Monthly Archives: December 2010

Blogging Every Day

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I have accepted the challege of blogging everyday in 2011.  I think each of us that accomplish this goal will find we have grown in our writing abilities. I know for myself, even though I have been published, I have so much more to learn about the  field of writing.  As I have been told all of my life,  “there is always room for improvement.”  That one little line is so true in my case.  I want to learn how to improve in every area of my writing.

I am also purchasing me a kindle for my reading.  I am not sure how I am going to like it, because I am a paper person when it comes to books.  I think the time has come for me to take the step.  Kindle users let me know what you think about using the kindle and which one to purchase.

Everyone have a safe and Happy New Year and I will see you next year.

Ways To Find Ideas for Your Blog

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This is actually a review of a great little book by Steven Aitchison called “100 Ways To Find Ideas For Your Blog Posts.”  In the introduction of the book Steven writes, “There are times when blogging can be tough and it feels like we have just run out of ideas for our blog posts or as a freelance we dometimes think there’s nothing else to write about.  Where does the muse go when we are feeling like this, and how can we get it back?

He goes into great detail of his 100 ways to find ideas.  It is interesting to read and the ideas are fantastic.  I found the book on Amazon and I am glad I did.  As a newbie to blogging, I am trying to learn all I can and this book was very helpful.  A few of the ways he has discussed within the book for blog ideas are:

1.Talk to children

2. Visit TED.com

3.  Do something you normally would not do.

4. Write a controversial post

5.  Open up your encyclopedia

I have found that his ideas make a lot of sense and are easy to do.  If you would like to know  more of his ideas just let me know and have a look at the book on Amazon.com  I happen to think this little book is great to have on hand as a resource guide.  That’s my two cents for the day.

A Short Story “The Dinner”

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Friday, April 16, 2010 is a red-letter day.  I have a new job, I live in my own condominium, my health is good, and my family loves me.  I have so many blessings I can’t list them all.

I have a boy friend, Andy Wilson.  He is such a loving person.  He makes me happy. I keep a smile on my face when I am
with him.  I am falling in love, and I never want it to end.  He is a man who has everything. He is wonderful, happy, smart, rich, educated; handsome beyond words, and is still single.

The doorbell is ringing. I slowly cross the floor and open the door.  “Come in, Andy”.  “Wow, you look absolutely wonderful”.  He grabs me, pulls me toward him, and kisses me.

“Dinner will be in about ten minutes, relax for a few minutes.”

“Dinner is served, sir.  We have a standing rib roast, mashed potatoes, Sautéed asparagus’, honey sweetened baby carrots and yeast rolls.  I made fresh strawberry short cake for dessert.”

“This is wonderful and I don’t want it to end.  Would you care to dance?” Andy asks.  We dance as my mind keeps telling me; this is too good to be true.

“Paula, I do not feel well.  My throat feels a little tight.” “Sit down on the couch. Would you like a glass of water”?  His face was beginning to swell, especially around his mouth.

“Andy, I need to call an ambulance for you.  You are beginning to scare me”.  I called 911, gave them the address and returned to Andy.

His respirations were fast, and he was starting to squeak when he exhaled. “What is happening to you”, I asked.  He could not answer me.   My mind is screaming, where are they, it is taking too long.  I can hear the sirens. “They are almost here, Andy.
Hold on honey, please hold on”.

I followed the ambulance to the hospital.  It seemed I waited forever and then the door opened and a nurse in scrubs came to me and asked if I was the person with Andy Wilson.  I said, “yes, I am his girlfriend”.  She took hold of my hand, and said”, I am so sorry, but we could not save him.”  My world went cold and black.

Andy died from anaphylactic shock.  It turns out he was highly allergic to peanuts.  I kept running our dinner repeatedly through my mind.  Where could he have gotten peanuts with our dinner?

I went to the pantry one morning to get  my oatmeal.  My eyes scanned the shelves; I noticed two bottles of oil sitting next to each other.  One was a light corn oil and the other was, the other was, oh my god, its peanut oil.  Now I know, I killed my Andy with my good
intentions.

My Poem For Today “Call Me A Violin”

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Listen to me whine
Listen to me cry
Listen to the heart strings
I am surely going to die.
Let my sound
Reverberate your soul
Remembering my broken heart
You gave to me so long ago.
When you hear the sad, sad sound
Remember you made my world go round
Listen to me whine
Listen to me cry
Knowing my world has ended
Because you said goodbye.

A New Beginning, Sort Of

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Christmas is over for another year and now we are waiting for the new one to arrive.  A brand new year full of all the possibilities our minds will let us imagine.  We can start the year with the peace of mind that comes with every New Year, except now we all seem to fall back into our normal patterns.  You know the one, of worrying about the bills that will be arriving in the mail box,  someone in the family is very ill, or a couple of family members were not getting along well at Christmas dinner.  The myriad of things that life puts before us.

I don’t think it is possible to ever start a New Year fresh.  We may think in our minds we are going to and make plans to do so but they never seem to work out.  Could it be because we all carry the baggage from last year into the new year?  You can’t help but carry it over.  You have the same family, probably the same house, the same friends, and of course the same bills, plus some.

I know this sounds very pessimistic about life, and I don’t intend it to be that way.  I just want to be aware of what we actually deal with in each new year.  We still have all the same struggles we had in the previous year.  I think the only thing we can change about any new year is our way of thinking.  I am a Christian, and I am going to try give all my worries to God.  It really doesn’t do any good to worry because it doesn’t accomplish anything at all other than making us a little more miserable.  How do you think you will handle the coming year?  Will anything change?

Long Term Care, Part 3

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The numerous complaints called into a state office is usually held until survey time unless there has been harm or potential harm to the patient.  One or more surveyors will go to a facility and pick a number of residents including the one the complaint
was about.  Trying to prove a complaint can be very difficult.  Let’s say mom told you they are not changing her at night and she is laying in a wet bed all night long.   First thought  you have is, how dare they do that to my mother.

You go to the Director of Nurses and you tell her the staff is not changing your mother at night.  She then tells you it will be
taken care of.  She instructs her staff in checking and changing the patient’s every two hours.  It is well documented in the patient record.  You go back in a few days and mom tells you the very same thing.  This time you are livid, and you will take care of it, so you call the state and complain.  Unless the patient has a bedsore, the state will probably hold that complaint until the next survey and then look into it.

So now you are frustrated because you think the state doesn’t care and is just blowing it off.  Finally the survey happens and someone from the state calls you and tells you that your complaint is unsubstantiated.  You just can’t understand this at all because you know they are not changing mom at night.

Let me explain a little to you about what has to be looked at, and what has to be there in order to prove your allegation.

1.      Mom’sinitial and subsequent evaluations has your mom coded as incontinent.

2        Does your mom have any skin break down.  Has she had previous breakdown and if so did it heal properly.

3.    Has your mom had any urinary tract infections.  Females tend to develop UTI’s more frequently if not changed.

4.    What is your mothers mental status.  If the evaluation the facility has completed, has her sometimes confused, then that can be one of the factors that will cause a complaint to be unsubstantiated.

5.     What documentation does the facility show on her record.  They have shown the patient is checked every two hours and dried when necessary.  The argument can be, it is not our fault we go in to change her and she is not wet, and then after we have gone she wets on herself.

Unless you can prove beyond doubt that care was not provided.  You can’t substantiate the complaint. On the other hand let’s say mom developed a really deep bed sore from lack of care.  The facility can be given a deficiency.  They would be required to fix the problem for the person named in the complaint, and anyone else who could be affected.  They would have to devise a plan to make sure it doesn’t happen again and who will be monitoring do make sure it doesn’t happen again.  This is all put on a form on sent to the state and the federal government.  Usually within thirty to sixty days someone will go back in and make sure the plan was put into place and everything is done appropriately.  If it is not corrected then fines can be put in place by the government.

If it is never corrected to the satisfaction of the state, then the facility can go into the process of being shut down.  Sometimes, facilities will sell and the name will change and all of the previous problems will be wiped clean.  The new facility will have an opportunity to go through the whole process from start to finish.  If they took care of it, then all is well.

The Nursing Home Association has a very powerful lobby in Washington DC.  They keep a lot of rules and regulations from passing they feel could harm the industry.  As you can probably surmise, the care of our geriatric population is very omplicated.
It is overrun with many problems and it’s a constant struggle.

I don’t want anyone to misunderstand my feelings here.  I know there are some very good facilities in this country that take excellent care of their residents.  They have loving caring staff that does what it takes to provide the needed care.  I also know they are facilities I would not let take care of my dog, much less one of my loved ones.

I am fortunate in that I have a family of nurses and care givers and my parents or one of my immediate family will not go to a nursing facility.  I know everyone does not have that choice.

Be planning ahead, and if you have to find a facility then  look at it very seriously.  The years previous survey has to be posted for public view, that is law.  Look at the survey, go at different times of the day and observe what they are being served at meal time.  If you enter the facility at 9:00 in the morning what does it smell like.  You are always going to have some odor on the hall just because of someone being changed at any given time.  It should not remain in the air consistently.  How clean is the facility kept?  Are people sitting around in wheelchairs parked in front of the nurses’ station?  What type of activities do they have going
on.  Are they appropriate for the mental and physical abilities of the patients.

This is only the tip of the iceberg, and I hope and I have give you some information you can use, as well as educate you a bit.  We have some major problems to overcome, when it comes to the care of our geriatric age group.  It takes a very special person to go into long term care and stay.  We have to do our best and keep striving to make things better for those who can no longer
care for themselves.

 

 

 

 

 

Commentary on Long Term Care Part 2

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Facility staff are overworked and underpaid for what they do.  That is how the system is set up and will continue to be until something changes.  I’ve got ahead of myself. I was talking about staffing.  Some states do not require a particular number of staff to take care of the patients.  Some states require a minimum.

Back in time when I was working in LTC, Oklahoma required one to seven direct care staff to provide care to the residents on day shift.  This number counted the LPN giving the medications and providing treatments.  It also counted the activity director as providing direct care.  I always felt this was very deceptive.  The CNA’s on the floor where the ones who were bathing, feeding, dressing, walking, cleaning changing, taking to the bathroom and just doing whatever the person could not do for themselves.  The number of CNA’s decreased with each shift.  If you had four people on day shift providing care on one wing, that would go down to two on a wing and then for night shift it could go down even further.

For some reason, the thinking is there is not as much to do on the evening and night shifts. That  is not entirely true.  You still have to do the care, feed the patient, problem solve, ect.  I think you can see my point.

The facilities have people who call in sick, without thinking of the problems it will cause. You also have people who are so dedicated or need the money so badly, they come to work when they should have stayed home.  That in itself can cause problems.  Rampant virus illness is not pleasant for anyone, and it can go through a nursing facility quickly.  Care should be taken, family or staff if you are sick, stay home.

It is not easy finding staff to work when someone calls in.  Usually some overworked CNA, who needs more money will volunteer.  It is not uncommon for the caregivers to work more because of the low wages they receive.  When someone is tired, they can’t give their best, even though everything in them says they are.

States that do not have mandatory staffing use the premise that a facility must provide enough staff to care for the patients.  This is well and good, sort of.  You can have five on the floor caring for ten patients.  You would think all the care would be done, and everything would be wonderful.  It could be, only two of those people are really working.  They bust their behinds
getting all the work done while the other three take smoke breaks outside, hide, look busy doing something else, but not really accomplishing anything.  So there is the dilemma.

Unfortunately, I have been in facilities that consistently ran short of staff to provide care to the patients.  During the three days of survey, they would bring in staff from sister facilities to really make it look good.  The survey team knew what was going on but nothing could be done about it.  We would hear statements from patients such as “I am really glad you’re here, we have so
much more staff today than we usually do. Another might say, my call light is sure being answered quickly today.”  I always felt the difference I made in patient lives were the three days I was there doing a survey.  I think it is a very sad thing not to be able
to completely trust the care that is given to some of our geriatric population.

The general public has no idea how many restrictions are really placed on surveyors that go into a facility.  We all started the job thinking we were really going to make a difference in people’s lives. Those money hungry cooperation’s that provide poor care, because they are trying to get more of those sacred dollars are going to be shut down.

Nope, that is not the reality.  The federal government has a very large book of regulations for LTC and what you can and can’t do.  It is almost impossible to shut a home down.  It can be done, but it takes a great deal of time, effort and money that states do not have.

Then you have to consider the patients in these homes. Where are they going to go?  In some areas they may be moved fifty miles away before a facility can be found that will accept them.  If they have family that visits them, what happens if they don’t have the transportation or resources to get to where the patient is located.  Families can’t take care of mom and dad like
they use to because of being scattered across the country, or everyone is working trying to survive.  So where does that leave the patients?

The survey process itself is unannounced.  The facilities do not know exactly when the survey team will show up.  What they do
know is, a three month time frame it could happen in.  The tension can be felt in a home when it is getting close to survey time.  It has happened that a survey team will check into a motel and the facility will know the survey team is in town.

Surveyor’s are not suppose to talk about their schedules.  It could mean their job if it is proven they let a facility know when their survey is going to take place.  If a town has several facilities, you could go into a home to do a complaint and every facility in town will know you are there.

As soon as a team walks into a building, fresh drinking water starts being put out, and call lights put within reach of the
patient.  You can see the activity of preparing for surveyor’s beginning.  If it wasn’t so sad it would be comical.

Commentary on Long Term Care Part 1

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Because of the length of my commentary I will be dividing it into three parts.  I hope you find it informative and useful.

Part 1:

My writing this piece is a purging for years of frustration.  I am an RN, and I have been for over thirty-one years.  I grew up in
Long Term Care (LTC) and my children were raised in the environment also.

My family built and ran LTC facilities.  I have worked at every job in a facility from laundry to cook, NA, CNA, and Director of Nurses.  Later in my career I was also a LTC surveyor in two different states.  So you can see this particular topic is near, and dear to me.

My LTC background started at a time when you had individual run homes.  You did not have the large corporations coming in and buying several in a state or across the country. You still had good homes and bad ones. Trying to make the all mighty dollar would drive a lot of issues.

The LTC facility I was first involved with was Regency House Nursing Center.  It was owned by my uncle and my mother was the administrator.  As I grew up, as I mentioned before, I did every job in the facility at one time or another.  I knew how things were suppose to be done.  Over time I became the Director of Nurses.  It should go without saying the administration and myself had a very direct line of communication.

The first rule in that home was, you had to give good care.  All of the patients were like family members.  Even the poor souls who no longer were themselves.  You had all  the personalities from the very aggressive to the very meek.  It was a family, and I lived with that family for ten years.  I watched people I cared about leave this world and new ones would come in to take their place.  It was a cycle of life.

We had annual state surveys, that nursing always did well at. They might find a medication not being initialed, but the patient care was excellent.  The building always received the same deficiency every year, but there was a waiver to cover that particular issue.  Everything ran smoothly, and the patients were happy.

The food was good and fresh for three meals a day.  The menu was catered to the farming community the patients came from.  Diet guide lines were followed for the most part, but the bottom line was the patients were happy with the food.  You also must know, there is always someone who doesn’t like something.  The fact that the food can’t be seasoned properly with salt caused a lot of unhappiness to be voiced.

Then of course you always have the hard to please family members.  You know the one’s that every member of the staff cringed when they came through the door.   Absolutely, nothing you did, or tried to do made them happy.  It didn’t matter if you had
seventy other people who required care.  If Mom or dad wanted something right now, then right now they should have it.  Life in a facility did not and does not work that way.   Luckily those family members were few and far between.

Since that time, let’s say from the mid 1980’s, multiple cooperation’s have bought up the LTC facilities and have also built many
more.  I feel the majority of Administrative staff in today’s homes want good quality care.  The problem as I see it, is the cooperation’s bottom line has to be money.  So everything is maintained at the bare bones level and if you talk to them about
staffing the words will come out such as “we have more staff for the amount of patients we have, than what is mandated.”

Staffing a facility is a constant changing nightmare, for a number of reasons.  Once again you are dealing with all different types of people and their personalities.  I believe the majority of the personnel in any facility want what is best for the patients they care for.   This goes from the maintenance person, to the nurses and CNA’s that are working directly with the patient.

A Cry For Help or an Opinion

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I am working on my second book called the Dobyns Chronicles.  It is being narrated by my great-grandfather.  My question is:  Do I write as he spoke or do I keep him using correct grammar?  I have gotten opinions both ways.  I would like to see  what the general consensus here is.  Please just drop me a line and tell me your thoughts on the subject.

I’m a Ditz

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At least that is what I have been told.  would someone tell me what a ditz is?  If it is a woman who has a problem with short term memory, raised two kids, became a college graduate with a nursing degree, and worked until retirement, then that is me.  I qualify without a doubt.  Maybe it is the side of me that can’t walk and carry a cup of coffee without spilling it.  I know my calling was never to be a waitress.  I firmly believe God puts us where we are suppose to be.

I think it is remarkable how people can be labels on others without knowing anything about them as a person.  I have now reached the age I could care less what people think, but I know how much it can affect a young person.  The damage labels can cause.  They are placed without any regard to the consequences that could happen.

Now to entirely change the subject; I really am a ditz, can someone please tell me how to set the time to central standard time using this code thing they have going on.  I think according to the time I have displayed, I should be in Russia instead of Texas.  Help is appreciated.