Paper Trails A Must In Long Term Care Facilities

Paper trails are a must as your loved one progresses to need more care, more time and "costs" the facility more money. 

Without your tracking the challenges you've seen first hand or become aware of through a visit, your concerns and complaints become a lost cause to try to remedy when the State comes calling, as they do, for either a regular visit or for a special investigation.

Aides are the lifeline and the heartbeat of Long Term Care Facilities. 

They are the 24 hour people responding to the call, the buzzer, the needs and wants of the residents. And, they see, hear and touch residents having the most frequent contact and the most active physical, emotional and psychological contact.

Yet they are the most under-trained and seldom given first hand, from the best source (especially any from outside a facility), direct experience training.

Aides usually get "retrained" after an "incident" that has involved a resident and caused some form of need to acknowledge a problem. 

Think you're protected? A Federal program. The Ombudsmen (actually men and women).

In our area this Federally Mandated service is now called "VOYCE" so check closely to find your "version" of "Ombudsmen".

Then look closely. You'll probably find variations on a theme. The theme? Must be invited in. Aren't there to really meet with, work with. Usually only able to spend a few hours in the whole facility. Let's see -- a few hundred people -- how many do you think they really "get in  contact with"?

In many, they're not the advocates they're supposed to be. They're "mediators" only activated and coming into the facility when a phone call or email activates a "need to respond" and even then, it may be only a phone call to "check it out" and not a "real personal visit".

CNA's have the ability to see actions on the part of the resident that could lead to more serious challenges, that is if they are encouraged to spend time with the resident and observed and their input is valued and not dismissed or told "that's the LPN or RN's job".

EVERY PERSON IN THE LIFE  OF AN OLDER AMERICAN WHO LIVES WITH, PROVIDES FOR OR COMES IN CONTACT WITH is an important link in the chain of ensuring Seniors have quality of life.

Most facilities are understaffed with CNA's, sometimes as in Mom's old facility with one CNA for a whole half floor, numbering between 15 and twenty people, and one LPN per wing/half floor -- or in some cases for the entire floor.

State Regulations should be based on the needs of the patients and also on the concept one person (Aide) cannot be in two places at the same time; it's like two kids who want something at the same time or who NEED something at the same time and a parent can't be in two places at once.

Taking this concept a step further: think of it this way -- one parent, one child versus one parent five children. Now, have them all be "sick" at the same time although the levels of "need" from providing medication to changing bedclothing or clothes varies. Could you predict when the one parent will begin to "lose it" and or not give the right service at the right time?

That's exactly how our LTC's shouldn't operate but they do. Faced with mounting bills and reduced compensation, they struggle to keep staff and usually face cuts all around -- staffing, services, food, etc.

Ever notice when you visit how early the residents "go to bed"?  

Do you really think it's their choice? 

Ever notice how "sound asleep" they are?  

Did you know they're probably "knocked out" for the night? 

Doctors associated with Long Term Care Facilities are "selected" by the facility, are "allowed in" by the facility. So who do you think they work for? The patient? 

Did you know, at least in the State of Missouri, as I discovered yesterday in my readings of State Rules and Regs that the Facility Doctor in charge can actually "override" and "add" to the PNR's given to patients and among these, of course, can be meds to allow "rest" for the patients who seem to be causing "disturbance's" with their ability to roam, call out or in other ways "disturb" other residents and staff. 

IS THIS WHAT YOU WANT FOR YOUR LOVED ONES?  

HOW ABOUT FOR YOURSELF IF YOU BECOME ONE OF THE MANY FACING BEING "INSTITUTIONALIZED"?

Keep a "Visitation Diary" noting the date, the time arrived and specific notes.

OBSERVE  and check out drawers, closet, medicine cabinet, bathroom, bed.

Where is the call button when you arrive? Within reach? Or pulled out of the connection?

Take off your shoes and walk across the floor. Is it dusty, dirty or slick? 

Any visible black and blue marks? Ask to see the record and when it/they were noticed and what was cited as "the cause".

Check out medical records if you have the Medical Power of Attorney. What meds are give regularly and MORE IMPORTANTLY, ask for a list of all "as needed" drugs still on the record.

WANT TO REALLY ENSURE YOUR LOVED ONE'S SAFETY AND WELL BEING?  

Ensure someone has a Medical Power of Attorney and hopefully you have a family unit that works together so that all members observe, notate and share with other "care givers" what they've observed and heard.

Ask yourself.....as a parent did you use a "nanny cam"? Did you question the children about their "sitter"? Did you interview others who used the caregiving services?

Why do we "turn over" complete care to people who are paid based on the amount of services rendered?

Why do we "assume" our loved one is well taken care of and the facility only has their "best interests" in mind?

Many do. Many don't.