If anyone has any tips/tricks/hacks for care givers, please let me know! No tip to common so feel free to suggest and don't assume I've already heard of the technique. I want this job to work. God put me there! But really need some advice due to the severe minimum staffing level on how I can work faster! Thank you for any advice you can provide.
3 caregivers:
Supervise against elopement/inappropriate behavior
Notify the nurse's assistant in writing when a resident if off kilter
Notify the nurse's assistant when a resident does not have adequate supplies
Assist the nurse's assistant as needed
Assist the activities director as needed more days than not
Set/clear tables for a meal
Serve one hot meal and choice of hot or cold drinks in the dining area
Serve dinner to the rooms of residents who don't come to the dining room
Make fresh sandwiches to those who don't like the dinner offered
Provide on-demand additional snacks
Toilet and dress about half the 57 residents
Wash and put away dishes, cups, mugs, flatware and some pots from dinner
Put everyone to bed, put on pajamas
Serve on a shower team
Wash, fold, and return residents' laundry on a team
Chart
Tidy-up inadvertent messes
Forage for emergency supplies when families don't stock enough
Update lists
Try to impress visitors
Take out toilet trash immediately for each resident
Take out a 33-gallon garbage
Take out trash from a couple restrooms and a break room
Do other tasks as assigned
Remove dog waste from the exterior as needed
Can 3 people really do this for 57 mentally incapacitated elders? Any reasonable person knows it's impossible. If there any serious neglect or abuse worth reporting of course it will get reported, so I don't want readers to worry about the elders. Everyone I work with has a huge heart & wants to please the residents. But it's impossible to serve 57 people with 3 people. I find myself getting shorter and shorter with residents. I don't have time to look at their lovely photos or listen to their problems! But when I did care giving in people's homes, we always had time to listen because companionship was just part of the job. But not when you are caring for 19 people by yourself! One care giver generally could probably serve 10 people but certainly not 19! Washington State allows ANY staffing level as long as the job gets done.
The job does not get done! Because we are low staffed there are bugs in the kitchen, things are chaotic, residents shoelaces are hazards since we don't have time to un-knot them, meals are not truly served hot, sometimes a waste basket with a brief in it does not get immediately emptied., fruit gets microwaved on some dinner plates, caregivers are not as sanitary as they should be (caregivers have provided toileting care with no gloves, soap runs out of dispensers), paper towels run out, floors are not as clean as they should be, laundry is often a terrible chaos, caregivers are not truly familiar with emergency procedures/equipment. There are many gaps in service.
After most shifts, I am ready to die in horrible pain, can barely walk or stand up straight, and am kicking myself because of gaps I left in service. My coworkers do not even take their short breaks & we all work charting when we are supposed to be on break or lunch. Whenever anything goes wrong, the care giver is blamed, not the staffing levels. There is constant staff turnover. Why is skeleton staffing legal? Is the government accepting kickbacks? Why doesn't the health department check our kitchen after hours?
understaffed. The SNF my mom was in had 40 patients, 2 RN's & 2 CNA's. I'd call the nurse station nobody ever answered the phone. Couldn't reach my mom by phone one weekend, called the AL building&threatened to have the Sheriff Dept do a welfare check. I felt terrible for the staff, patients and especially my mother.
I have no way to know, OP, how old you are or how long you’ve done this VERY NOBLE and ESSENTIAL WORK, OR (very important) whether your geographic area was effected by COVID (mine was a hotspot, with ongoing devastation).
Instead of having a central, scientific, well ordered approach to wholistic care, we as a country had…….what we had.
Some areas didn’t see any of this as a problem.
Some suffered, from hands on personnel to medical staff to “government” inspectors. Our “family” residence did.
I apologize to you OP, and applaud you for wanting to make things better. You have described what I have seen.
In my geographic area, there are not enough healthy, able, well trained people to meet all of the demands currently needing to be addressed.
No obvious solutions around here.
It's so hard wearing a mask. I have my own health conditions like asthma and more. For 40 years, the industry made us get TB shots because "You'll never, ever be able to wear a mask while working, especially in summer! You couldn't do it!" But, suddenly we all had to do it, and are still doing it, thanks to Covid. I guess there's no need to get the TB thing now because we all have to wear masks anyway lol. "I'll wear the mask" ha ha, I wonder if they still accept that. We do have a shortage of workers right now.
Are many of your residents 2:1, though?
But as I said yes you do have my heartfelt sympathy. There is no time. There is too much work. There are standards we aspire to and are held accountable for which are impossible to achieve in reality. There are common practices in the sector, including gaslighting and double binds, which are so blatantly abusive of workers that the fact we don't even consider reporting them itself shows that the gaslighting is successful. Take your gloves issue as an example.
You MUST wear gloves.
There aren't any gloves.
Why didn't you order the gloves?
We did order the gloves, they haven't been delivered.
You can't provide personal care without gloves. Now, why hasn't Mrs Muggins had her shower this morning?
[Credit where it's due - when this came up with us once, mid-Covid, our Service Manager got in her car and drove to God knows where to get PPE which she paid for herself.]
Why can't we get the staff... Is it the pay? Is it the profit? Is it the government? If you ask me, it's the negative social status. Why aren't people with a decent standard of education and domestication and moderate personal hygiene - which is all you need, really, to make a start - prepared to engage in a career that is unparalleled in terms of fulfilment and social value? Because... I can put it in a nutshell. My children are embarrassed to tell people that I'm "a carer."
And the clients' attitudes?
"So, S, why are you doing all this dirty-work?"
"You can't be from [team]. You look much too professional."
"I couldn't do your job. I don't know how you can do your job."
"Can you girls make sure you put the cream on" - this one does bring on my red mist, because it's always from District Nurses who are young enough to be my granddaughters and who apparently haven't noticed that quite a lot of us are boys.
Anyway. The next time I hear anyone whining on a radio phone-in about failure to recruit to the social care sector I'm going to call in and ask what they're doing about it. "If not you, then who?"
This skeleton staffing is not legal. Something fishy is going on at whatever AL facility you're talking about.
Either the administrator is asking too much of the three people on staff because they want to keep a full house which keeps the payroll cost down. It sounds to me like the people who run the place are letting residents stay even when they have progressed to the point where they need a higher level of care.
This is totally illegal.
There are no tips or hacks anyone can tell you that can make a three-person staff for 57 function successfully. I am shocked that you would even dare to even ask such a thing. Grow a pair and report this facility thatyou work in to every government agency that will listen. Call a couple of news stations too and tell them about the care facility full of 57 incapacitated elders with severe dementia and there is a staff of three caring for them. They'll be all over it. Contact the state's governor.
Then the three of you need to approach whatever passes for the DON or administrator of the place and tell them that you are going on strike.
Go on strike. This is what is best for the residents and the workers.
I'm feeling a little burned out, too. Okay, each shift has between 2-4 care givers. My shift always has 3. That's for care givers. Meals, medicine, coordinated activities, some snacks and weekly room cleaning are done by other workers.
Thanks for telling me it sounds like residents need higher care. My supervisor is very interested in that topic because he came from a mega-home where that was being done so unethically that it caused a lawsuit. So he will be sympathetic and you've given me the reminder to always chart assistance above and beyond the care plan.
I read the law and it said there is no ratio requirement here, at all, as long as the job gets done. But we cut so many corners to get it done. We are not unionized. I only know of one unionized care giving service locally and I don't recommend them because they squeeze the life out of their workers, too. Thanks for the reminder to chart residents' needs as they increase. I really appreciate it!
I am so sorry that you don’t have more help. I don’t know how you’re still standing. I would be dead from exhaustion!
Has it been this way since you started working there?
There are no ‘tips’ to offer in a situation like you have, because it’s impossible for three of you to do all that is required for the residents.
I don’t know how the three of you are surviving this. What happens if someone quits in your skeleton crew?
What will happen to the residents or the remaining workers then? How many hours are you working during your shift?
How many complaints do you hear in a day? I am sure that many residents have needs that are not being met and have a right to complain about it.
It was hard enough for me to take care of one person, my mom, in my home. I can’t even imagine working as a caregiver in a facility and being that short handed.
You say, “God put me there.” I admire that you are living out your convictions but I would be praying that God would take me out of there!
It sounds like you are trying to do your best, but even your best efforts wouldn’t ever be adequate for that many residents.
Are other facilities in your area the same as yours? Have you considered doing caregiving with an agency or independently?
How do you even find a minute to use the bathroom when you’re at work?
Honestly, I don’t know how your facility hasn’t been shut down. I know of one facility in my city that was shut down. They had numerous complaints and they are no longer operating.
I certainly wouldn’t want to be a resident in the facility that you are working in. Nor would I want to have a family member living in it.
Surely, you have complained about your working conditions, yes? You must have shared that your residents need more assistance than you can offer, right? What was your boss’s response?
Do you think the low pay is the predominant reason why they can’t get help? Not everyone is like you and feels like God placed them in caregiving.
People need more money than minimum wage or slightly higher to pay their bills. It’s a shame that the pay is so low for caregivers. They work so hard.
This is long.
Yes, it was worse when I started & has gotten a little better as I have tried to be an example to other employees in reducing chaos by multi-tasking and being proactive. However, I have to be careful with that because if I stock soap or paper towels, I may be considered a slow employee for not getting enough residents to dinner in a timely manner. As I've gotten older, I have noticed that I seem to work in certain places for perhaps God-given reasons. I've made a difference in individual quality of life and in getting better processes in place to prevent problems. So before I bail out on this job, I hope to wait and see for when I get that feeling of, "Oh, so this is the employee/resident God put me here for". I just don't know if it's right to stay to help one or a few people, if it means condoning poor business practices. So yes, I am concerned about adequacy for sure.
Most of my prior care giving has been in independent houses/apartments of disabled people, and one small adult family home. I grew frustrated with not getting enough hours whenever "headcount" went down. I need consistent income. But to answer your question, I did serve 2 weeks in a "home" about the same size as this one a couple years ago before the state came in and made them re-organize. It was just like this. There were service gaps. But it inconvenienced residents, like one man having to pack up all his belongings in a heavy backpack several times a week to go to dialysis because no one bothered to show him that his closet was secure and had a lock and key! One (truly helpless but recovering) woman was not given her blood pressure medicine right. Her husband was very watchful and came daily. He noticed her BP was high, in the potential heart attack range. But she remained okay. It was after that the state came in and said that more CNAs needed to be hired, so they let a couple workers like me go. I had been doing paperwork, and acting kind of like a hostess to residents at times. To be continued...
I agree that tips and tricks are not the solution. But I think I could use a little guidance. For instance, I didn't know the plastic bag trick for putting on compression socks until I read it on You Tube. That saves a lot of time and energy. I also learned to keep my pockets full of any item I could possibly need from gloves to a piece of chocolate to placate a rager.
We have had people quit, and then normal staff starts working doubles. But they are exhausted so laundry gets backed up/lost, the kitchen is not really right at the end of the day, and the floors don't get cleaned. The residents face longer wait times when they use their call buttons, their laundry seems lost, their loved ones get upset about that, and workers continue to perform only the bare essentials while dispensers run out and supplies are not ordered.
I hear small complaints that I can fix a few times a day, like, "I'm cold", "My food is dry", "There is nothing to do", or "The ladies aren't friendly" (a male). But I don't hear daily complaints but once a week or so a loved one will ask why there aren't more staff, where a garment is, about a confrontation between 2 residents, etc... I am surprised there aren't more complaints, but these residents do not seem to come from loving families and truly are a disoriented set of people and they don't have the mental capacity to make strong complaints. When they do, their complaint is based on delusions (dementia). Many do not know a shoe from a telephone, honestly. Care givers work seven and a half hours per shift, with a half lunch and supposedly a very short break. If we worked 8 hours, the company would have to give us another short break. I think residents' essential needs are taken care of since any serious red flags quickly get fixed, like food, drink, medicine, security, shelter and changes in residents' health. But I don't like to see people come to dinner with mis-
What should we do? How can we help?
"Hello. There is nobody available to take your call at the moment and you can't leave a message. Please call again later."
The client arrived home about two hours later to everybody's delighted surprise (yes, including his), but without his medication or discharge summary and with the wrong night bags for his new indwelling catheter, and only four of those. And without a two-person assist, despite the OT's request, which made getting him up the nine steps to his front door interesting.
It isn't just us, it's murder on the dance floor for all areas of health care right now.
CM,
How many accidents do you see with the elderly dealing with stairs?
My uncle ended up living in his basement before entering a facility because he could no longer go up and down the stairs in his 90’s.
"The New Jersey bill calls for: 1 CNA for every 8 nursing home residents during day shift (typically 7 am – 3 pm) 1 CNA for every 10 residents during night shift (typically 3 pm – 11 pm) and. 1 CNA for every 16 residents during overnight shift (typically 11 pm – 7 am)"
IMO this home is running illegally. They need to hire other aides if possible or shut down. Residents are paying for care and not getting it. I am surprised the State allows this.
No way can one person care for 19 people.
This situation is criminal but, Washington state is corrupt to the core.
I would end up in a mental hospital. Seriously. I would be nuts if I were taking care of that many residents.
No one should even attempt to be managing in such conditions. The state does make some regulations on facility care. Granted the bar is set pretty low on standards of care that have to be met, but it is there.
The three CNA's who have to care for 57 people (which the more I think on it seems like it might be exaggerated a bit), need to report this facility to the police and any other authority they can think of and then stop showing up for work.
Go on strike. The three of them can head down to the unemployment office and explain to them why they're not showing up for work anymore.
They won't be denied. Then picket the place until the state forces them to clean up their act.
After observing my father’s recent SNF stay, it’s apparent that the roles & tasks of nurses have greatly changed. LVNs do the hands-on technical medical care while the RN is mostly administrative. CNAs do anything & everything else. Far too much.
In the situation described above, it’s not difficult to do the math. Please report your experience to county authority/regulators. A picture is worth a thousand words, we all got phones & you don’t need to identify anyone to prove the point. Although I wouldn’t worry about any repercussions, obviously they’re too short staffed to loose you. And I completely agree, what’s occurring with these nursing facilities is shameful.
Best of luck & don’t give up.
It doesn't matter if it's wrong all you can do is report these things to the proper agencies. More than likely nothing there will change.
All the money they charge for this is truly sickening that most are not held accountable with required staffing.
As people are living longer and longer with dementia and incontinence and being bed ridden I dont see this getting any better only worse with an aging population.