Residents arranged around nursing station at nursing home; is this the normal way to supervise residents?

My mother is in an assisted living facility in the memory care unit. I agree with the answers already posted. By the nurse station is where the action is, and many residents like being there. Hopefully the facility also provides activities so that they get some different things to do, but the activities are usually just for an hour or less, so most of the time they are sitting, napping in their chairs or rooms, having their meals....In nice weather I like to take her outside and she'll sit outside and likes to watch people coming and going, but she always needs to have someone with her when she leaves her area in the facility.

I've seen that at every care home I've been too. I've been told the reasoning is that the staff has a lot of paperwork they must complete before shift end and they are not allowed any down time to do it. The paperwork must be done, while also caring for patients. They put the ones who are the most likely to "get into trouble" if left unsupervised all around the desk area so they can do everything the boss expects of them in the only way they can figure out to do it all. It seems to be common practice. Not good for patients or staff but from what I've seen, it's common.

My mom was walking when she was admitted into rehab for a fractured arm, simple enough...right. Not so much, apparently. Although she has Alzheimer’s/Dementia she would not wet her self. Being in bed or chair she would get up to walk across the room to her bathroom. ADMIN & STAFF knew of her orthostatic (dizzy when standing) were not competent enough to put in place basic toileting routines. Long story short ... they started keeping mom at the nurses station in a wheel chair. Needless-to-say; once discharged...she no longer walked and wore diapers!

I could write a book and appear before a congressional hearing about our hellish ten (10) months of nursing home/rehab experiences.

CHECK ON YOUR FAMILY MEMBERS. MAKE ADMIN & STAFF ACCOUNTABLE!!!

Dear Razzle Dazzle -

In all the years that I have visited hospitals, rehabilitation facilities, care homes, nursing homes, and hospice facilities - I have only seen patients voluntarily sit near the nursing station, but have never seen them encircling it.

Perhaps you could ask the facility/head of nursing why this is done.

I would consider the pros and cons of this practice in the specific facility -

Are residents being given enough in the way of stimulation and activities?

Is the patient-resident ratio adequate? Is this a solution to inadequate staffing?

Is the facility designed for this? Are pathways/exits blocked? Can staff, EMT or gurney move swiftly through the area?

Do residents have a choice about where they are placed to sit at this time of day?

Do the staff engage with residents during this “circle time” and visa versa?

I think answers to these questions might help you understand if the facility is a good fit for your loved one.

Very best of of luck to you.

You can add all the staff you want but unless you change the fundamental philosophy of care homes they will all just offer the same institutionalized care. I've done a lot of reading about alternative models that sound amazing but I've never seen any in action, I'd love to be a fly on the wall at an Eden home or an Alzheimer's Village to see if the claims are as good as they seem.

Even the expensive, fancy looking ones look like cow barns at feeding time. apparently they like the money to decorate their facilities more than to hire more staff. these homes are not the movie version where the patients are being wheelchaired around the sprawling garden grounds.

I had a friend in a nursing home for three years. When visiting, there were always patients sitting in wheelchairs in the hall and around the station. I would smile and speak to them and some responded. Those in the hall had TV to watch. One had a little electric keyboard for a while and was able to play some songs. That was entertaining for everyone. I think it is for them to see some activity instead of just lying in bed. When my friend was still able to sit up, she was occasionally there and I think it was good for her.

The nursing/rehab home my dad was at in Florida did this. I hated seeing him like that. However, when he was alone in his room in the wheelchair, he sometimes slid out of it. One time I came in and he had been there for hours without anyone helping him back to bed or chair! They lied to my stepmother and told her he had eaten breakfast in the dining room - he had scrambled eggs and finished them all. We both knew that was a lie because my father hated eggs and wouldn't touch them. I fed him a carton of yogurt and he practically inhaled it he was so hungry. I also noted that one of his legs was much bigger around than the other. When the "doctor" made his rounds, I asked him (sarcastically) if he thought my father's legs looked normal. "Gee, no, looks like he threw a clot." Dad was in an ambulance on his way to the ER before he could blink. I live in New York State and I'm sure we have facilities like that here, but it did leave a bad impression of Florida facilities for me.

It was like that when I visited my Mom when she was in a nursing home for respite care.

While visiting someone at a nursing home, I had observed this practice also. As I was walking past, a few of them asked me to help them get back to their rooms. I advised that I could not do that; I didn't work there and why don't they ask the staff? I was told that the staff puts them out there and they are not allowed to leave.
The ones who were not alert were sleeping with their heads on their chests -- they looked so uncomfortable. Some were falling out of their chairs.
I felt really badly but did not get involved. I didn't know what to do.

No, it isn't. My mom was in one of these half circles around the Nursing Station here in GA. She was falling out of her chair. I was not happy. Ended up getting Hospice. They were not caring for their patients.

Worked in nursing homes for many years . Was nurse, activity director and staff development coordinator. Often residents cluster about the nurses station. Sometimes I think it makes them feel secure to be near nurses. On the evening shift may also be for resident safety(unfortunately less staff on later shift) Various reasons that you see residents near desk, not all bad!

I just started working in a rehab and nursing home. The residents do sit around or in the nursing station. The nurses use this for residents who mite be risk falling or some residents just like to visit with the stsff

My mom hates being put in these circles or taken anywhere and “left for hours” as she puts it. I think mom is best suited for inbtween Assisted abd Memory ward. Currently we only have those options but new place opened up closer to me and they have a middle option. Will visit them!!!!!

I am going to answer this from my experience as the patient. If your LO needs rehab, this is important!

First, if possible, visit your final options early in the morning, before work. Are patients parked there up to 90 minutes before medication and meal times, so the, often only LPN does not have to walk the halls to give meds and check on patients.
I was in a rehab facility for several weeks about a decade ago. This was supposed to be a highly rated facility, and they did have a good PT department. Staff would start getting patients ready for the day by 6 am, or sooner. They would go down the hall. Get them dressed, transferred to wheelchair, reclining Wheelchair, or gurney ( with head elevated. Then park them around the nursing station so the RN or LPN could more easily give them their morning meds when she came on duty. They would stay there until the dining room opened and they were rolled into the dining room to eat.
These we're people who had been there a while...over a month. It was their normal. Look at what is going on, when other activities to stimulate Patients or get them moving.
My roommate, who had Huntington's was visited at least every 2-3 hours in her room. She had private insurance and a husband who came daily.
At first I was too weak and refused to be dressed and loaded at 6 am to sit there for hours. Then they tried it, and I was too vocal, so they kept me in my room, as I questioned the practice.

IMPORTANT, I was on a time sensitive, complex medication regiment, which did save my kidneys. I was repeatedly told that they Couldn't give me My Medications As Ordered because " they couldn't be running down to my room every 5 minutes!"
There was a medical necessity to my schedule. I needed to have one of my anti- nausea meds 'on-board' 90 minutes before what I called my Nasty Medicine...it smelled like skunk and I would throw everything back up without this regiment, plus a meal. Other medicines needed an empty stomach or spacing of 2-4 hours between certain foods or medication, but the staff wanted to just bring them all at once!

I was told that I was being a problem, and it could not be done to the point of harrassment. In fact, a night nurse, not wanting to have to give me an enema, after going to the ER via ambulance, in part due to complications to my constipation and distention. So she refused to give me my night meds. The ER had rushed my discharge so I could get back to have this medication, which ERs do not stock. Going 24 hours between doses, threw off my labs, and I became toxic.
First Do No Harm! I don't care if they are 100% Medicaid! Figure it out, or don't be in the NH business.
I was competant enough to stand my ground, literally to the point of exaustion. Finally, a wonderful night shift LPN asked if I would be ok with her waking me at the end of her shift, to get the nausea medications in me at the right time goes, I happily agreed. Like most people, I don't want to be woken from a sound sleep, unless absolutely needed, but this was the only solution offered to get this facility to follow my doctor's orders!

So visit before visiting hours, when you are down to a final few. Are these same patients there almost all day? Is the real reason to save steps and transfers for the staff? Sitting in a wheelchair all day is very hard on the back and posture. It is worse then being bedridden and your position never changed! You will get weaker, sore spots making rehab more difficult.

Poor staffing, high turnover, and understaffing are problems. But people are in a NH because they need more care then can be provided at home. Not less!

On the other hand my GM was in a Continuum of Care facility. Several family members worked there. No Circle of dazed patients! Adequate staffing and many regular volunteers. When the facility was sold, this changed. Within a year they all quit. They couldn't change things, and refused to be a part of it.

Several reasons. Social for the residents, afternoons is sundowners time when they change their personalities often for a few hours , so staff needs to watch them.

I too have seen it but the burden of paperwork on staff is high because they do a report on each resident on each shift - I have seen staff talking & laughing with residents while doing this paperwork because these residents are near the nurse's station - between cat naps some interact while others are no longer capable starting an inter personal interaction so staff will stop & say something to them or just touch a shoulder as they go about their duties - I would worry if they were all in their rooms all day with nobody around

personally for myself id want to be there than shut away and forgotten alone in my room with no one to see.

But also i want to be cared for no matter where i am.

There are a number of reasons residents are situated around the nursing station for long periods of time:
- Isolation and boredom are the saddest aspects of aging. What looks depressing to you may be all the social engagement they are capable of. Making an occasional comment or observation, receiving a few words here and there (between multiple catnaps) is connection.
- Some residents are not safe in their rooms alone for even short periods unless they are reliably asleep. People who get up and cannot support their own weight (restraints are illegal), people who have health conditions that can become acute throughout the day... Unless the family has the funds for one-on-one, 24-hour care, the staff must ensure their safety by grouping them where there is observation. Personally, I've thought that, if my parent needed such close attention, I'd insist they at least have the comfiest wheelchair I could find.

Of course, it's entirely possible that the SNF is understaffed or the staff is poorly trained. So, take a closer look at who is sitting there and how the staff interacts with them. Ask questions, too. They can't tell you any specifics of any resident's health concerns, but should be able to answer generally about why the residents are there.

I don't know if it is normal, but the same happens at the home where my father is staying. I think the residents like being around the nurses station because there is activity there and visitors coming and going. It surprised me as well, but there is no harm in it.

It’s pretty normal. My friend is a concierge at a fancy assisted living (although a large percentage of the residents need MORE help) and many residents congregate around her desk in the lobby to chit chat. Some just sit and observe, while others are waiting for the next activity to begin. They choose to be there...
Its safer and more engaging being out of their rooms and in the eyes of the staff and visitors. However, she also said that the “circle” of friends often mimics the cafeteria tables in middle school! Sometimes there are cliques and some residents are exclusive of others, and just because the residents are elderly, it doesn’t mean that they don’t engage in “mean girl” behavior! She watches out for that, too, and often steps in to help create a mutually respectful environment.

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.

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.

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.

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.

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.

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.

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.

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😩

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.