Unit 23
Admission
Do you remember your first day at a new school or a new job? Do you remember feeling nervous and excited at the same time? Residents may feel the same way when they move into your facility. Most new residents have recently had some sort of major loss which prompted the move to the LTC in the first place, so they may be coming in feeling depressed and likely more scared than excited. Remember Maslow's Heirarchy of Needs? Many new residents have just fallen from high up in the tiers and landed flat in the Basic Needs column. They are scared that the staff won't help them and their basic needs won't be met. They may be wondering, will they help me eat so I'm not hungry? will they clean me up after I've gone to the bathroom so I'm comfortable? will they be careful when dressing me so I don't bump my paralyzed arm? These are heavy questions, and one's you must understand may take extra effort on your part and your co-workers to prove to the new resident that their basic needs will be met.
Your first meeting with the resident and their family may be the most important in helping your resident adjust to their new way of life. Be cheerful, positive and considerate of how your resident might be feeling. Some other responsibilities of the CNA on admission might include:
Preparing the room- ensure it is clean and ready for the resident's belongings. Housekeeping will usually do this, but you can gather some necessary supplies such as a denture cup and toothpaste, a hand towel, toiletry needs, and water jug.
When the resident arrives, smile and introduce yourself.
Orient the resident to their room
show them their call light and how it works
show them the bathroom and where their things may be stored
show them which side of the closet is theirs
advise them on LTC regulations that may impact their living space or belongings i.e. no electric blankets or candles, and not to stack things in the closet within 18 inches of the ceiling or near sprinkler heads
Introduce them to their roommate. If you are aware of any commonalities you might mention it. For example, if the new resident once owned a flower shop and the roommate keeps up all the flowers in the garden, that might be a good conversation starter.
Give the resident and their family a tour of the facility and orient them to the different aspects of each department. For example, when showing them the activity room you might tell them what types of activities they have and how to find out what activities are scheduled. Explain the dining room schedule- when they are open, where the menus are, and how they will order their meals. Show them how to sign out when they leave the facility and orient them to the sign out policy as well as any other policies they should be aware of.
Introduce the resident and their family to other staff members. The more friendly faces and welcome smiles they get the more this will ease their anxiety.
If needed, assist the resident in arranging their personal belongings. Remember that their possessions are precious to them and treat them with respect. Allow the resident to choose how they are arranged or where items should be hung as long as they don't interfere with their roommates space or violate facility policies.
Label the resident's own equipment that could potentially get mixed up with other residents', i.e. walker, wheelchair, toiletries, etc.
Sometimes the resident's family opt to do the their laundry, but if the facility is doing their laundry you will need to label each piece of clothing. How you label their clothes will depending on your facility's policy. Some facilities have iron-on labels while most simply apply the resident's initials to the tags or the bottom of each sock with permanent marker. Be careful that it is legible and not visible when the resident is wearing it.
Create the inventory list (this will be discussed in greater detail in the next section).
Get the resident's initial weight, height, and VS.
The nurse will need to examine the resident's skin from head to toe on admission. This may feel very violating for the resident considering they are already nervous and don't know anyone yet. As violating as this may seem for the resident's first day, it is necessary to document any skin breakdown, bruise, or other anomaly so it can be treated properly and to prove it did not occur while in the facility's care. For their comfort it is best that the nurse wait to inspect private areas when the resident is already exposed, as when the resident is taking a shower or when they are sitting on the toilet. Be prepared to coordinate these opportunities with the nurse.
The Inventory List
The inventory is a very important document that the CNA is usually in charge of filling out on admission. It is a comprehensive list of all of the belongings a resident brings with them to the facility. Although you should list shirts, pants, socks, etc., you do not need to state the number of these and these will change frequently and are poorly updated. It is however, very important to be specific regarding jewelry or anything of value, whether monetarily or sentimentally. For example, if the resident brings two watches with them, their description should include some detail that would discriminate between them. Be sure to include jewelry the resident is wearing, such as a wedding ring. When the inventory list is completed, the family will sign it as well. The inventory list protects both the resident and the facility in case something goes missing.
In order for the inventory list to work, it is necessary to update the list as it changes. So, say the resident later loses weight and the family is worried their wedding ring might fall off and be lost, so they take it home for safe-keeping. This must be updated on the inventory list stating when the item was removed from the facility and who took it. Therefore, it is very important to educate the family about the inventory list when they sign it so they know that they must tell the nurse if they take anything home with them. It is also very important that they understand that they must have items added to the inventory list if they give the resident something new such as an updated television, new hearing aides, or new diamond earrings for Christmas!
When the resident leaves the facility, the inventory list must be checked again. Now it will be necessary for the staff and family to go over it together to ensure that all of the items are returned and nothing is missing. So, say the resident's son Henry is the one taking mom home, and he asks where his grandfather's antique pocket watch was as it is not amongst her things, you should be able to refer to the inventory list to see that his sister Julie took it home in April last year. If there is ever any discrepancy, it should be referred to the nurse. The inventory list again should be signed by you and the family and kept in the medical record.
Discharge
Whether it be to move closer to family, a different level of care, or perhaps they have recovered well enough to go home, residents are sometimes discharged or transferred from their facility. This may cause the resident to feel similar to the first day they came to your facility - excited but nervous. Even if they are going home which may have been the goal from the beginning, they may be worrying whether or not they are ready or worried about not being able to take care of themselves just yet. If they are transferring to another facility, not only will they be leaving a routine and staff they have grown accustomed to, but now they have to go through it all over again with a new facility. They may also be a little sad to say good-bye to the staff and other residents. So this can be a very emotional time for the resident and it may also be very confusing. It is best to be supportive of the change. Remind them how well moving to your facility went and the next one will likely be the same. It is okay to tell them you will miss them, but you should still encourage them to continue the path they have chosen.
In addition to providing emotional support, the CNA will also be responsible for the following:
Ensure all the items on the inventory list are accounted for and returned to the family
Allow the resident to say their good-byes to other residents and staff
Assist the resident to pack their things
Assist in carrying small items to the car (maintenance will be in charge of furniture)
Assist the resident to the car
the resident should be seated in the front seat with the seat pushed back as far from the dash as possible
have the resident sit down before pulling their feet in
assist with their seat belt
Pick up the empty room
remove the sheets and blankets
throw away trash
prepare the room for housekeeping to do a deep clean of the room and prepare for the next resident
“This Is My Life Now” An Interview with a Nursing Home Resident
by Sarah Wood
I walked into the cheerful, rather narrow halls of the care center. It didn’t smell of feces and urine like many I had been in. Up the hall from where I walked in, was a small dining room. Some of the residents were sitting there. I found out later that they were waiting for dinner. It was two in the afternoon. They don’t eat until five thirty. “I’ll just wait,” said one resident who sat in a wheelchair, watching people walking by. She called all the nurses by name. She had been here a while, I imagine.
I traveled down the hall to the room of my friend. She was lying in bed, reading a book. The room is small, two beds, two dressers and two nightstands in this room are a tight squeeze. My friend has many pictures of loved ones on the wall. “I can’t remember who they all are, so my daughter pasted those little name tags under each of the pictures.” She explains. Her roommate is not so lucky. No pictures of loved ones adorn her walls. She has very few living relatives and none close.
I sit down to talk with my friend. “How are you doing?” I ask her. I haven’t seen her in a while. “ Oh, about the same. Same thing every day.” My friend says. We fill the air with some more conversation. My friend loves to talk. She enjoys sharing stories of her life. She has many to share.
“Y’know, I survived the great fire of 36’” she tells me. She has short-term memory loss and she knows it.
I have heard her stories before. I don’t mind hearing them again. Someday, I will miss hearing them and treasure each time that I did. We get to talk about some “girl talk” stuff. My friend loves to talk “girl talk”. My friend says she feels like we’re sisters. I agree. I ask my friend how she likes it here. She has lived here for three years.
“Oh, it’s alright I guess. It’s not home. I’d rather be home” she tells me.
What’s the best thing about being here? I ask her.
“Having somebody to take care of you. If something goes wrong, if you have an “accident” or anything, somebody is here to help you. But, it takes them so darn long to get to you. Sometimes I wonder if it really matters to have the nurses here at all.”
What do you think they could do to make it better for you here?
“Hire more nurses! The nurses are always saying that they are short handed. That they’ve got too many people to take care of and not enough of them to go around. But, the nurses say that when the money gets tight, the extra nurses are the first to go. Most of the time in the evening and at night, there are only two nurses here. I get sick of waiting for someone to come change me. I think nurses should have a union. If they don’t hire enough or pay them very much, they should strike!” My friend says. But, that would mean that until things were settled, there’d be no nurses for you, I tell her.
“ Yes, maybe. But, at least something would change. Right now, it’s the same old thing; “Not enough nurses! Too short-handed! Not enough time!”
If you could run the nursing home for a week, what would you do different? I ask her.
“I wouldn’t want to run this place. I wouldn’t want to be president, either. Too much responsibility. You’re never going to make everybody happy. I know that. But, I’d have more nurses. And I wouldn’t have grumpy ones either. Y’know, ones with problems. That one girl that worked here, her husband was on drugs. She was so nasty all the time. Poor girl, I know that must’ve been terrible for her. But still…and I’d PAY the nurses more, too. Most of these girls said they don’t make enough to make ends meet. Then they get mad about that. That’s not my problem. But, when they are so gruff with you; that’s my problem….”
Have nurses ever been gruff with you? I ask.
“Oh, you get them sometimes that are gruff. I guess it can’t be avoided. Some people are just like that.”
What do you do when a nurse gets gruff with you? I ask.
“What can you do? Just ignore them if you can till they go away. I try not to ask them for help. But, sometimes, I have nobody else to ask. I got tired of asking for the bedpan. It would take so long for someone to come and then when they got tired of bringing it to me, they left it where I could give it to myself. Then I’d spill it and they’d have to change the bed. And they’d think I did it on purpose. Who would do something like that on purpose, for heaven’s sake? About the only thing you can do is hope that those nurses don’t work with you that day.”
Have you ever told anyone else? I ask. “What good would it do? They don’t like it when you complain. Besides, things get worse sometimes if they found out you complained.” There was some silence between us for a while and I know that’s when she has said all she care to about some topic.
Is there enough to do? I ask. Are you ever bored?
“Oh, yeah, waiting for lunch, that’s the worst. Usually we just sit there and wait and wait. Then where lunch comes, it’s the same old thing. I think it all taste the same. I can’t have salt. And I can’t have too much cholesterol. I can’t see the food very well. It all looks the same. I love chocolate. But, everybody keeps telling me I can’t just eat chocolate. Then, the nurses complain that I’m getting too heavy to lift. It takes two of them to move me. They can’t do it with just one of them like you can. They need one on each side of me. That’s why it takes them so long to help me to the commode. Because they have to go find someone to help them. And, no one is ever available. So, I wait and wait. That’s all I do these days. Oh, they try to make sure there is something to do, I guess. Except for right before lunch. You have about an hour with nothing to do but wait. I would just rather go to bed and read.”
Are you happy here? I asked her.
“I’m as happy as I can be. This is not the way I thought my life would turn out. THIS is my life now. This is it. I’ll die here, I know I will. I don’t want to. But, people die here all the time. This is where they come to die. This is my life now. Waiting to die. I know now why my husband shot himself. He didn’t want to get old and helpless and die in a place like this. I understand now…” She looks around her room a little and shrugs: “ This is my life now.”