner hour was over.

I was told by an aide when I was allowed to use the call light and when I was not allowed to use the call light.

I wasn't there very long on days when I would go and assess this patient but I was there enough to see how things were done. I made meticulous documentation and stayed in touch with the family. I would speak to the family after my assessments and if I let them know what I saw was objectionable the family would high-tail it up there to see what was going on. I can't tell you how many times that happened.

The relationship between private duty and regular staff in a nursing home is very poor. Private duty antagonizes staff for some reason. Keep that in mind if you have private caregivers with your loved one in a NH.

No matter how nice the facility is it's still institutional living and your loved one is always just one among many. I can't tell you the horrors I saw in this lovely, expensive nursing home and it chilled me enough that I may never do private duty nursing in a facility again. The unprofessionalism of most of the staff, the way the staff treated my patient (with me standing right there!) among many other things I won't go into here. My dad was in a nursing home and now I have to wonder if he received this kind of treatment? He was on hospice but he wasn't supervised 24/7? Did the NH treat my dad this way?? Anyway, I had to submit my documentation to my nurse manager and seeing it there, documented day after day after day, she was aghast at how my patient had been treated and she set up a meeting with the facility based on my documentation, which are considered legal documents.

Anyway, nothing would surprise me at this point and based on my own professional experiences I would say 30 minutes is d*mn fast.

(Sorry I ranted. This subject really sets me off.)

My dad went into a Nursing home for rehab after being in the hospital, we as a family having always heard horror stories about nursing homes demanded that we be allowed to stay with him 24/7. He needed more care that we knew they would give him. He had had radiation in his head and neck so as a result his mouth was so dry and we had a rinse that we gave him every few hours to help with the dryness. We knew they would not give him the rinse so the only way he would get it is if we were there to give it to him. One day my 89 yr old mom was with him and he had to go to the bathroom, mom helped him into the bathroom and when he was done he asked her to press the call button so someone could come and help him, she pressed it, no one came so she went to the desk and they were all sitting around talking and laughing, they told her they would be right there but again no one came, she went to the desk again and was told they were on their way but of course no one came so after 45 minutes my mother helped dad off the toilet. They never did any physical therapy with him, they wrote him off as soon as he came through the door. maybe us being there bothered him but we were not going to leave him there to fend for himself. All of us saw horrible things, people are ignored, not just my dad. They know who has family who is involved in the care and who has no one looking out for them, those poor people are left in dirty diapers for hours, they are not stimulated at all and no one gives them the love and care they deserve. We took dad out of the nursing home after 2 weeks and brought him home where he passed away 2 weeks later. For those 2 weeks though dad was taken care of the way every elderly person deserves to be cared for. There may be some really good nursign homes out there but I have never heard a good story about any of them. It so unfortunate to because there comes a point in families where the only choice is to put the loved one in a nursing home, families do it with the hope that their loved one will get the care they deserve but in most cases they do not and its very sad.

Sad but the problem is lack of staff, just like hospitals. Profits, not getting payment by Medicaid, all of these things are what is part of the problem with our medical system.

My daughter is a ICU trauma nurse. Because of patient surveys that have to be competed for Medicare and Medicaid to pay the hospital, many hospitals are not getting paid for Medicare patients as they should. Why? These surveys have to meet 100% satisfaction. Impossible with short staffs.

One of the problems patients complained of in my daughter's ICU unit was the alarms going of for patients who code. Or in other words are dying. So her hospital turned them down to satisfy patients. The result? Two deaths in the past two weeks due to no one hearing the code. Why do this? To satisfy patients in order to get a good survey results.

What does this have to do with nursing homes? Like hospitals all are for profit. Even if they say they are not. So there are less employees doing work for more people with less pay. And they say it will get worse in the future.

A call to the Department of Disabilities and Aging will open a case against the nursing home and it will be investigated. My father was in a nursing home (against my wishes) and he assured me it would be OK for my husband and I to travel and see his parents. We were gone 1 week when my Dad called me at 4:30 am to tell me he hadn't been fed and to come and get him. I jumped into clothes and was on a plane home by 7:30 am. I got to the NH and he looked great. Clean linens...sitting up in bed. But he was very distraught. Let me stress the word 'looked'. Looks as they say are deceiving. I saw first that his bedside tray was pushed up against the wall and some type of liquid was in Saran Wrapped covered cups...the call button was on the bedside table out of reach...my Dad told me the man vacuuming the carpet gave him the phone so he could call me. I pulled back the covers to help my Dad move to his wheelchair and that is when I flipped shit. He had a skin tear on his elbow that had been weeping for so long that there was a 21 inch circumference dried stain on the sheet. His IV was infiltrated and his leg swollen...why they had a SQ IV is beyond me. His Foley catheter was taped to his leg with silk tape and had caused a stage 2 ulcer. The catheter upon entry was crusted and his penis bleeding. I had my camera and began taking photographs. I then found the RN in charge and asked her when did she last assess him? She lied and I let her have it. The social service coordinator threatened to call security...I begged her to call the police because I was filing charges against them. I pulled one of the elder abuse pamphlets from the holder on the wall and called right then. I demanded my father be taken to a hospital and in all my 30 plus years in nursing...I've never seen a transfer happen so quickly. I was thankful...so was my Dad. I can talk about it now without crying...it's only taken 3 years to get past it. I couldn't imagine anyone treating my Dad that way. I wanted to kill them. DADS took the complaint and they investigated the NH in record time...I received a letter about a month later thanking me for reporting...that they found multiple residents in the same or worse shape and that they implemented strong fines and stipulations in order for the NH to stay in business. This was in Texas as well.

Is there no law out there with a specific time?

In my mother's NH sometimes residents stay in the dining room after a meal to have more coffee and visit. There is a difference between staying the dining room and being left in the dining room. Can you be sure of which this is?

Could it be that since this is repeated every night, the staff "knows" that the call is about putting Dad in bed, and that just doesn't have the urgency of all those residents getting done with their dinners and out of the dining room? Does it also take this long for an "unscheduled" call in the middle of the afternoon? Because a half hour is TOO LONG by anyone's best practices or standards. I can understand the delay once they find out that Dad is fine and just needs help getting to bed, but that initial delay concerns me.

Who have you talked to so far at the NH about this? The nurse who is usually assigned to him on that shift? The Director of Nursing? The Administrator? I think that is the order of contacting them. Also be sure to attend the care conferences for your Dad and bring it up there. But start with his "usual" nurse and see if you can get an explanation and better yet improvement.

I wonder if this repeated request could simply go into his care schedule? That this resident needs to be helped to bed at 6:15 pm (or whenever), and no call would be necessary.

I too am curious about what the "expected" response time is to call buttons.

My experience as a patient in two local hospitals has been excellent in call answering department but in the infection control area there was often a lot to be desired. As a nurse myself, now retired I have also been guilty of these sins myself. I worked on-call for hospice and when I entered a home in crisis I am afraid I went to the patient's bedside to provide comfort rather than ask the caregiver where I could wash my hands. Sometimes patients and families felt I did not respond quickly enough to their requests but here I have to use that over used term TRIAGE. This is some thing that all staff have to do on a daily basis. They often know their patients needs very well and anticipate their call is not urgent. This is not right and should not happen but when they have a patient walking down the corridor trailing diarrhea behind them they have dealt with the thing that seems the most urgent. What I would want to see happen is for bells to be answered within 5 minutes and for some one to explain why a request can't be met immediately and give a time frame in which they would be free to comply with the request. I would also like to see patients and families told on admission and frequently reminded when it is a good time to help with certain activities. For example maybe the gentleman who likes to watch the news after dinner could be put to bed before dinner and eat his meal in bed.
As far as the aides and nurses are concerned I feel their pain and I am sure home caregivers share their difficulties. Often there will be one trained nurse on a floor of 24 patients and all her time is taken up with giving medications.
The nurses and aides all have lives outside of nursing and their pay is far from optimal. The nurse that works overnight may have to rush home to get the children ready for school and do whatever needs to be done in the home. Then she has maybe six hours to sleep if she is lucky before the kids get home. the result is she goes to work very tired and does not work at a very fast speed. Some of the aides in particular are much older, overweight and have many disabilities. they really should not even be working but they have to survive. They may be divorced and are too young to retire. They may also not qualify for health care and can not afford needed medications or have treatments that would make life easier.
The real question is not how long it should take for a call button to be answered but there needs major system changes that regretfully we are unlikely to see in this financially driven environment. Becoming a nurses' aide is one of the easiest and cheapest trainings to get. The training is often offered free to people willing to work in a nursing home and in any event only takes five weeks So you see why call buttons take so long to be answered.

family advocacy is definately important . a lady at my aunts nh has toenails about 1/2 an inch long and are beginning to turn into rounded claws . very painful without a doubt . i thought my caregiving days were over when aunt went into nh . not at all . her personal and emotional comfort are still very much reliant on myself and pia ..
id suggest everyone be respectful of staff and plan your work with the loved one so its an asset to staff as opposed to a hinderance or a source of friction ..

I cannot vision our Federal or State governments spending months in committee meeting, using taxpayers money, to decide to put a law in place as to what would be the longest wait for a call button in a care center. Then what? Arrest the Aide or Nurse for not coming within the time frame?

There are patients who over use the call button because they want attention. We could bring our love ones home and we hire our own nursing staff, but I bet call buttons or bells rung wouldn't get immediate attention, either.