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DARK TO LIGHT SOLUTIONS ON HOW OUR NURSING HOMES SHOULD BE ORGANIZED AND CONSTRUCTED
Just think what this world would be like if evil was defeated. If evil was defeated, we would have a world of Kindness in our hearts and actions with our bodies.
Let’s dream together for several minutes. What if there was no evil in the world.
If every human being allowed themselves to be motivated by Kindness and Love for each other. What an amazing place our world could be. Think of a world like this.
1. Neighborhoods where we show kindness, love, and help to all our neighbors.
2. Nursing Homes that are fully staffed and designed for its residents and staff. How wonderful it would be for our loved ones in nursing homes to live their remaining years with the best care possible given to them.
3. Police Departments designed to serve and help the people in its community.
4. A Military completely redesigned to serve those in need.
5. Hospitals that promote health and are owned by the community in which the hospital is located.
Keep in mind these important words
1. Do not be overcome by evil, but overcome evil with good”
2. Evil is never defeated by evil; once that road is taken, rather than defeating evil, one will instead be defeated by evil.
3. Saint Paul proposes, to flee what is evil and hold fast to what is good ( rom 12:9).
4. The one way out of the vicious circle of requiting evil for evil is to accept the apostle’s words:
“do not be overcome by evil but overcome evil with good” (Rom 12:21). As stated in number one above.
We must overcome evil with every act of kindness we can give to every person we come in contact with. Love and kindness can defeat evil. To steer a path between the conflicting claims of good and evil, the human family must work towards moral values bestowed by God himself.
For this reason, Saint Paul encourages all those determined to overcome evil with good to be noble in fostering generosity and peace Romans 12, 17 through 21.
We must overcome evil with every act of kindness we can give to every person we come in contact with. Love and kindness can defeat evil.
In closing, don’t wait for someone to start your neighborhood kindness group. This is your opportunity to make a difference in the war of good vs evil.
Just think what would happen in a community of 30,000 if a neighborhood kindness group sprang up. Then another, and then another. Wow what a place to live.
The purpose of this document is to provide information to the general public about ideas that could assist others in creating a better experience for our loved ones and staff in Long Term Care facilities. (LTC facility is a Nursing Home or an Assisted Living Facility)
LTC TRAINING CENTERS– Before I get into LTC facilities I will discuss another key component which would be LTC Training Centers. After LTC Training Centers, I will discuss the building of LTC facilities. First of all, I would build as many LTC Training Centers as needed. LTC Training Centers would be located throughout the United States and LTC staff would be sent to them for yearly training. One month would be for Administrators, a month for Directors of Nursing, a month for nurses, a month for Ombudsman, a month for the doctors at nursing homes, a month for CNA’S, a month for Activity Directors, a month for kitchen personnel, a month for vendors to display their products etc.
A LTC Center would consist of an actual functioning nursing home and right next to it would be school for training LTC staff. The staff would go to the school for training and then go down the path to the nursing home to see the principles put into practice. The staff would have hands on training at the nursing home facility.
LTC Training Centers would be located in a community that has major hospitals and colleges available. This kind of location would help with having the available equipment, staff resources, and accommodations needed to have such training center. The school would also be for training those going to school to be certified or to learn the latest techniques, equipment, guidelines, technology, etc. to become Management Staff, DON, CNAS and those that are currently working in the field that want to learn how to better serve their residents.
When you first enter the school, you will enter in a reception area where you will be greeted, complete your paperwork, have your name tag made, receive information on the program being offered, schedules, community information, etc. In that area will also be offices of those employed by the school.
After you complete your registration, you will proceed thru the double doors to a meeting room with refreshments while registration of all attendees is complete and then have an orientation with all those in attendance and staff introduction and question and answer session.
The next entry way would be into the training facility that for the most part would resemble the Nursing Home located next to the school. There would be the central nurse’s station and four halls (the halls will have street names). One street will have the same setup as the Nursing Home described above for the most part. A second Street will have a state-of-the-art kitchen and dining room as described in the Nursing Home section above. This kitchen will be used by school staff to teach those enrolled the latest information on preparing meals for residents.
A third street will be a combination street of physical therapy and for training Program Directors. A fourth street will be a combination of rooms to be used for best practices for record keeping, Social Worker, admission records for residents into nursing home, etc..
Besides the four streets there will be a large meeting room that would be used to have a place where those companies that manufacturer nursing home supplies could showcase their items such as the latest in wheelchairs, Hoyer lifts, beds, linens, briefs, furniture, kitchen supplies, electronic aids, etc., etc.. Besides this room there would be smaller classrooms for the school training.
LTC OWNERSHIP- LTC’S would be operated by the city in which they reside and be not-for-profit. (Note 1)
CDOLTC- CITY DIRECTOR OF LTC FACILITIES- Each city that has a nursing home would have a City Director of LTC Facilities employed by the city. The CDOLTC would report to the City Manager who in turn would report to the elected city council members. The person in that staff position would have to have a degree in Hospital Administration. It would be a position that any of the Excellent Care Administrators (new name of LTC Administrators) could advance into that position.
The City Director of LTC Facilities would hold monthly meetings/meetings as needed with all the LTC facilities within the city limits. The City Director of LTC Facilities would also coordinate with the LTC facilities the use of the city’s resources.
A. The Parks and Recreation Department of the city would be responsible for maintenance of outside grounds of the LTC Facility and the grounds would be open to public.
B. The technology staff of the city would be available for major technology issues.
C. The City Director of LTC Facilities would also coordinate meetings with the director of the County Emergency Planning Department. They would work out advanced planning to move residents to other facilities in case of damage to facilities due to fire, tornado damage, flooding, etc.
Each LTC facility would have a board of advisement consisting of residents of LTC facilities, loved ones of residents, staff members of the facility and other interested citizens. The Board of Advisement would give feedback to the Excellent Care Administrator and the City Director of LTC Facilities.
THE NEW ORGANIZATIONAL STRUCTURE FOR NURSING HOMES
Most nursing homes generally have the same structure. A nursing home administrator, sometimes an assistant administrator, a DON, a nurse in charge of Care Plans, a person in charge of Nursing Home Records, a person in charge of Kitchen Staff, a person in charge of Housekeeping, a Maintenance Director, Social Worker, etc.
ECA- EXCELLENT CARE ADMINISTRATOR (Note 2)
The new name for the nursing home administrator would be, Excellent Care Administrator (ECA). Their job description would be developed around these key areas.
1. Manage the day-to-day operations of the facility and keep the organization on track for providing the best care possible for its residents. The ECA would also be an advocate for all staff advancement, treatment, welfare, and their ability to have opportunities for input into the operation of the facility.
2. Coordinate and provide leadership to all departments and ensure that they work together effectively.
3. Hires all department heads within the LTC facility.
4. Hires and supervises the ECDON (Excellent Care Director of Nursing).
5. Hires and supervises the COF (Caretaker of Finances).
6. Is the staff member that would work directly and report to the City Director of LTC Facilities.
Act as the “face” of the nursing home to the city in which it resides, the public, and residents’ families, and as a liaison between, staff, residents, and families.
The ECA would be the staff member that develops a relationship with the city leadership in which the nursing home is located. (Note 3)
A. Attends the city council meetings.
B. Belong to the Chamber of Commerce and plays an active role in the chamber.
C. An active member of one of the city Service Clubs.
D. Develop a working relationship with all ECA located in the city. Participate in monthly meetings will all city ECA under the leadership of the City Director of LTC Facilities.
E. Work with the Caretaker of Finances in planning the yearly budget.
7. Ensure the facility operates in compliance with all local, state, and federal regulations.
AECA 1- ASSISTANT EXCELLENT CARE ADMINISTRATOR 1
There would be two assistant nursing home administrators. Assistant Excellent Care Administrator 1 (AECA 1). Their job description would be developed around these key areas.
1. Be responsible for leadership of facility in absence of ECA.
2. Develop programs to motivate, recognize, advance, and maintain staff.
3. Train all staff members on resident’s rights and work closely with the AECDON 2 on resident rights.
4. Develop a working relationship with area high schools and colleges.
5. Develop programs to recruit new staff.
6. That position would be in charge of training and work with ECDON and other department heads in staff training and advancement.
A. Major emphasis on training would be infection control with all staff.
B. Residents Rights.
C. How to prevent and deescalate conflict between residents and staff.
D. How to make our facility a fun and great place to work.
7. Be an active member of one of the city Service clubs. Not the same service club as ECA.
8. Be a team player with AECA 2.
AECA 2- ASSISTANT EXCELLENT CARE ADMINISTRATOR 2
1. Coordinate and provide leadership to all departments and ensure that they work together effectively. The department heads not under the leadership of the AECA 2 would be the Caretaker of Finances, and Excellent Care Director of Nursing.
2. The AECA 2 would be responsible for hiring the office manager.
3. The AECA 2 would be responsible to provide the leadership for nursing home admissions and paperwork for admissions.
4. The AECA 2 would be responsible for the creation and printing of promotional pieces within the facility.
5. The AECA 2 would work with all departments to insure safety to residents and staff.
ECDON- EXCELLENT CARE DIRECTOR OF NURSING
1. The ECDON would be a senior RN with training in geriatric care.
2. The ECDON would have a close working relationship with the facilities doctor.
3. The ECDON would have a strong working relationship with the Ombudsman.
4. The ECDON would hire all RN’S and the AECDON1 and the AECDON 2.
5. The ECDON would be a hands-on care to the residents in the facility. This position would be all about hands on care to the residents. Not an office position.
6. The ECDON would make sure that all resident Care Plans are followed.
AECDON 1- ASSISTANT EXCELLENT CARE DIRECTOR OF NURSING 1
The AECDON1 would work under the direction of the ECDON and provide leadership to the nursing staff in absence of the ECDON. Their qualifications would be an RN with training in geriatric care. Their job description would be developed around these key areas.
1. When the ECDON is not available the AECDON would provide nursing leadership.
2. The AECDON1 would hire all LPN’S, Medication Aides, and CNA’S with the ECDON playing a role.
3. The AECDON1 would be the wound nurse and be in charge of infection control and work closely with the AECA 1 in training.
4. The AECDON1 would interview potential residents to see if the nursing home could give them the treatment and care needed if admitted to the facility.
5. The AECDON 1 would assist the ECDON with hands on care to the residents of the facility. This would not be a sit in the office position.
AECDON 2- ASSISTANT EXCELLENT CARE DIRECTOR OF NURSING 2
The AECDON 2 would work under the direction of the ECDON. Their qualifications would be an RN with training in geriatric care.
1. The AECDON 2 would be the staff member in charge of scheduling of nursing staff, medication aides, and Certified Nursing Assistants.
2. The AECDON 2 would be responsible for creating a work environment that is rewarding and fun. The AECDON 2 would work with the AECA 1 and AECA 2 to accomplish this goal.
3. The AECDON 2 would be responsible for reports, record keeping, training of floor staff of data entry into the computer.
4. This position would train all staff members on resident’s rights.
5. This position would work closely with the Excellence Care Administrator Records (ECAR).
6. This position would keep all staff up to date on new regulations regarding nursing home care on a state and national level.
7. This position would provide the Ombudsman a listing of all residents and their location within the facility.
8. This position would provide family members with all nursing home records within 24 hours as requested.
9. This position would make sure all staff members are following Care Plans.
COF- CARETAKER OF FINANCES
Caretaker of Finances (COF) would be a department head. The Caretaker of Finances major responsibilities would be.
1. Prepare the yearly budget with input from each department head. They would submit the yearly budget to the ECA for approval who in turn would submit it to the City Director of LTC Facilities for approval.
2. Set up a system for the care and safety of resident’s money.
3. Set up an LTC Endowment Fund similar to college endowment funds. A LTC Endowment is an aggregation of assets invested by a LTC facility to support a comfortable end of life experience for all residents of our city. Individuals within the city could include the LTC Endowment in their will, give gifts in memory of a loved one, take out a life insurance policy with the LTC Endowment as the beneficiary of the policy, etc.
The LTC BOARD OF ADVISEMENT would make recommendations as far as the use of these funds. The only funds available would be the interest off the funds.
ECSW- EXCELLENT CARE SOCIAL WORKER
ECRD- EXCELLENT CARE RESTAURANT DIRECTOR
ECAR- EXCELLENT CARE ADMINISTRATOR OF RECORDS
ECMD- EXCELLENT CARE MAINTIANCE DIRECTOR
ECHD- EXCELLENT CARE HOUSEKEEPING DIRECTOR
ECPD- EXCELLENT CARE PROGRAM DIRECTOR
ENTRANCE INTO LTC FACILITY
The first room that you would enter would be a room that has a sink for all persons entering the facility to wash and dry their hands before entry and exit from the facility. A visitors’ guest book for all to sign, area for a nurse to monitor guest during a possible pandemic or the flu season. Posted in that room would be a list of RESIDENTS RIGHTS, name and phone number of the CDOLTC- City Director of LTC Facilities, names of key staff and their location in the building, map of inside of facility, daily honest staff count with staff to resident ratios, and last three years state surveys.
SECOND ROOM IN FACILITY
A large room with the first part being filled with all type of sitting arrangements and in the center would be a greeting and information center. Off to the side would be several office spaces for the helping those with information about questions and having someone admitted to the facility. The area behind the large sitting area would be the open area with the five little different restaurants. The kitchen would be behind the restaurants.
NOW WHAT WOULD THE INSIDE OF THE NURSING HOME LOOK LIKE
This is what the Nursing Home would look like. Let’s take a look at one of the nursing homes hallways. I have included a picture of how it would look.
Hallways would be designed to look like communities. (Halls would be given street names with street signs instead of hall numbers) . One street of the nursing home would consist of twenty home units with ten home units on each side staffed by two CNA’S for every 10 residents. The CNA’S and nurses would have a No more than 5 residents per one CNA. When not busy on their side of the street the CNA would help on the other side of the street. There would always be 2 CNAS on each side of the street because there would be floating CNAS to relieve CNA for lunch and breaks. The other CNA and Nurse would be there to help with two people assist and Hoyer lift. There would be more time to give individual help to residents.
There would be a FACILITY STATION located halfway down the street. A FACILITY STATION is the area designed for the nurses, CNA’S, and medical staff.
Across from the facility station would be a custodial closet with a large custodial sink, mop bucket and wringer, etc. A separate closet for dirty laundry and trash, and then a large room for storage (Hoyer lift, wheelchairs, extra furniture). The facility station would consist of three stations. One for the nurse and one for each of the CNA’S. The MD would also have access to the computers. There would be an area for clean linens and supplies for use with residents, a room with sink, microwave, ice box, ice machine, igloos, cups, etc. . The CNAS and nurses would have a Google Home Mini Watch (not yet developed but it will be)that they would wear on their wrist. With the Google Home Mini watch it would alert them when a resident calls, they could call the other CNA or Nurse on the Google Home Watch, reminders could be placed on watch, DON could be called, weather and fire alerts could all be put on Google Home Watch. All home units would all be designed different on the street view with different colors, doors, doorbell, mailbox materials, etc. These home units could be designed like bread and breakfast and have like cottage names posted on the door.
There would also be a well-designed room for bathing residents. Temperature controls are important. It would need to consist of large shower area to hold a shower bed, a bathroom for use of residents, a hand washing basin, a closet for clean linen, a closet for dirty linen, a closet for other supplies, a custodial closet with wash basin and cleaning supplies.
Each home unit would have a front porch and a rear patio. The front porch of each resident’s home would have enough for several residents to sit and visit or just for the resident to sit on porch. There would be only one resident per room. Room size would be at least three times the size of average 2-person nursing home. The room would consist of three areas. Bedroom, dining, and living room. The large bathroom would not be considered part of the increase in space, and neither would the increase in space for closet and storage. Technology would be widely used throughout the resident’s home. Monitors is all areas except bathroom. Voice commands (if desired) to operate all smart TVS, radio, Google Home, Computer, temperature control with safety controls.
The back patio would be large enough for several residents to sit and visit. There would be hummingbird feeders, and bird feeders. There would be flowers to attract hummingbirds and butterflies. Small water features would also be present with wind chimes. A little rock stream could run the length of the 10 outside patios.
NOW LET’S TALK ABOUT THE DINING HALL
It would be called THE RESTAURANT. There would be 4 different sections in the restaurant, and it would be decorated in 4 different themes. One theme would be Country Cooking, Little Italy, Down Mexico Way, Soup Salad and Sandwich, and China Town. Each theme would have its walls and tables decorated in that theme. Themes could change every three months. Nursing homes would serve organic food when possible and purchase food from local farmers when possible. Each theme would serve three different menu’s that could rotate each month. An example would be “Country Cooking” could offer the choice of fried chicken, meatloaf, or goulash. There would be 5 different vegetables, or salads to pick any 3. The choice of 5 desserts would be the same for all 5 themes.
Another example would be Down Mexico Way could offer the choice of cheese enchiladas, cheese and bean nachos, or chicken fajitas. There would also be a 4th section for those needing special consideration or help in eating. In this section would be a hands-free washing station for staff and residents and a custodial closet for cleaning all dining areas. This section would also be open all day for those wanting tea, coffee, hot chocolate, snacks, etc.
LET’S TALK ABOUT OTHER STREETS-
1. Street #2 would be for Beauty Shop, Barber Shop, Crafts Room, Game Room, Vending Machines, Technology Room, room for families to use for birthday parties and other needs for large space.
2. Street #3 would be designed for community member to live to receive rehab after surgery.
3. Street #4 would be for staff needs.
A. Office space for ECDON, AECDON 1, AECDON 2, A room for the the ECSW.
B. A room for the Excellent Care Program Director to office and store supplies.
C. A room for physical therapy.
D. A break and locker room for staff.
E. A supply room to store LTC supplies.
F. A room for clean laundry.
G. A room for dirty laundry and trash.
H. At the end of that street would be the entry way into three large rooms consisting of a laundry, a maintenance room, and a storage area.
NOW LET’S TALK ABOUT THE OUTSIDE OF THE NURSING HOME
A very wide cement trail would go all around the nursing home. It would dart in and out of nature areas, gardens, hummingbird feeders, bird feeders, water gardens, children’s play area, wind chimes, and so much more. An animal enclosure you’re your choice of horses, ponies, sheep, goats, cows, donkeys, deer, alpacas, giant tortoises, pot-bellied pigs, rabbits, guinea pigs, chickens, ducks, peacocks, and geese.
The outside area would be open to the public for use as an additional city walking trail.
Every entrance to the facility, except required emergency exits, would have an ENTRY/EXIT ROOM. That ENTRY ROOM/EXIT ROOM would have a sink for visitors to wash and dry their hands before entry and exit into the facility, visitors guest book, area for a nurse to monitor guest during a possible pandemic or the flu season. Posted in that room would be a list of RESIDENTS RIGHTS, name and phone number of the nursing homeowners, names of key staff and their location in the building, map of inside of facility, daily honest staff count with staff to resident ratios, last three years state surveys, and other needed supplies and information.
All restrooms within the facility would have automated equipment to help prevent the spread of contamination. Toilets, wash basins, lights, trash containers would all be automated.
TOPICS I NEED TO COVER
1. Leadership
2. Making Your LTC Facility a Fun Place to Work
3. Training
4. District Facilities
5. Rehab
NOTES
Note 1- I am a strong believer in, the less government involvement, the better off the citizens will be. But in this case, I believe that LTC facilities should be operated by the city so the citizens of the city can hold the city responsible for the care of our loved ones.
Note 2- The use of the term, Excellent Care, before each job title is done for several different reasons. It is done for the purpose of stating what that position is all about, Excellent Care to the residents of the facility. It will be a constant reminder to the one holding that position and all citizens of the community what you and your facility is all about.
(Note 3) It’s my opinion by the Excellent Care Administrator being active and part of the community it will hold him more accountable for providing excellent care to residents. Citizens will get to know the administrator and will develop a working relationship.
