How many hours of care will you get in a nursing home?

You won’t get the hours promised

Direct and indirect care is more complex than you might think.    How many hours of nursing care will you really get?  I’m going to crack the door open a little bit by explaining subdivisions in care.  When you look at nursing time promised to your, it is divided into many groups.  The first subset is Direct vs Indirect care.   Direct care is the care that is “hands on” with the caregiver, in your room.  Indirect care is when staff are not in the room they’re not with you and they’re doing something else, but what they are doing pertains to you.

Direct Care:  This will show how many hours of nursing care you will receive before you subtract indirect care.

Taking vital signs:  includes blood pressure, pulse, temperature, respiration and oxygen saturation readings.

Taking your weight:  can either be done on a scale standing up, in a wheelchair where they wheel you on to a big scale, use a bed scale included in the bed or that can be attached to the bed.

Activities of daily living:  include brushing your teeth, taking you to the toilet, coming your hair, washing up, getting dressed, putting on shores and braces and make up.   These things take time and are included in the activities of daily living.

Changing the bed while you’re in it, because when you are in the bed they must do a special process to turn you over and over back-and-forth rearranging the linen underneath you.

Dressing a resident: takes time, choosing the outfit, getting the residents OK.  Assisting their arms and legs in them, getting them buttoned up zipped up and looking presentable.

Feeding a resident:   it may seem easy, just put the food down in front of them and let them eat them their own food. But not every resident can eat on their own.   There are different types of diet’s, and residents have different types of abilities to eat.  Some residents have difficulty swallowing so the staff provide one to one care hand feeding them their food.

Assisting with mobility: means walking and exercise.   A lot of times they just need staff to walk with them.   Then some people need a gait which wraps-around your waist giving staff a place to hang on to in case you get wobbly.  Many people need different types of things such as canes, walkers and holding on to a wheel chair. Mobility includes different types of footwear and braces needed for stability.

Emergency aid and support: is direct care involving many things such the initial assessment.   CPR or the chest compression and respiration.  The Heimlich procedure is included in the emergency and support which means anything take over for you while you are not able to do it yourself.

EKG’s is also direct care because staff are doing the tests.

Calorie count are done every shift.

Range of Motion is something staff does either passively, actively or with patient assist.  It means helping a limb to move or have motion.  If you don’t have motion you eventually stiffen and not be able to move at all.  Range of motion is very important

Repositioning and transferring:  With a gait belt or a mechanical lift which is used if a person cannot support their own weight and need to go from bed to another bed or to a chair or a shower chair.

Setting up equipment while you’re in the room is also direct care.

Assisting with incentive spirometer and cough deep breathing:  The Incentive spirometer will help strengthen your lungs.  Staff will teach and encourage to cough deep breath which clears the air ways.

Oral suction is direct care helping to remove mucus from the throat and upper chest area.  It will help you to breathe easy.

Setting up chest tubes:  preparing for placement or changing the canister.

Preparing fora sterile procedure:  creating a sterile field and supplying it with sterile supplies to do a sterile procedure.

IV care:  observing the site, changing the dressing flushing, flushing and medicine through the system.

Post mortem care is the care your body receives after you have died.


Indirect care:  This will show how much indirect nursing care you will receive.

Cleaning equipment: when you’re not in the room.

Room care:  don’t need to be in the room to have the room cleaned and the bed made or sweeping and mopping.

Taking Specimens to the lab

Making phone calls: calls made in your behalf to doctors, therapist, your family or any one of many people involved in your care.

Assembly of Orders:   After the doctor gives orders the processing of the order is not always easy.  It takes a bit of time to get that order all the way to completion.  It needs to be entered into the computer, and a decision made to which times of it’s a medicine is going to be given not to interfere with other medicines.   It’s may be a dressing or a special diet. Equipment may need to be ordered or arrangements for transportation.

Stocking supplies: Many supplies are used throughout the day in many different procedures which need to be ordered and put in the supply room.

Cleaning the nursing area:  a good clean nursing area helps the keep things organized and running properly otherwise papers may fall on top of other papers causing chaos causing things misplaced.

Cleaning patients after a procedure:  Doing the procedure is direct care, however cleaning up a patient and the supplies are considered indirect care.

Supplying the cart:   Besides the stock room we have many carts to stock and maintain such as the emergency cart, and Oxygen cart to name a few.

Obtaining and delivering blood products: is a very timely procedure.  First the order sent down to the lab, so the lab tech’s can order and check the product. Once verifies by them, a nurse will double check everything with the lab tech.  Then two nurses will double check the order and the product before bringing it into your room.  At that time, it will be double checked with two nurses again and vital signs taken.  It can be a very lengthy process.

Orienting ancillary staff:  or staff that comes in to fill in during a nursing shortage.   They need to be brought up to speed, given instruction and filled in on the operation of the unit.

Keeping logbooks up-to-date:   There are many logs to keep current, from how many staff are on each day on which units, refrigerator temperatures and tally of supplies.

These are the first two divisions of time, this will better show the hours of nursing care you will receive.   By looking at this you will see the time promised to your is effectively cut in half.  So, if you expected to receive 3 hours care, at this first juncture of division, you now know you will receive only 1 ½ hours care.  But stay with us and you will find that there will be many more divisions, and the time you expect to receive will become smaller and smaller.


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How to stop Thieves in a nursing home

By using various anti-theft measures, you can outsmart Thieves from stealing your parents valuables.


Some Tips:

  1.  Keep valuables at home
  2. Lock box
  3. Tracking measures
  4. Banking system in facility
  5. Substitute expensive jewelry for knock-offs
  6.  Bring in small containers of lotions and perfumes
  7. Don’t expect your parents to understand how understand peoples intent like they used to.
  8. Video cameras

This is a story, written by permission, of a woman I once cared for in a home based situation.  If this information would have been available to her family when she was admitted into a nursing home it would have saved them a lot of trouble.  It is possible to outsmart thieves in nursing homes.  This is a topic we will provide more than one article on.  Here is Emma’s story.

The Orphan

Emma was born in 1925.  She lived in an orphanage in Chaska, MN.  There is a plantation on Highway 41 close to the Flying Cloud Airport. When Emma was six, she was sent to live in the plantation every year until she turned 18.  The orphanage routinely farmed out the children to earn income.  Emma lived on a plantation with approximately 100 other children.  The orphanage built cinder block one room buildings, where children slept on cots lined up 20 to a hut.  At 5 a.m. the children were lined up and fed, before beginning a long day of work.  They worked from sun up to sundown.  They each had the same quota, whether very young or an older teenager.  If a child didn’t meet that quota, they would not be fed the next day.

Emma recalled when the measles ravaged the camp one year.  She said being sick didn’t mean you could get out of work.  You just worked sick.  She remembered children who died on their cots, overworked and exhausted.  The children’s bodies were just taken away, and Emma never saw them again.

The children working on the plantation weren’t given new clothes, and they didn’t have shoes, as they were constantly walking in the mud of the plantation.  The huts were very hot in summer and very cold in spring and fall.  There was no time to be a child.


Upon becoming 18, Emma was turned loose into society.  She got a job in a dairy.  That is where she met her husband, Albert.  One day he proposed.  When they were married, he gave her the best ring he could afford, and she cherished it.  She stared at it for hours, hardly able to believe anything as lovely belonged on her finger.

They worked hard, saved and eventually bought the dairy.  In those days’ milk was delivered to your doorstep because of lack of refrigeration.  But as the years passed, the supermarkets took away the need for door to door milk distribution.   Emma and Albert had purchased a home in downtown Chaska, and raised four children.

The Ring

Emma and her ring were the source of pride in the family.  She displayed it prominently in every photograph.  Carefully taking it to the jeweler to be cleaned every year.  The ring was more than a symbol of the love between her and Albert, but also that she was free from hard labor.  It was her symbol of emancipation.

It was late in 2001 when Albert took sick and died.  As time went on the family noticed Emma forgot things, such as where the grocery store was, and even their names.  She had also become unsteady when she walked.  The family finally admitted Emma into a local nursing home.  Her forgetfulness increased until she forgot her beloved Albert even existed.

The Nurse

One day a traveling nurse gave Emma an extra dose of her evening painkiller, and while Emma slept, the nurse removed Emma’s wedding ring.  The nurse pawned her ring in a neighboring city.  When Emma awoke the next morning, she didn’t remember she even had a ring.  It was her children who discovered it was gone and called authorities.  Thankfully the ring was found and returned.


Emma’s family could have read the mandatory staff log and know if there was a history of PRN nurses.  If a facility cannot keep enough regular staff, it could be a sign that staff are refusing to stay at the facility for any number of reasons.  But, it could be a starting point for dialogue with the staff before something like this happens.  At least it would have given them a heads up.

In every facility there is a log that should be prominently posted, in plain sight, telling everyone the staffing for each unit and each shift.  That way from day to day you can see if there are problems with a anticancer unit or shift and their staffing.  If you do not see this information, be sure to ask where it is displayed, and be diligent in looking at the current day but also at the previous week.  Keep a log of the different staff, that way you will know if there are people who are not regular employees.  That way you will be able to ask staff about them.

Hired staff and PRN staff, (staff from an agency) are held to different standards.  You also have the right to refuse a specific person to care for your parents.  It is your right to refuse to have agency or PRN nurses to care for them, and they need to comply to your wishes, unless it is  impossible.

Is it safe to leave valuables with a patient in a facility?  The short answer is no.  However, it would be terrible to remove a highly sentimental wedding ring.  However, once a person is so senile, they don’t remember it’s significance, you might want to consider replacing it with a nice one, that is less expensive.

Expensive items are very tempting to some workers.  You never know who it is who lacks the morals to keep their hands off them.  Things can also be lost in the laundry, or mistakenly taken by a roommate who thinks the item is theirs.  Caution is the key word.  Make sure things are locked up, and that your parents not only know how to access them, but that the key is secure and staff can’t just pick it off the bedside table.

Money is a problem, as it can vanish quickly without a trace.  Use the facility banking system for resident’s, it is your best bet.  That way if they want to buy something from the gift shop or some candy or a magazine, or pay for a newspaper subscription they have the ability to use their own money.  There is a little hassle to this process, but it keeps the finances securely in their control.

When you visit you might ask them if some one on staff is has repeatedly told them their birthday is coming up, or that they need money for their child’s operation.  It is a way that some staff pressure the good will of a resident to hand over money.  It happens more than you want to think.


Here at Best Nursing Home Inspections we plan on giving you information and insights to the good things and also the problems that people face in a nursing home.


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