Nursing Homes: 10 Worst States for Nurse Staffing

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I have been a nurse in the state of Washington state over 20 years. During this time I have seen some horrible downturns in the Long Term Care industry. Nurses are expected to care for more patients who are taking more medications. These same nurses are taking care of patients that are acutely ill, just released from hospitals. These patients are on IVs, wound vacs, breathing treatments, TPNS, vents, the list can go on and on. But even though the level of care has skyrocketed, the number of patients that a nurse has to care for has not declined. A Nurse in a hospital might have 10 patients to attend to, tops. But in our nations rehab/extended care facilities the number can reach as high as 50. Can you imagine caring for 50 patients with at least half of them being sub acute care? How do you safely assess patients, mangage Iv therapy, respiratory therapy, wound management, pass meds, chart, and supervise the CNA staff in an eight hour shift? Something needs to be done. How do we start an online petition to insure that our government officials not only hear our concerns but act on them.

Anselma of WA 2:42AM March 03, 2010

AMEN to Lisa of TN, on the post she made this morning. That is EXACTLY, TO A TEE how it is here in ARIZONA. It is apalling that any 'business' who cares for human beings is allowed to run this way......and THEN to turn it around and BLAME the nurses who are running themselves into the ground, for EVERY little thing that goes wrong. For gosh sakes, what kind of quality care do you think a patient is going to get with these nurse/patient ratios?????? NONE, ZERO, there is NO 'quality' involved. When we sit down to do our charting all we can testify to is that they were "alive & breathing when we passed them their meds". And believe me, as sickening as that sounds, its the truth. And the sad sad sad fact is that these states allow themselves to be blinded by the facts. It is a VERY SAD day in the life of a nurse when she/he regrets ever entering the field of nursing. Yet, this is what is happening again and again. And you wonder why there is a nursing shortage in this country.

Corrina of AZ 12:49PM March 02, 2010

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Workereven of 10:02PM December 31, 2009

I'm an LPN I am licensed in Florida, and Tennessee, I have been in the healthcare field for 12 years, and can tell you that a number of changes to our nursing home care system need to be made. As for the above comment about if we had 100,000 or more people just like their daughter, we do, most people go into nursing because they want to help people, I do agree that there are those out there that just don't belong, and are there just to earn a paycheck, most of those don't last long because people like me like to run them off. We want people that care to take care of our residence. I will tell you that most people that complain about the care that their loved ones get have not taken a realistic look at things. The state tells the nursing home they are coming, or goes in a particular pattern when they come to inspect each year. The staff all of a sudden has increased in numbers in our nursing home when the state arrives. We typically have one nurse for every 35-40 residence, that means you have about 15 minutes per patient to give them medications,most residents have an avg. of 15 just in the morning which you have to take out of individual packs, and record with initials for each one that they have taken it, and some have to take meds two more times in your shift also, make sure the 2 CNA's you have if your lucky 3 have fed, bathed, and cleaned the room, as well as brushed their teeth etc.,if your resident has a safety devices,which most do, is it working, did the kitchen send the right meal if they have swallowing difficulties,has laundry sent the supplies we need, and don't forget to take care of any wounds they have, and chart all this in 3 places. I haven't even touched on reporting to the on coming staff, or calling the doctors if someone needs an appointment, or is sick. (remember 15 minutes per patient) Wake up you can make the changes, the administration isn't going to hire enough staff if the laws don't make them, because it would take away from their pocket (salary). Americans need to inact a law that governs the number of patients one nurse can take care of, and while we do this, we also need to protect those who work with us, don't kill the cnas they need to be protected with how many residents they can take care of. Help you healthcare workers, they may have to take care of you some day!!!

lisa of TN 2:33PM March 02, 2009

I have been an advocate for nursing home residents for over nine years and have come to realize that there is no way to fix nursing homes as they currently exist.
Who wants to end her life incontinent because no one would help with her toileting? Who wants to be in pain because of decubitis ulcers (bedsores)? Who wants his dignity eroded as he is paraded naked (except maybe for a thin sheet) down the hall to a shower between rows of people slumped over in wheelchairs? Who wants to be unable to see because her glasses are missing and no one has any idea where they are? Who wants to be in a continuous fog because of a mix-up in medications? No one.
We need to deinstitutionalize the places where our frail elders spend their waning years. The Green House Project is a model that has been replicated in many states already (albeit not VA). This concept features a homelike atmosphere with 8-10 people, private rooms with private bathrooms, open kitchen and dining areas, accessible yards,nutritious and appropriate meals, etc. The best part is that there is plenty of well-trained, caring, competent staff. The cost for all of this is comparable to a nursing home and in many cases it is less. These places cannot be created fast enough.
In the meantime, we need to recognize that Ombudsman programs cannot do the job they are mandated to do because they are tied to politicians who receive mega bucks from the health care industry. To be effectual, they must be stand-alone entities separated from the political arena...and lots of luck on that ever happening.

Janet Clement of VA 10:41PM December 26, 2008

Why doesn't someone compare these "ten worst" and "ten best" to State Medicaid reimbursement rates. That might give consumers a little more insight. You get what you pay for...

Anne Mayes of OK 2:46PM December 22, 2008

I'm a traveling therapist and people in the biz tell me "don't take an assignment in the south". I guess the evaluation just confirmed what people were telling me all along. It's funny in wisconsin people retire, move down south to escape taxes, get sick and move right back to wisconsin for their care. It's true, you get what you pay for.

padriac mccormac of WI 2:35PM December 20, 2008

You get what you pay for - its as simple as that. Get over it.
Its what it is. I lived in the UK for 30 years and you should
see the absolute terrible state of their homes.

of AZ 11:28AM December 20, 2008

Down in FL there is a 6 month window for the Annual State Survey, which could translate into 3 months before or after the previous annual visit, etc...This gives facility limited time to correct, perfect previous violations due to variables related to a nursing home atmosphere such changes needed in personnel (e.g. firing, hiring), in-service staff, which may be ongoing for high turnover facilities (i.e. new staff), and may non-staff related (i.e. broken equipment or systems such as water pressure).
I see your point on a "secret" reviewer, but in FL the Department of Health visits on a Quarterly basis, but not meaning 3 months to the day, etc...just like the Annual Surveys, these are "surprise" visits and I feel that the DOH representative or the State Surveyors obtain a similar picture of the level of care at a particular nursing home based on their daily visit (DOH) or weekly visit (State Survey). Also, we have Ombudsman who are Volunteers who work for the state come in on an unscheduled visit for their yearly visits and just like the State Survey team, Ombudsman can come to any facility on a complaint anonymously made to the State/Local office, which has been either an employee, family member, or the patient themselves making the claim, etc...
If PA doesn't have a similar set-up, I know FL inspection schedules are sufficient.
In addition, if a facility in FL is "tagged" heavily the State Survey team may visit on a bi-yearly basis (i.e. two weeks with 40+ hours in each facility per week). I have seen teams arrive as early as 6am and not leave until 8pm and their visits do not exclude weekends or nights, where staff is more liable due to less facility management team members are available, etc...
Lastly, I believe the ratio in FL is much better with RN/LPN to patients numbers. Typically though most buildings only have 1 or 2 RN's because the LPN our responsible for passing out meds, managing CNA, etc...while the RN are usually on the facility management teams such as the Director of Nursing or MDS coordinator, etc...
I strongly believe the State Survey process is sufficient in FL, especially due to their new process they use with their issued laptops and state mandated software, assuring the highest control over every area in a nursing home. It is the most thorough process to date by my experience.

Steve of FL 12:51AM December 20, 2008

My daughter has been a CNA for close to 10 years, currently working in Texas. She's worked in both the general wings and the alzheimers wings of various nursing homes in several states, even though the pay leaves much to be desired. She is extremely dedicated to the patients she cares for. She does her job with love and compassion and has been recognized for it many times by the families of the people she deals with.
However, this is not the case with a large number of the personnel in these places. She has told me of call lights going unanswered while medical staff ignore them, under the guise of "someone else will go see what they want." Many times she's had to finish the work of the shift ahead of her, whether it's giving baths, getting patients in or out of bed for the day or cleaning up after the patients because their calls for assistance have been ignored by staff who are more interested in getting off work on time than doing the job they're being paid to do. She's worked her shift by herself numerous times, because the other scheduled girls call in sick so they can go to a concert (among other excuses)or don't call in and don't show up at all.
There are the employees like my daughter who truly care about doing the best job possible to make these patients as comfortable as they can, and then there are the other employees who are just there for the paycheck. Sadly, the latter far out number the former.
But probably the saddest thing is that while she has tried talking to her superiors on many occasions about things that can be done to improve the efficiency of the staff and the quality of life of the patients, she is looked upon by them as someone who is "stepping out of bounds" by expressing her concerns, and as a result, nothing ever changes. Seems like the superiors are just there for the paycheck, too.
Yes, she could quit and go into a profession that pays better without having the stress of having to work with people who have no regard for their work, but as I stated in the first paragraph, she has compassion for these patients who have reached a point in their lives where they can no longer take care of themselves.
Now, if the nursing industry could just find 50,000 to 100,000 more employees just like her, these kinds of news articles would be a thing of the past. Part of finding these dedicated employees would be accomplished by paying a decent wage. That would attract a wider range of applicants and get rid of the need to hire just anyone who walks in off the street because a nursing home needs the help and can't find anyone else.
These nurses aren't standing in the front of a store thanking you for stopping in; they're working in a profession that means the difference between the life and death for the people you love....for God's sake, recognize them for it.

Cindy S. of IL 11:06PM December 19, 2008