Thanks Tornado, discouraging. Seems like only thing we (the tax paying public that contribute to Medicare and receive it) could do is lobby for change. With my local elected reps that’s like spitting in the wind, but doing nothing is not a good thing either. The money making companies would and do kill patients to solve the problem If it weren’t for Regs and inspections.Latest scandal I read about is over medicating patients because they don’t have the staff to care for them, so dope them up so they can’t move until they get gangrenous bedsores and die.
Sheepfarmer, its funny you mention that article about the over medicating dementia patients. I just read that same article this morning. I forwarded it to my wife as well in case she misses it because she will enjoy reading that. The article was very good and does highlight a problem. The only downside is that it misses some aspects to that problem I wish they could share, but that would require nurses at those nursing homes being able to speak freely. It would not alleviate the blame or the problem, but it would help give some context to what the nurses are often dealing with in these nursing homes. Also I agree with you on the regulations. There is so much going on in the care of others that regulation has to be pretty tight. My wife would also agree. She does see these inspectors as necessary evils. It makes her life hell, and often feels nit picking, but she understands the necessity of it all - despite its frustration.
As the article stated, and as I have laid out here, many of these facilities are chronically understaffed. Many of these facilities are also ill equipped to care for patients with severe dementia. My wife has had some severe dementia patients, and other mentally ill patients in her facility, and they are so so hard to care for. By law they can not restrain them, so often these patients roam around and just cause total havoc in the building. Some of the things my wife has seen in these patients: Assault nurses and other staff, curse out people and use racial slurs, throw stuff all over the place, smear feces all over the walls, throw feces at nurses or out into the halls, pee on stuff, try to run around naked, refuse medication, pull any health devices or monitors on them off, refuse to eat or throw their food all over the room, the list goes on and on and on. Often times these patients tend to fall a lot, or hurt themselves in other ways with all the crazy antics. One of the many things that is monitored and can ding a nursing facility is falls. They are counted and one of the many parameters that are monitored. If one patient is constantly falling or hurting themselves it can quickly become a problem for the facility. You cant restrain them, you cant sit over them and babysit them, but you cant let them continue to fall or hurt themselves. What do you do? It is a tough balancing act. My wife has had nurses walk off the job over specific patients treatment toward them. CNA's in particular bear the brunt of this, and are paid little more than fast food workers. If you are cursed out every morning, hit, have feces thrown at you, have a grown angry old man hitting you, or in some cases trying to grope you and being sexual toward you, and you have to deal with it every morning, how long do you work there? Eventually these worst patients become the bane of the staff. No one wants to have them on their rounds. They dread having to go into their room. While I do not condone what this article highlights I can see how it would be easy for some to want to just sedate them. This is another one of the things that covid has made worse in nursing homes as well. With family not allowed to visit, some of these worst case patients have gotten even worse. Some have even become suicidal with the lack of being able to see family.
The article also briefly touched on a very important as well. That nursing homes have increasingly become a "dumping ground" for a lot of really tough patients with no where else to go. Patients who have no real family, are very ill, have no money, etc. end up in one of these facilities. You can often have some very mentally ill people in nursing homes being treated by a nursing staff who has NO experience in psych patients at all. Sometimes the nursing home has no say in the admission either, it is done from a central intake office further up the corporate chain or something. Another issue, but slightly off topic of this issue is the admission of high acuity patients to nursing homes, meaning ones who are simply very sick, or have bad wounds that need constant care and close attention. Here again you often have nurses who have never worked ICU or dealt with a high acuity patient. You can have all the education you want in nursing, experience is king. Having multiple years of ICU experience looks really good on a resume for a nurse.
As with most problems of this size, there are a LOT of angles to it. The article sort of leaves the impression that the nursing homes are just being careless to these patients. In some cases they may very well be. There are some bad facilities out there, no doubt about it. A lot of bad facilities though end up giving in I think to jus the poor, unmanageable mess as I've highlighted in my post here. It often feels like the whole system is so broken, so it can be easy to want to just throw your hands up and say "Screw it, no one cares, so why should I care " It is very disheartening. But caring for lots of old / sick people requires a LOT of money, time, resources, and attention. Money doesn't grow on trees, and these companies want to make profits, so this is the mess we have. It will never be perfect. Caring for sick and/or old people with huge lists of problems will always have big challenges, even to a facility with endless money at their disposal it would be a challenge. It is a big job what these nurses are tasked with. The work load, the level of responsibility, the demand for accuracy and critical thinking skills means that we as humans are going to falter, even in the best environment. It is true too that there are a lot of poor nurses out there. There are a lot of nurses who simply don't have strong critical thinking skills. You have some nurses just in it for the paycheck and don't care. You also have some brilliant nurses, who can school many doctors in the patients they look after, who are true patient advocates, who actually care and care deeply. Unfortunately those good nurses are the ones who get dumped on the hardest. If you are one of the few who actually care, then you end up doing a lot of the work of those who don't care, so you just burn out even faster.