We have been discussing recently all the difficulties we have encountered as caregivers, when our person has been in a facility. Most of us acknowledge that it revolves around the Feds and the recent cut backs - since 2010. In 2011, the Feds said "hey wait, baby, we gave them too much money!" And have spent the last year revising the numbers. We are now on revision number three. Is it really unrealistic to understand why the SNFs have no clue as to what their projected budgets will be?

So back in the dark ages - LOL, just before I had to go out on personal leave to tend to Bruce, our facility was in State Inspection. At that time, all "feeds" were brought to the dining room. We had two CNAs on duty to help that. Not so now. One of the CNAs in the dining room, during inspection, came to me and said "Debbie, I am the only one." I am Charge Nurse, so off I go. CNA points me to a long termer who is a "feed."

I am one of the few Nurses who was never a CNA before I was a nurse, but heck, I can get through this. I do know the rules. Tray is there, Puree - yes it is. Inspector, who thinks this is funny, decides to sit down and watch me. I unwrap the utensils and I have soup spoon, knife and fork. No teaspoon. Now regulations state that I must feed - 1/2 full - with a teaspoon. I don't have one. I can hold the meal until I get one, but then the meal is cold - also a citation. So off I go with the soup spoon, after callling for the teaspoon. Patient is in la-la land. She has no clue, so it is all on me.

Teaspoon finally arrived, but Inspector said to me "you are really something!" I think that was the day I really knew I was meant to do this.

Every year the State focusses on the "Problem du jour". We had a patient who set a SNF on fire - several deaths - because she lit a cigarette and fell asleep. Last year we had four choking deaths in the State. Pain and continence are always an issue. And also dentition. How many teeth, can they function with that?

It is impossible to nurse, effectively at this level. I know they are medicated for whatever reason that is necessary. Yes, their meals are delivered on time - are they correct? Did they get to their therapies today? Who is going to Recreation? Are they peeing, did they have their BM? Are they medicated for pain? How does their incision look? Labs - in normal range. Who has a temp? And one step beyond all this, was the proper spoon used? Debbie