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Lupara

I have a relative in a elderly care facility

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Who makes these stupid and dangerous decisions?  What is a patient decides to sleep outside on a window ledge, then escape as my father did, almost falling three stories in the bargain?  He almost took the male nurse with him.  That was at Phillipsburg Hospital.  

 

There are different levels of care needed.  Some patients have crystal clear minds and others are living in fairy or devil land.  Some can stand but can't walk or navigate well.  Some climb out a window or a door, or wander into other patients rooms and hurt them.  Some need restrained to make sure they don't fall out of their chairs.

 

I would NEVER sleep in a hospital bed without the rails up.  They are security when you are sick.


"The world will not be destroyed by those who do evil but by those who watch them without doing anything"

Albert Einstein

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7 hours ago, lavender said:

I spent at least 15 years working with the Area Agency on Aging. During that time we were advised that state visits were announced in advance. I certainly knew when they were to occur as I had to be there for the closing.  It was always emphasized that the advantage of ombudsman visits were that they were spontaneous. 

I agree that these facilities need more staff however they must be staffed to a certain level by state law so it is not as though they are being run with a less than safe level of staff. Employees must log enough hours , depending on their position, to spend a certain amount of time with each resident. If they don't have records of said staffing levels they are cited and must correct the problem. Failure to correct problems leads to withdrawal of accreditation, which leads to no more funding.   There is, of course, no way of ascertain that an RN, for example,  has spent the same amount of time with John Doe as he has spent with Richard Roe. And that includes the rest of the staff as well. Believe me that the miserable, combative resident or one that is totally passive isn't going to get the same attention as the sweet, cooperative, delight to be with resident. Visiting relatives or volunteers can sometimes bring problems to the attention of the staff that they have overlooked. 

It is not as though volunteers or relatives are watching the staff just to catch them in a dereliction of duty but  residents may share problems with these people that they won't share with the staff,  either because they don't want to complain or they can't get their attention. I once interviewed a perfectly rational man who was in a facility recovering from surgery. He wasn't eating and apparently no one noticed or if they did they put it down to lack of appetite.  It wasn't lack of appetite but the fact that he couldn't feed himself because of his position in the bed and the position of the tray. He didn't want to complain and he was going home eventually so he was just going to tough it out. Family and visitors are important as advocates for people who often cannot or won't  advocate for themselves. It isn't all just tourchy, feely, make the resident feel good.

Why should these people have to "advocate for themselves"?

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state visits are not announced. The staff have no clue when they are coming.

It is state law no bed restraints and seat belts. According to the state family cannot sign a release. If you want to complain go to your legislators. The law is in place because patients have rights. It is not the nursing homes fault they cannot control state law.

Alarms agitate the residents and when they do go off the patient has already fallen so they are useless. 


Every time the Government IMPOSES new Regulations to Protect Us, we LOSE a Little MORE of our FREEDOMS....

MORE Government = LESS Freedom

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20 minutes ago, Gator11 said:

state visits are not announced. The staff have no clue when they are coming.

It is state law no bed restraints and seat belts. According to the state family cannot sign a release. If you want to complain go to your legislators. The law is in place because patients have rights. It is not the nursing homes fault they cannot control state law.

Alarms agitate the residents and when they do go off the patient has already fallen so they are useless. 

At the Adult Training Facility that my son attends they know the state inspection is coming at least a month before! Maybe they fall into another category?


"Any man who can safely drive a car while kissing a pretty girl, simply isn't giving the kiss the attention it deserves"... Albert Einstein

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1 hour ago, rossiter said:

Why should these people have to "advocate for themselves"?

You have to understand that by "advocate" we simply mean asking or arranging. The folks who can say what time they want to get up or go to bed do so. They can fill out their own menus or choose how their day is arranged. They can accept certain procedures or refuse others.   That is advocating for themselves. Those who can't or aren't comfortable in doing so can benefit by having a relative inform the facility that their dad is accustomed to sleeping later or fill out a week's worth of menus indicating foods that dad likes. All nursing homes have care plan meetings for each resident. These are attended by specific staff members, family and the resident himself if he so wishes. The resident can advocate for himself or have someone else do it.

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For their annual visits they do have somewhat of an idea when they will be there(no specific day) especially when they visit other nursing homes in the area but if a family calls the state the staff have no clue they are coming. Plus the state make other visits besides their annual ones and the staff I talk to when they visit they had no clue that the state was coming and they were not concerned either because they give their best care  everyday


Every time the Government IMPOSES new Regulations to Protect Us, we LOSE a Little MORE of our FREEDOMS....

MORE Government = LESS Freedom

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1 minute ago, Gator11 said:

For their annual visits they do have somewhat of an idea when they will be there(no specific day) especially when they visit other nursing homes in the area but if a family calls the state the staff have no clue they are coming. Plus the state make other visits besides their annual ones and the staff I talk to when they visit they had no clue that the state was coming and they were not concerned either because they give their best care  everyday

The staff may not know when the annual visits are coming but the administration knows. They are informed.  Agreed that they may not know the exact day as these teams come from out of town and presumably can get backed up on their schedules. I've never known the state inspectors to make surprise visits off their regular schedule. If they come in there is a serious problem such as abuse.  Talking to staff is not always the best way to get accurate information. If you want the definitive answer I suggest you call the Area Agency on Aging or the state.

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2 hours ago, old farm boy said:

It's not just the elderly with these types of problems. The profoundly disabled are affected by these types of regulations. My son who is profoundly mentally and physically disabled has to have a mantoux TB test every two years to attend an adult training center during the day. He will fight a needle every time and it will usually take 2-3 people to keep him still. He last had the test in December of last year, at that time the doctor mentioned that they could not restrain him in any way due to regulations.

You are correct in the fact that these facilities get advanced notice of an impending inspection. In my 45 years of working retail grocery I never once heard of a city, county, state or federal health inspector giving advanced notice of an inspection!!!

I think that one reason that the annual inspections are "announced" is that they don't want to shut down a facility, unless all options are exhausted.  Where would the residents go?  There is a facility in this area that had so many bad inspections several years ago that no one could understand how they stayed open.  There was another near the State College area that did get shut down in the past, so for that to happen, the conditions must have been pretty bad and the facility could not correct the deficiencies.  

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4 minutes ago, TucsonSunset said:

I think that one reason that the annual inspections are "announced" is that they don't want to shut down a facility, unless all options are exhausted.  Where would the residents go?  There is a facility in this area that had so many bad inspections several years ago that no one could understand how they stayed open.  There was another near the State College area that did get shut down in the past, so for that to happen, the conditions must have been pretty bad and the facility could not correct the deficiencies.  

I think that the major reason that the inspections are announced is so the administrator and his major people are present. The teams also inspect records and policies and if these are readily available it shortens the time it takes to do an inspection. You are right, of course, they don't want to shut down facilities and these inspections are not necessarily antagonistic. Yes, they come up with stupid stuff (I've got some really good ones) but they also provide an outside eye that may see more clearly. There was one year when quite a number of facilities were cited for not cleaning dryer vents. Maybe they did prevent a fire or two.

There have been at least 3 enforced closings in  Clearfield county in recent memory. One was for sexual abuse and the other two were owners who couldn't or wouldn't follow state licensing laws. In one the residents were actually at risk. The other was more exploitation. There was another where they couldn't pay the staff and most of them left. They were struggling with a few compassionate people who were apparently working without much hope of getting paid. I remember attending that one but can't remember where it was. I know the facility you are talking about and I don't know how much it has improved. I guess they are still squeaking by They apparently are willing to work with the state, which is what keeps them open. 

Remember the fire at the facility in Clearfied? Families and the Area Agency on Aging did a remarkable job of getting those folks resettled. The same thing happens when a facility is closed except they have a more reasonable time period to find accommodations.

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It's my opinion that they should receive absolutely no advanced notice of an impending inspection, be it elderly homes, group homes for the disabled or training facility/hospital. You hear of abuses quite often as it is now, wasn't it just a few weeks ago that there was a problem in Brookville or Clarion? Does CYA announce their visits? 


"Any man who can safely drive a car while kissing a pretty girl, simply isn't giving the kiss the attention it deserves"... Albert Einstein

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OK, I take it back. The regulations have changed. Both personal care home state visits made by DPW and nursing home inspections made by the Department of Health are supposed to be unannounced. Adult training facilities are inspected by the DPW. I'm trying to find out if these facilities legally get advance notice. There is, of course, many a slip twixt the cup and the lip so what should be often isn't. Unannounced visits may simply mean we aren't going to tell you the day but here is the week. Be there and be prepared.   Don't know about CYA. I'll add it to my list when I get some free time. 

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14 minutes ago, lavender said:

OK, I take it back. The regulations have changed. Both personal care home state visits made by DPW and nursing home inspections made by the Department of Health are supposed to be unannounced. Adult training facilities are inspected by the DPW. I'm trying to find out if these facilities legally get advance notice. There is, of course, many a slip twixt the cup and the lip so what should be often isn't. Unannounced visits may simply mean we aren't going to tell you the day but here is the week. Be there and be prepared.   Don't know about CYA. I'll add it to my list when I get some free time. 

Sorry but in my opinion they shouldn't even get this. Would people be comfortable if restaurants, grocery stores etc., got advanced notice of a food safety inspection?


"Any man who can safely drive a car while kissing a pretty girl, simply isn't giving the kiss the attention it deserves"... Albert Einstein

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Just now, old farm boy said:

Sorry but in my opinion they shouldn't even get this. Would people be comfortable if restaurants, grocery stores etc., got advanced notice of a food safety inspection?

I agree but they definitely knew when I was attending the closings. I'm sorry to say that rules and regulations are often circumvented for whatever reason. In this case it was probably convenience.

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On 8/11/2017 at 1:48 PM, TD said:

I used to play in a band and we would set up and play at many homes in the area. It was interesting to note that some did a better job and ran a better operation than others. Maybe it would be nice if the county could put together a crew to visit all these places and make note of the best practices and pass them around. There were some that made you want to hold your nose as soon as you walked in. Too bad.

The caregivers themselves are restrained in what they can and can't do.  The myriad of rules, regulations, and even wants and and needs of the families are frustrating and mind numbing.  As vast majority of healthcare workers want to do the best for their patients.  No one method may work for all patients, but rules and regs don't allow for individualization of care. One family is ok with drugs and physical restraints, another family isnt, but guidelines demand something different.

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10 hours ago, old farm boy said:

Sorry but in my opinion they shouldn't even get this. Would people be comfortable if restaurants, grocery stores etc., got advanced notice of a food safety inspection?

 

 

I think we are confusing different agencies here.

The  Department of Health can and does pop in at any time. They do not give administration any heads up.

If there are any questions about this then talk to and ask administration from whatever facility about this or even call the Department of Health or shoot them an email. When in doubt go to the source and ask.

Like I said earlier facilities have an idea from other facilities when they may be coming for their annual inspection which could last several days or just one depending on the size of the facility. Now I am talking about Department of Health.

I believe lavender was talking about Agency of Aging completely two different entities.

Now when the Department of Health is done with their annual visit a competent, alert oriented patient needs to be present along with an ombudsman, the D.O.N. of the facility and an administrator for the exit interview.

************************************************

The Agency of Long term living review patient charts is that not correct lavender?

They will and do call the facilities for this in advance to get certain patient charts. So yes this agency can and does announce their visits to review charts. The Department of Health does not.

The Department of Health will and has done inspections throughout the year besides their annual inspections especially when they get a call from patients, family or anyone really that has concerns about a facility or patient care. They have so many hours to respond to such a call and they do not inform the facility they are coming. Now maybe the people who called inform the facility that they called and then yes they would know someone from the Department of Health will be visiting.

 

 

I know this info from having family who have been in nursing homes and close family who have worked at nursing homes for 27 years and friends from staff on up.

 

Also not all falls need to be reported. They all need investigated but only falls involving trips to the E.R need to be reported to the state as far as I am aware.

Like I said earlier the state ties the hands of these facilities, in that according to the state the patient has rights(which they do) and they cannot be restrained physically or medically. also no family can request a patient be restrained according to the state.

The staff cannot sit with these patients 24/7 they have to perform their duties and there is only an x number of staff available.

Also if anyone is interested I am sure people can do volunteering at these facilities. This would help out during meal times especially if you could help with the patients during meal times and help free up staff for other duties.

 


Every time the Government IMPOSES new Regulations to Protect Us, we LOSE a Little MORE of our FREEDOMS....

MORE Government = LESS Freedom

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2 hours ago, Gator11 said:

 

 

I think we are confusing different agencies here.

The  Department of Health can and does pop in at any time. They do not give administration any heads up.

If there are any questions about this then talk to and ask administration from whatever facility about this or even call the Department of Health or shoot them an email. When in doubt go to the source and ask.

Like I said earlier facilities have an idea from other facilities when they may be coming for their annual inspection which could last several days or just one depending on the size of the facility. Now I am talking about Department of Health.

I believe lavender was talking about Agency of Aging completely two different entities.

Now when the Department of Health is done with their annual visit a competent, alert oriented patient needs to be present along with an ombudsman, the D.O.N. of the facility and an administrator for the exit interview.

************************************************

The Agency of Long term living review patient charts is that not correct lavender?

They will and do call the facilities for this in advance to get certain patient charts. So yes this agency can and does announce their visits to review charts. The Department of Health does not.

The Department of Health will and has done inspections throughout the year besides their annual inspections especially when they get a call from patients, family or anyone really that has concerns about a facility or patient care. They have so many hours to respond to such a call and they do not inform the facility they are coming. Now maybe the people who called inform the facility that they called and then yes they would know someone from the Department of Health will be visiting.

 

 

I know this info from having family who have been in nursing homes and close family who have worked at nursing homes for 27 years and friends from staff on up.

 

Also not all falls need to be reported. They all need investigated but only falls involving trips to the E.R need to be reported to the state as far as I am aware.

Like I said earlier the state ties the hands of these facilities, in that according to the state the patient has rights(which they do) and they cannot be restrained physically or medically. also no family can request a patient be restrained according to the state.

The staff cannot sit with these patients 24/7 they have to perform their duties and there is only an x number of staff available.

Also if anyone is interested I am sure people can do volunteering at these facilities. This would help out during meal times especially if you could help with the patients during meal times and help free up staff for other duties.

 

All I can say is that I worked as an Ombudsman for approximately 15 years and some of my information differs from yours. I do know the difference between the AAA , DPH and the DPW.  I never had to inform the facility as to when I was making visits whether they were at the request of the resident or just an inspection, which we did through the Area Agency on Aging once a year. At the time I was doing this we were told that we were the only people who could go into the facility unannounced and we could not be kept out of any licensed facility.  State visits were announced. This has apparently changed.  I attended many exit interviews and was put on alert at least a week ahead of time so I could keep an approximate date open. Since an ombudsman had to be present at a exit interview I'm not sure how they could have slipped an unannounced visit by me. There was on per year per facility at least in DuBois.     

The rules and regulations for both Personal Care Homes and Nursing Homes are online at the PA website and I still have bound copies of both regulations and policies. Like most things regulations are open to interpretation and policies change. I can cite any number of things that were done by order of the state that proved impractical or even dangerous that have since been changed or they simply don't enforce them. One that comes to mind was the ruling that residents that had dementia had to be mixed with the general population. They are apparently no longer going with that as it was detrimental to all concerned. Restraint policy has changed in major ways over the last 20 years and may change again.  Even long term care facilities are not always aware of what the current rules are and what is being enforced. This is why they get caught short. There are both state and federal regulations that must be followed and they are separate from individual nursing home policies. Frequently a nursing home will justify a  policy by saying it is state law.  It is a complex subject and may get 3 different answers if you ask 3 different agencies. There are very few people who know it all.  I've been at training sessions where exercises required finding regulations that governed certain situations and you wouldn't believe the different interpretations assigned to a given regulation. The state is the final arbitrator and they may choose to honor either the spirit of the law or the actual wording. 

As for patient chart reviews, while there may now be other agencies who review them for various reasons, the Department of Health inspectors reviews them for nursing homes and the Department of Public Welfare reviews them for Personal Care Homes. I have been there while they were doing it and have listened to their evaluations  on patient care that was gleaned from medical charts. If they weren't looking at charts I'm not sure where else they would have gotten the very specific information that they used in their evaluations. 

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