Friday, October 29, 2010

Choosing a Nursing Home Part 2

I did my last noc shift night before last, which means I have more time now again! In fact, my new job is split day/eve shift, but never both in one day, and I'll always have 2 days off in a row; isn't that called a weekend? I can't remember. It sounds heavenly though.

So now I have time to share my hard-learned lessons on choosing a nursing home to live or work in. I think they can be the same post, because if a nursing home is bad to work in, it's probably bad to live in. The reason residents are there is to get care, and if the employees are miserable, the care is going to be substandard. If the employees are happy, the residents are happy, and it creates a happy cycle.

I made some big mistakes on my last job hunt; I let schedule and pay dictate which facility I chose, and overlooked some red flags. I'm actually pretty embarrassed about that, but at least I can come clean here so any readers (hopefully) won't do the same things. I was just so focused on finding a job that would allow me to keep my homecare job that I chose the wrong facility. If I'd been willing to give up my security-blanket job at the homecare agency earlier, I think I'd have chosen differently. Oh well, here I am about to start at the GreatRep, so it all is for the best now!

Mistakes I made:
1. On my tour of the facility, I didn't insist on seeing into any of the resident rooms.
Realistically, this may not have saved me, because usually you don't get to see one that's currently occupied. The "model" room or apartment is usually empty and therefore looks perfect. But at the Crapdorable place, I had no idea that around 20% of the residents sleep on mattresses on the floor. It's for safety, to keep them from falling out of bed, which makes sense and all, but is incredibly hard on the caregiver's body that has to try to change their briefs and reposition them while kneeling on the ground next to them. This is why I was limping after each 4 day rotation there. The other reason to ask to see the rooms is to see what type of beds they have (if the facility provides them) and whether they're adjustable or appropriate for employee and resident safety.

2. I didn't ask the hard, slightly rude questions.
I did ask about aide to resident ratios, length of shifts, etc. But I didn't ask about how long management had been in place, whether there were any recent or upcoming changes there (new Executive Directors, new Administrators, etc). I didn't ask about their employee retention rate (20% at the Crapdorable place - huge red flag that I wish I'd known before I began there). I didn't ask about their call-out policy; if the answer is "you can't leave until the next shift arrives" this probably isn't a good place. Of course you can't leave, that's common sense that you cannot abandon patients. However, a good answer is "If there's a no-call no-show, your manager will find someone to come in, and will make sure the floor is covered in the interim". An excellent answer is "We provide an incentive for anyone who comes in on their day off so it's usually pretty easy to find coverage". A typical, reasonable (in my mind) policy is that if you call out, you must find your own replacement. The idea here is to discourage people from calling out hungover, or for other fishy reasons. Each employee gets a phone list, and usually if you're calling out for a real reason and have tried to find coverage and can't, a good manager will help you from there.

Another big question that's good for families AND employees to ask is "how full is your facility?" (aka what is your census like). If it's very nearly empty, proceed with caution. Sure, there's a recession, and more people are trying to make do with home care. But the good places will still be fairly full. Because locals have heard good things about them and prefer to put family there, rather than the sketchy ones. And if the answer is "lower than normal because of stop-admittance orders" RUN AWAY. Remember, that means they did something so bad they cannot allow new residents to move in for a set period of time. BAD.

3. Take a good look at the residents and employees you see during your tour. Do the residents look clean and kempt? Is their hair greasy, or is it combed pretty neatly. Do they themselves smell bad at all? Are their clothes weather appropriate and fairly clean? If it's a dementia facility, lower your standards a bit, because the residents often resist care, but still should get as much as possible. If they look visibly dirty, or unwashed, or their clothes obviously haven't been changed for days, this is a bad place. Now how about the employees? Are their uniforms clean? Is their hair reasonably done? Are they wearing inappropriate makeup? Do they look professional, or do they look like they should be smoking out back of a gas station? I know I'm judgemental here, but if the employees look trashy, it's a warning sign. If the employees look like they could be posted on it's not a great sign.

4. Lastly, smells. Any bad smells should be temporary. Or have a specific reason for them. If the entire place smells like old pee, it's because it's covered in old pee. The hallways absolutely shouldn't stink. Individual rooms sometimes might, especially if the resident living there has a habit of peeing on the floor (many do) or has frequent UTI's. Nonetheless, staff should be working on it to keep it to a minimum. A stinky place is probably not a clean place.

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