Unseen call lights flash down the hallway. 4 nursing home residents have pressed their call buttons for help and there’s nobody to be seen. The nurse’s station is empty.
“Where is everybody?” I think to myself, as I often do.
I’m making my morning round to touch base with new patients and interview them for food preferences and go over diet information based on whatever diet the doctor has them on from the hospital.
Before I go to my first patient’s room, I need to tend to these call lights. “Every light, every time.”
I go into the first room and knock on the door. “This is Sarah, the dietitian, may I come in? I see your light is on.”
It’s 8:45 a.m. and the patient is lying in bed with her pajamas on trying to sit up to eat her breakfast that was delivered at 7:30 a.m. I push the button to lift the back of the bed up so she can sit up more easily. Her food is ice cold and she has debilitating arthritis and can’t open anything without assistance. I ask if I can heat her food up, and she doesn’t want me to fuss with it. She needs to use the restroom. She uses a walker, and I’m not competent enough nor do I know her well enough to know how to safely get her to the restroom. Nobody wants to eat cold breakfast with a full bladder.
I poke my head out of her room and look around to see if I can see anyone.
The other 3 lights are still flashing down the hall.
“WHERE IS EVERYBODY?!” I think to myself, again, for the second out of 1,000,000 times today.
“Let me go see if I can find someone to help,” I try to reassure her that she’ll get help soon. There’s no telling how long these lights have already been on.
I’m on a wing of the nursing home with 20 patients. There are 2 nurses and 2 nursing assistance on the wing. The nursing supervisor is in a manager’s meeting, 1 nursing assistant is in a room feeding the patient, the other is in the dining room helping to feed a table, 1 nurse is still passing 7 a.m. medications, and the other is giving a bolus tube feeding. There are 17 unattended patients on this hall alone and 4 of them need someone to help them.
There are not enough hands.
“We meet the State’s requirements for staffing ratios,” I heard all the time when I brought up patient safety concerns.
Ok then, why are we discussing a fall report every morning?
And who makes those ratios though for real?
This scenario was stupidly common during my time in nursing homes. It was frustrating as a non-nursing personnel, because most of the time I needed to be helping in the kitchen, getting preferences, filling out all the required paperwork, re-calculating tube feedings, gathering weight data, etc., was filled with answering call lights, lifting beds, refilling water jugs, telling people “I’m sorry let me see if I can find someone” 15 times a day when they had to go to the restroom but needed 2 people to assist them, feeding people when I felt incompetent to do so but they were hungry, etc. Top priority was meeting the patient’s need, but sometimes I couldn’t and it killed me. I know the therapists and other non-nursing personnel were frustrated by it too, but hands down the most frustrated people in a nursing home are the nurses and nursing assistants. Oh and the patients.
They have such good hearts and incredible work ethics (the majority of them anyways, there are always a few iffy ones), and I can’t imagine how it would feel to have 10 people entrusted to you to care for and keep well and you’re constantly scrambling to meet all of their needs. The patients are angry that it’s taken so long to get help and many times they just couldn’t wait any longer and would get up and try to do whatever they needed to do by themselves.
Falls. So many falls. Then the nurse that wants to be able to help all of her patients is now filling out 3 hours of incident report paperwork, calling families and doctors and taking even more time away from all of her patients because of the fall.
I always said, you could NOT pay me enough to be a nurse in a nursing home. It was always worse in the facilities with acute short-term rehab patients because the patients turnover constantly and you’re getting to know new patients and new family members and new therapy schedules and new medication passes and new everything all the time. With long term care, the same nurse has her same patients over time and can get into a good flow with them. There is no flow for nurses in the acute care facility setting.
A simple truth hit me while I was there. They always talked about ratios of nursing personnel to patient. If the ratios have been set over time, then that’s the root of the problem.
Nursing home patients are, on average, not “normal-weight” people. As a dietitian, you’re pressured in that environment to ensure your peeps don’t lose weight. This is contrasted by the overwhelmingly obvious fact that most of them are morbidly obese and the conditions they’re there for are actually related to the obesity.
If, in 1950, you had a certain ratio of nursing staff to patients and that has remained the same for 68 years, the biggest thing that’s changed is the actual physical weight of the patients. From my experience, much of caring for mostly bedridden elderly is turning them in the bed, getting them to the restroom, and keeping them clean and fed. All of these activities would usually take a 1-person assist. But what if the weight of the average nursing home patient has doubled, tripled, quadrupled in 70 years and it now takes 2-3 person assist on average to care for these basic patient needs?
I don’t know actual percentages, but the vast majority of my patients were 200+ pounds. Some 300+, some 400+, some 500+, and one 600+. How many people does it take to turn a 400-pound patient to prevent bedsores? How many people does it take to assist a 300-pound patient to the restroom? I don’t even know the answer, but I know it’s more than 1 person. So technically, the ratios are no longer the same, nursing staff are left scrambling around trying to get everything done with the pressure of management thinking, “What’s wrong with you?!” But worst of all, these poor patients. Patient care has diminished not because of lazy nursing staff, but because they literally can’t keep up with the ever-increasing weight of the patients.
What’s the answer? I have no clue. What do you think the answer is?
This is why I moved into preventative wellness. Preventing even just one person from needing to go into a hospital or nursing home facility to begin with would be a win for me.