After work every day, I visit my dad in the NH to feed him dinner. The staff is supposed to but they never do. After dinner, my dad likes to lay in bed and watch the news. I can't get him into the bed by myself, so I hit the call button. On the average, it takes the staff 30 minutes to come into the room and turn off the button, and another 30 to 45 minutes to get someone to put him to bed. I've noticed that some of the residents are left in the dining room in their wheelchairs for well over an hour. I looked up online for the guidelines for call systems and it only talks about the fact that the NH should have one. They have a wonderful call system, but it is ignored completely. Once I happened to hear a woman crying for help, no one was around, and I had to go into the physical therapy room during a patient's session to the the PT to pick her up off the floor. I'm documenting all of this to report it, but I'd really like to hear from everyone if they know of a "best practices" guideline for call buttons, for nursing homes only. Thanks!
There can be some consideration on both sides, believe me, the better you treat staff and thank them for the care and help the more they will respond and try to please it is so nice to be treated kindly for a change.
There are times 2 staff members are assigned to 30 residents to clean, bathe, shower, feed, etc. Then you get an admission that the family is feeling a lot of guilt for not being able to take them home and take care of them and having to rely on a facility and strangers that they have unrealistic expectations and time seems longer than it its. They will turn on a call light for family to be assisted to bed and no one comes, more that likely you will not see one of them in the hallway, you may find them in a room helping get someone off the floor who had fallen, they may be feeding someone or something. In all the homes I have been to you would not find an administrator or DON or floor nurse who would not respond and investigate the issue. Sometimes actions are taken from the investigation that all are not aware of if they determine an infraction was done.
A half hour call light time sounds like a luxury to me. I'd use the call light and someone would come in after 30 minutes or so and turn the call light off and leave the room and it was anyone's guess as to when someone would come back.
The staff ratio was 1:13 and if any resident needed anything during the dinner hour it was tough luck because the aides were in the dining room feeding patients who couldn't feed themselves. I knew better than to use the call light during the dinner hour. Sometimes my patient would mess herself waiting for help until the dinner hour was over.
I was told by an aide when I was allowed to use the call light and when I was not allowed to use the call light.
I wasn't there very long on days when I would go and assess this patient but I was there enough to see how things were done. I made meticulous documentation and stayed in touch with the family. I would speak to the family after my assessments and if I let them know what I saw was objectionable the family would high-tail it up there to see what was going on. I can't tell you how many times that happened.
The relationship between private duty and regular staff in a nursing home is very poor. Private duty antagonizes staff for some reason. Keep that in mind if you have private caregivers with your loved one in a NH.
No matter how nice the facility is it's still institutional living and your loved one is always just one among many. I can't tell you the horrors I saw in this lovely, expensive nursing home and it chilled me enough that I may never do private duty nursing in a facility again. The unprofessionalism of most of the staff, the way the staff treated my patient (with me standing right there!) among many other things I won't go into here. My dad was in a nursing home and now I have to wonder if he received this kind of treatment? He was on hospice but he wasn't supervised 24/7? Did the NH treat my dad this way?? Anyway, I had to submit my documentation to my nurse manager and seeing it there, documented day after day after day, she was aghast at how my patient had been treated and she set up a meeting with the facility based on my documentation, which are considered legal documents.
Anyway, nothing would surprise me at this point and based on my own professional experiences I would say 30 minutes is d*mn fast.
(Sorry I ranted. This subject really sets me off.)
My daughter is a ICU trauma nurse. Because of patient surveys that have to be competed for Medicare and Medicaid to pay the hospital, many hospitals are not getting paid for Medicare patients as they should. Why? These surveys have to meet 100% satisfaction. Impossible with short staffs.
One of the problems patients complained of in my daughter's ICU unit was the alarms going of for patients who code. Or in other words are dying. So her hospital turned them down to satisfy patients. The result? Two deaths in the past two weeks due to no one hearing the code. Why do this? To satisfy patients in order to get a good survey results.
What does this have to do with nursing homes? Like hospitals all are for profit. Even if they say they are not. So there are less employees doing work for more people with less pay. And they say it will get worse in the future.
Could it be that since this is repeated every night, the staff "knows" that the call is about putting Dad in bed, and that just doesn't have the urgency of all those residents getting done with their dinners and out of the dining room? Does it also take this long for an "unscheduled" call in the middle of the afternoon? Because a half hour is TOO LONG by anyone's best practices or standards. I can understand the delay once they find out that Dad is fine and just needs help getting to bed, but that initial delay concerns me.
Who have you talked to so far at the NH about this? The nurse who is usually assigned to him on that shift? The Director of Nursing? The Administrator? I think that is the order of contacting them. Also be sure to attend the care conferences for your Dad and bring it up there. But start with his "usual" nurse and see if you can get an explanation and better yet improvement.
I wonder if this repeated request could simply go into his care schedule? That this resident needs to be helped to bed at 6:15 pm (or whenever), and no call would be necessary.
I too am curious about what the "expected" response time is to call buttons.
As far as the aides and nurses are concerned I feel their pain and I am sure home caregivers share their difficulties. Often there will be one trained nurse on a floor of 24 patients and all her time is taken up with giving medications.
The nurses and aides all have lives outside of nursing and their pay is far from optimal. The nurse that works overnight may have to rush home to get the children ready for school and do whatever needs to be done in the home. Then she has maybe six hours to sleep if she is lucky before the kids get home. the result is she goes to work very tired and does not work at a very fast speed. Some of the aides in particular are much older, overweight and have many disabilities. they really should not even be working but they have to survive. They may be divorced and are too young to retire. They may also not qualify for health care and can not afford needed medications or have treatments that would make life easier.
The real question is not how long it should take for a call button to be answered but there needs major system changes that regretfully we are unlikely to see in this financially driven environment. Becoming a nurses' aide is one of the easiest and cheapest trainings to get. The training is often offered free to people willing to work in a nursing home and in any event only takes five weeks So you see why call buttons take so long to be answered.
id suggest everyone be respectful of staff and plan your work with the loved one so its an asset to staff as opposed to a hinderance or a source of friction ..
There are patients who over use the call button because they want attention. We could bring our love ones home and we hire our own nursing staff, but I bet call buttons or bells rung wouldn't get immediate attention, either.
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