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Recently I was in a couple of nursing homes. In both cases it was mid afternoon and it looked like about a dozen residents were arranged in their wheelchairs or other chairs around the nursing station. The residents mostly seemed asleep or dazed. No one was talking.


Is this the normal way they supervise groups of residents in facilities? or is it a bad sign that the staff and residents are not engaged? I didn't expect a party atmosphere, but this looked depressing.

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Yikes. Is it possible the facilities were very shorthanded? I believe being shorthanded on staff can be very common. Not saying this situation is right, but perhaps there was no choice. If you go back and see this situation again, could you ask the staff? I'd be interested in knowing.
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shad250 Oct 27, 2018
Easier for staff
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Yes, that can be perfectly normal. There are many different levels of care in a NH that the staff have to determine on an individual and even daily/hourly basis. At Moms, some are engaged, can participate and get to activities on their own. Some will participate with lots of encouragement. Some are brought to activities but don’t participate or sleep through them. For some the activities are too stimulating and cause the resident anxiety. Some who are no longer a fall risk or need medical care stay in their room and sleep or watch their own TV. And of course a resident can fluctuate between these levels on a daily basis. Mom gets too stimulated at some activities, so they know not to bring her to those types. She loves the singalongs, but cannot deal with loud, action TV shows. So they move her away from the TV when it’s loud. They move residents closer to the nursing station if they want to keep a closer eye on them if they are a fall risk from their chair. Those sleeping people eventually wake up! And mid afternoon is usually a sleepy time anyway. I would estimate 80% of Moms floor take a nap in their room from 2-4, or sleep in their chair in the common area. Few stay awake right thru dinner, that’s why there’s fewer activities in the afternoon, most are from 9-12.
So I wouldn’t be concerned if there’s a group of people near the station. I would be worried if there were no residents at any activities. And I would be very worried if residents are left in the hallways away from the eyes of the nursing station. And you might see a different picture if you visited in the morning.
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Normal, although in our case it was in the lounge beside the main entrance, offices and nursing station. I'm always amazed when I read about people enjoying activities and socialization in a nursing home because, although there are programs, the vast majority of people are too far gone physically or mentally to really take part. Isolating people in their rooms is frowned upon, keeping residents together means that eyes are on them more often and since many of the rooms are shared keeping contact between room mates low reduces conflicts.
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My first thought was that they are short staffed and this is one way to get their paperwork (or computer work) done and still keep residents in the line of sight. I think I would be concerned if they were alone in their room each time I visited. Is there an activities calendar? Where my Dad is, they do have scheduled activities but often he does is own thing which is to eat and take a nap. (Depressing)
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Common and many nursing homes do this. It could because they are understaffed and/or it is easier to keep an eye on the residents assigned to that floor. There may also be a tv turned on to one station to watch movies all day.
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cwillie Oct 27, 2018
Ah, the never ending movie network - it may look like an activity to the uninitiated but I often thought that they may as well have pointed all the wheelchairs toward a blank wall🙄
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I don't think I'd like what the layout seems to be saying about what order the NH is putting its priorities in. If one of those residents had felt lively enough to lift her head and look around her, what would she have had to look at? Did they have anywhere else to sit if they'd wanted to?

You're right about the party atmosphere, though; and I have to admit that thinking back to the various views elders I know have had, it's made no real difference to how engaged any one of them was by that stage. Lovely gardens, art works, tropical fish, t.v., souvenirs, photos, other people... I suppose by the time you're that frail and tired, what's inside your head claims most of the attention you can spare.
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cwillie Oct 27, 2018
My mom rarely put more than two words together but when I left I always gave her the option "do you want to stay in your room or go to the lounge" - 99% of the time she said "lounge" because she knew people were coming and going and she was comforted by being among others, so sometimes it's not the view that's important.
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My mom’s Memory Care was the same way, but the regular wing was not. Even though she refused to attend any activities, I often found her sitting on the bench they’d put by the desk. Now, did the staff do it because they were lazy and it was easier for them? I’d say no. People who came to visit would greet the residents sitting there. Sometimes we’d get a response and sometimes not. But there was that opportunity anyway. I think to those residents, it was like sitting on their front porches in a “different life” and watching what went on in their neighborhood. This was their home now and this home included the area around the nurses’ station. The aides took the opportunity to change beds and housekeeping would sweep the floor. The bedridden ones could be Hoyer lifted into a special wheelchair they couldn’t fall out of so they could be part of the “action” as well. On the opposite and upsetting side, I saw a male aide actually yell at a female resident in a wheelchair once because she wanted to go the lounge to eat her lunch. This was in a different facility from my mom’s. He would have had to carry her tray down 50 feet to the lounge and then push her chair. To this day I regret not helping her myself.
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We would put Residents in front of the nurses station who were fall risks, it is the center of the the unit. Someone on staff always walking by and see the Residents. My mom is usually in the common area where activities take place. Once in a while my mom will “rest her eyes” as she calls it. It’s warm in there, makes me drowsy.
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It is usual and frequent to see residents parked in groups. Some may actually be fall risks but I have seen many others walking the halls who appear to be in much more danger of falling.
All of these places seem to be understaffed, the job is hard, often unpleasant and the pay very low. One wonders where the many thousands of $s goes that is paid each month for a residents care.
I have experience of working in NHs and being in rehab in one as was my late husband.
Neither of us was ever put in a wheel chair and parked some where, we would never have tolerated that. As it was we were quite vocal in our complaints.
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Veronica the people who were with it enough to complain would usually be allowed to stay where they choose and are for the most part never seen except at meal time or if the planned entertainment interests them. The shouters etc are parked where their vocalizations will be the least disturbing, that means far away from the huddle of residents and the nurse's station. And the pacers usually don't spend much time in any one place, they are almost constantly on the go.
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Ahmjoy, I think that your comparison to a "front porch" is great.  My Mom's roommate was not much of a talker and sat watching TV all day, so Mom would sit in the hall near the dining room or one of the little hallway alcoves where she could see anyone who walked by.  The CNAs/nursing staff would say "Hi" to Mom everytime they walked by and visitors would stop and talk briefly to Mom.  It was much more enjoyable for her to sit in the hallway where she could talk with other people then to sit alone watching a TV that she had trouble seeing and hearing.  And YES, sometimes Mom did close her eyes and nap in the hallway when she was tired or sleepy.  But she woke up easily and was ready to talk to whoever walked by.
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Ahmijoy Oct 27, 2018
This is exactly the point I was trying to make. The staff should not be considered “lazy” simply because they allow the residents to congregate around the hub of activity, the nursing station. That’s not fair to them.
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It works both ways – the residents watch the staff coming and going, and the staff keep an eye on the residents. It’s a whole lot better than charging private pay for a 24/7 care sitter!
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I have seen this too both when my mother had to be in one briefly right after surgery and also when a friend had a period of recovering after a stroke. I think it is a more positive sign than having severely impaired patients wallowing alone in their rooms alone for long periods. In both cases there was relative calm which is certainly a decent sign.
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Raise your hand: How many of you would like to live in a nursing home where everything different and everyone is a stranger to you? Would you like to “live” in a wheelchair?
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They did this with my father in rehab because he kept getting out of bed even though he was a fall risk. He would just get up and walk, one day he made it all the way to the nurses station without falling....they didn't take any chances they watched him at the nurses station.
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oftentimes residents are arranged near the nursing station so that the nursing staff can keep a close eye on them. especially if they are inclined to stand up from their wheelchair; it is a way to prevent falls.
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One of the nicest things I saw was for a cranky, not-with-it woman who shouted for 'help' from her room, but hated being parked along with quiet ones in the hall. She was taken to sit in on activities, which 'worked' for the hour, but days were long. The solution - she was given a seat at the main desk, along with a pad and pencil, where she spent days, happy as a lark.
In time the joy wore off, but it was great while it lasted.
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Paulcar Oct 30, 2018
There is a little lady like that where I visit my Grammy. Lorraine is little and scoots along in her wheelchair all day. She doesn’t stop too often but if she’s not scooting she can be found at the nurses station tapping in a computer screen (it’s off) or taking notes with her pad and paper. She doesn’t talk really but she sure lets you know when to go or when she wants to hold your hand or say hi. She’s one of my favorites even though on some days she’ll wave her hand and motion for me to go lol it makes me chuckle.
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My grandmother is in a nursing home and this is how they do it there as well. Especially around busy time that way they don’t have to go running to residents needing assistance in their rooms. Usually lunch time and definitely shift change. A lot of the residents like being out where the action is. But if they wanted to be in their room they can certainly ask to be put back in bed or just wheel themselves off. It’s kind of nice for me because I like greeting the residents when I see them. They become a little family. Unfortunately my Grammy refuses to go or do anything so she’s mostly in her room in bed all day.
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Another poster compared it to a front porch. Brilliant!

At first we, too, thought this was terrible. Then when Mom asked to sit there “& watch the action” when each of us would leave, we looked at it from her frame of reference. She loved watching all the comings and goings; loved being greeted by people walking by; loved talking with others about her beloved Yankees; loved gossiping with other residents; and overall just loved the quiet companionship of others. A bonus was she could doze off & on when her body told her it needed it.  

We came to realize that initially we were projecting our own expectations & lack of limits on her situation. WE would find it awful if we, who could move freely, were forced to sit there. However, for Mom, who wasn’t mobile, it was the best thing possible. It actually was no different than her & I sitting in the garden or the great room together & watching others. It was certainly preferable to her being isolated in her room. Or being forced to participate in an activity she had no interest in.  

Mom, who was way down the dementia path, was still teaching her middle-age children a thing or two!
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MaryKathleen Oct 30, 2018
I totally agree with you on the projecting our wants and expectations part.
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My father and husband were both in the same nursing home, at different times, and both with dementia. Neither was in a wheelchair. My husband was a fall risk and was moved to a room near the nurses station which I appreciated because he would sometimes get out of bed in the middle of the night. But, if he was not in his room or the living room, he could usually be found standing at the nurses station. He was not expecting anything from them - I think he just liked the nurses and felt comfortable being near them. When my father was there several years earlier, one of the nurses told my brother that Dad would stand at the station and sometimes at night fall asleep while standing there. During the day, I saw many residents in wheelchairs wheeling themselves to the nurses station where they arranged themselves around the others in wheelchairs. The nurses and aides were very alternative to my father and my husband, along with the other residents in the memory care unit. Putting a loved one in a nursing home is difficult and something none of us look forward to. But sometimes that is the only way to keep them safe.
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There's a Gilligan's island dynamic in every nursing home. I'mpossible not to be. They are all there 12 hours plus every day. But for my aunt I've always required at a minimum that they have to be able to at least know exactly where in building she is at all times.
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Razzle-dazzle, this is first, last and foremost a sign of inadequate staffing. Which does mean, as you've noticed, lack of engagement. This is, to me, the number one problem in long-term care homes. There are not enought aides to do all they need to do, so they cluster residents where at least one nurse will be able to keep an eye on them and hopefully ensure safety. But the residents are not getting the attention they need to maintain optimal cognitive or physical health. When we move a family member to a long-term care home it is necessary to stay alert to what's going on and to advocate for quality care, starting with adequate staffing.

And there is always your county ombudsman. If you notice sub-par care, call your ombudsman. This phone number must, by law, be posted in every nursing home. I'm so glad you've noticed this important fact of nursing-home life.
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anonymous806474 Oct 30, 2018
I did talk to the Ombudsman for another reason...Dad was in emergency after his caretaker died, my brother, anyway i decided it was time for a NH
after four falls in the home and i was having a nervous b not recovered from the sudden death of brother and funeral so i looked in the phone book and
found a facility up the street, well they were so pushy and accomadating
going into the emergency taking his clothes looking at urine speciman to see if he would be discharged while i was writing a check in the room as a downpayment for 4700 per mo facilty..long story made short as luck would have it nurses in emergency called APS...i did not know anything
but in hindsight the nurses knew that i was being pushed and ultimitly
Dad stayed in hospital and facilty was unable to secure him and i lost the downpayment which was illegal or rather i was not told the slightest
about someone needs to be assessed in the hospital and the social workers will place dad...so i called ombusman to report this lady...due to the inefficiency and just frankly ambulance senior chasers.............my naivete..the APS called me and warned me and assisted me due to the
lady trying to put a very old sick dad in an assisted living...he was way past that...............just to grab the 4700 even for a month, no supervision no
information for me and dads gp nurse yelling at me saying i gave u a number................for your dad........this i think since brother had died and they were i should say very unhelpful as i tried to get brothers records.........he was a patient of this same doctor..........no help and just winging it.........for me ..............i got half of the downpayment back............450.00 but thks to a
conscientous nurse reporting what she thought was unusual pushy behavior i was helped...................................i went and retrieved dads clothing from the AS ,not for dad, who wasblind could not walk, needed rehab...….
and after 2 weeks in the hospital dad was assessed properly and with the APS representative with me place in a NH for rehab and stayed there until he passed six mos later ...........................
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When my mother was in SNF, for 10 months before I discharged her & took her home, she either sat in hallway or in front of nursing station...she was not able to & never learned how to wheel herself..she cannot walk or stand & has dementia & gets combative when she refuses meds that control it...I always felt better leaving her in front of nurses station instead of hallway...even though they could look down hallway...her room was close ...but she was usually parked behind woman in reclining bed (who could not walk either but had all her marbles) ...right, it’s not a party atmosphere, but they do the best they can...it’s never going to be perfect..
.wherever they are ...& they are never going to be satisfied...at least my mother...who is never happy wherever she is😩
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I think it's a bad sign but, sadly, in my (limited) experience, a lot of nursing facilities do this. It's called "warehousing." And they do it so they can keep an eye on patients more easily--without having to run to their rooms.

I had a very experience with it with my mom who had 100% of her mental faculties but was in very bad shape physically (a bad heart and anorexia). She was placed in a rehab facility to attempt regain her strength so she could have a (hopefully) life-saving heart procedure. The second day she was there, they had done that with her. I walked right by her cause I literally did not recognize my own mother--her head slumped down, quiet (the fact they did this to her was overwhelmingly depressing to her--and me). I went to her room, she wasn't there, walked back out, saw it was her lined up near the nurse's station and I flipped out. I demanded to speak with the head nurse who said that's the way they do things for "the patient's own safety."

Long story short, I got my mother transferred to another rehab facility where they absolutely didn't do that, they put in the extra effort and she got to live out her last days (unfortunately her sickness was too far gone and she couldn't recover) with dignity and on her terms.
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anonymous826112 Oct 30, 2018
My condolence to you. I can’t imagine how hard that journey was!
My Mom, isn’t as sick yet as your Mom was and prefers to get out oout of her room to her secured place- The nurses station
Different stages of being sick
my prayers to you
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They do this where my Mum is living and I am so depressed when I come around the corner from the elevator and find her and several others arranged in a circle just sitting, dozing or occasionally chatting. However, I checked and found that Mum attends and participates in some of the daily activities so she isn't just 'warehoused' all day. She would rather be there than in her room. There are people around, people talking and even when she is dozing she knows she is not alone. To us it looks like a nightmare but to her it is a comfort.
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anonymous826112 Oct 30, 2018
My mom has never been one to be
social. But she feels very comfortable at the nursing station.
i personally think it is fine! Mom is happy not being in her room! Also my mom loves the fact that all the staff knows her name! Makes her feel secure and “loved”
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I wouldn't generalize. Sometimes a resident is placed there to keep them from being isolated. In other cases, I've seen them place someone who every two minutes tries to get out of their wheelchair when they shouldn't due to fall risk. Check the schedule to see if there is an activity coming up or just ended to explain this.
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My Dad was also in this circle of observation with the nurses and other mates in wheel chairs..at first it was depressing but afterwards I understood the reason and ill explain the only negative observations, firstly the residents need some stimulation even listening to others is better than sleeping in their room sometimes..but the transfer rate is something that is interesting...some people must be put to bed for a nap but u need to transfer...it looks like the less transfers
how about diaper changing...is my only question..i would roll dad to his room around 2 pm and make smoothies..with fresh fruit orange juice,apple cider,throw in anything I picked up at the grocery store that day next door to the NH,
ok I never say the nurses offer drinks to the seniors in the circle my DAd never asked for anything...there were names on yogurts in the common freezer and perhaps they had orders or paid more but I never saw anyone giving dad anything, also he and they are all meek...dad had water all the time by his bed but he never drank it...only when I was there feeding or liguid smoothie feeding,
so yes the social aspect of sitting around is good...being in his room would be like being at home with the TV...…...Dad succumbed to a Severe UTI infection
and was sent to ICU with Toxic Shock...…..looking back it looked like Dad was
very sick for a while......he did always sleep even at home...but sometimes I thought that the staff just sort of gives up or avoids really sickly people knowing that the end is near...………….doesn't the facility need the money......they did ask if I wanted to change his room to the dementia ward...I was just being a detective..
there was a screamer in the dementia,also maybe they need to fill beds,or maybe the staff nurses are not very attentive or efficient Ill never know...skilled nursing facility I saw quite a few lapses...………...u really never knew if he ate the food..
anyway I thought the least I could do was take the vitamin c smoothies everyday
to insure some killing of bacteria in the body.
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To me, the nurses station is live theatre for many of the residents. It’s “As The Nursing Home Turns” daily edition. It’s the closest thing to a main plaza or village square and serves to both help oversight by staff and for residents to socialize if they want to.

If a NH is heavily Medicaid residents, it’s going to be extremely tight on staff. Whatever the required minimum needed to be open will be what staff is. For some states, the daily Medicaid room&board reimbursement is at or below the daily operating cost. There simply isn’t the budget for more staffing. Medicaid R&B is set by your state, if you want the situation to be better, you have to vote in elected officials that will put state funds into Medicaid programs and support all Medicaid programs.
Remember this when you vote next week.
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Often the ones that are placed around or near the nurses station need more observation and supervision than people placed in a common room or left in their rooms. Often though there are residents that will place themselves near the nurses station because that is where there are people that will or may respond to questions, there is more activity there or they are waiting for "the next thing" lunch, a snack, being told it is time for an activity or they are placed there if they are scheduled for therapy when the therapist comes the client is easily found.

In some cases it is a "lazy" way to supervise but you do not know the underlying reasons. If this happens to a loved one ask why this is done. When touring facilities ask why this is done and how often the resident is moved if it is not a supervisory reason.
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Be concerned pretty much only if you see puddles under the chairs and/if people crying for assistance of some sort and being ignored. In nursing homes, it has always been thus.
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GraceLPC Oct 30, 2018
Dear Ithasalwaysbeenthus,

Does not mean it is right or good. If they are there of their own volition, fine. If they are there for staff convenience, a sign of inadequate staffing or lazy work ethic, IMHO
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