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Nursing home blues

Discussion in 'General Issues and Discussion Forum' started by alvin, Jul 22, 2010.

  1. alvin

    alvin Member

    Members do not see these Ads. Sign Up.
    I have been working as a domiciliary practitioner for over twelve years now and have built up a good base of patients. Almost exactly three years ago I took on a nursing home. All was OK at first as it was all new to me. About a year ago I started to not look forward to going to the home. This got steadily worse as time progressed. I have now resigned from the home. I now feel as if a weight has been lifted from my shoulders. OK, I no longer get an income from the home, but I feel almost liberated. My private work never makes me fee this way. I think there are probably several reasons why I felt this way. When I got to the home the patients were never ready, some staff I sensed almost considered me a nuisance, in as much as it interfered with their routine. I think most of all because of more time being wasted hanging around rather than getting on with the job, I never felt that I gave the patients my all. Has anyone else experienced this type of feeling?, and are all nursing homes like this. It will be some time before I consider taking on another home. I would certainly be interested if anyone else has had the same feelings about any nursing home that they have worked in. Or, is it just me?
  2. carol

    carol Active Member

    Oh yes! I gave up nursing homes about 10 years ago, mainly because I was getting £!0 a client and the homes were charging the resident £15. THen one day I went in and overheard an unqulaified carer say to a resident that she could do my job for nothing, I complained, I got asked to leave the building....end of!!
  3. podangel

    podangel Guest

    I work in a few nursing homes and love it. It's generally easy work and if you set a few ground rules in the beginning it can stop any problems. I insist on use of a suitable room to use, have the clients who want to see me on a list. A care assistant will bring those clients to me who aren't able to make it themselves, and anyone who is bedbound I seein their rooms at the end of the day. If it's a large home I insist on tea breaks and a lunch break where I leave the premises. As well as keeping my own records (obviously), I also insist on access to the patients care file if there are any problems or concerns. I will also offer treatment to staff members at the same price so they will come in even if it's not their shift (that one has been difficult to get management to agree to sometimes but I always get there in the end). I think you have to go into nursing homes and make sure they know that you are a professional and not just the 'nice lady come to look at your feet!!! My nursing homes usually end up being great fun, the patients get quality treatment and often end up sat outside nattering to different residents. The staff always seem pleased to see me and I go home at the end of the day having worked hard but with a decent size cheque in my pocket and feeling happy with what I've done. I always get asked to go back and reguarly take on new homes who contact me through word of mouth recommendation.
  4. Disgruntled pod

    Disgruntled pod Active Member


    This was discussed on the SCP forum a few years ago. To paraphrase a colleague of mine, "excuse me for being cynical but nursing homes and their relative care homes are concerned with one thing and one only, getting the job done at the cheapest possible price, they do not care about quality."

    Also, how many chiropodists use the same instruments on all of the patients without sterilising them?

    I gave up on nursing homes 5 years ago and have no regrets whatsover. The co-operation from management/care workers is nothing short of pathetic to put it politely. It is back breaking work with pitatnce financial reward.

    And SCP gave some written guidelines for members working in nursing homes. Was that idealistic or realistic guidelines?!
  5. Disgruntled pod

    Disgruntled pod Active Member


    Interesting to hear your experience but congratulations on that. You have built up a rapport and got ground rules. The ones that I used to do, that was next to impossible.
  6. charlie70

    charlie70 Active Member

    I think PodAngel went about it the right way.
    When I was unfortunate enough to do a couple of nursing homes I made the mistake of trying to fit around them (I worked in the treatment room but found that I was left to fetch the patients and take them back to the lounge. Getting any sort of medical record took repeated requests. A lot of the time the staff were nowhere to be seen and so I had to rely on the patients telling me their name or (in the cases of those with poor hearing/communication ability) the other residents telling me who they were.
    Oh, and payment was a joke.
    I was "sacked" from one residential home when I requested a list of residents who wanted my service a week prior to me coming so that I could effectively plan my time and requested that I be paid for my last 2 visits as the fees were still outstanding! I did at least get payment from them.
    I had another residential home for nearly 3 years and gave it up this week when again they started being tricky about paying (new management 8 months ago - it shows) and wanted me to treat the residents in the lounge area rather than the treatment room. I did it once but said I would not do it again.

    Yes, the money is good (even at £12 a resident) for what is mainly nail cutting and some callus reduction but it really isn't worth the poor attitude and aching back!

    JAYNES Active Member

    Hi Alvin, welcome to the real world. staff in nursing homes find Podiatrists a burden we disrupt their routine. i did high care homes for four years five days a week.
    Now in private practice and love it. don`t feel guilty do what you enjoy.
  8. alvin

    alvin Member

    Hi Jaynes, Thanks for your input. I think that I tend to agree with you. Nursing homes can be a great learning curve for fresh chiropodists, but private practice is the way to get maximum job satisfaction.
    Cheers, Alvin.

    P.S. I will not be looking for anymore nursing home contracts for a very long while, or ever.;)
  9. Suzannethefoot

    Suzannethefoot Active Member

    In common with most of the others who have replied to your question. I too had bad experiences with most of my care homes, I gave up all but one, a small home run very well by the owner/manager. It is still sometimes difficult to find all the patients, but I hand over my invoices at the end of the day and a cheque arrives about a week later. If I was ever tempted to take on any more care homes, (which is doubtful) I would set very strict ground rules, namely that there is a list of patients waiting for me and the money paid at the end of the day for the whole. I too felt a relief the last time I left one particular home, even though I have not been paid for al least four of the last treatments I did there, I just couldn't face going back to press them for the money.

  10. wend0164

    wend0164 Member

    Hi Yes, similar experience.

    I have found that other Podiatrists have sold themselves short and undemined the profession by charging rediculously low prices because it is in BULK.

    I found it like a factory assembly line, felt no job satisfaction.
    I now only do one off patients in nursing/residential homes.

    If you dont enjoy your work,theres no point doing it, ultimately the client suffers if your heart is not in it.
    Best thing you did to stop, and me too!!!
  11. jasper1966

    jasper1966 Member

    Could not agree more with all the negatives - i do six homes at present and it has taken constant badgering to get them to do the simpest of tasks ie bring patients to RX room and take them back.As for medical records or even DOB's you'd think you were asking for the earth.

    To be fair i put most of the problems i put down to low skill base amongst the carers, poor pay = low morale = lack of interest and poor motivation and lastly the almost unworkable staff to resident ratios.

    I do it for the money job satisfaction i get from my NHS riole and individual private patients.
  12. Mr C.W.Kerans

    Mr C.W.Kerans Active Member

    Its an individual choice as to how and where you practice. Nursing homes tend to be run for profit and suffer chronic shortage of staff to keep costs down. If you walk away from the residents/patients, their footcare needs will remain. Sadly, the poor conditions in which we are expected to provide a professional service are accepted without demur by many of our number for the money. Nothing wrong with money - a reasonable fee is what you can charge with a realistic expectation of getting it. Delays in settling fee accounts is unacceptable - you are in effect sponsoring the nursing home management in increasing their profitability. Not on.
  13. Pauline burrell-saward

    Pauline burrell-saward Active Member

    i was once not paid for residential work, so appeared next time went straight to the owner and said I was here to do the chiropody ,did he have the cheque for the last time.

    It took him a few minutes to cotton on that I was waiting and had no intention of starting without the cheque.

    Never had to ask again!!!

    still it was a great day when i gave them all up for a surgery
  14. alanward

    alanward Member

    I agree with your sentiments Alvin, went into one of my nursing homes today to be placed in a room that was half built . Ive never actually had a proper treatment room in this nursing home and have to treat pts between free bedrooms, library, hairdressers room -(although she always takes president to the extent that they want me to only come "when the hairdresser is not there"). I do always try to make ground rules ie payment within 30 days of invoice, pt list available on commencement and give them at least a weeks notice prior to visiting. But am constantly met with "oh your here today". I guess the way to look at it is that most of the clients 1) dont want to be there 2)certainly dont want to be annoyed with having their feet treated, 3) Are not like private prac pts who mainly "choose" to come to us. If most of us are honest we dont want to be there either. Having had the experience of having my own dad in one for 4 years and now been working primarily in them for the past 11 years Ive as the Aussies would say "have had a gut full". On the plus side they pay well.... there-in lies the rub..... So head down back (sciatica) ache.. onwards, well till i can get a fresh uncynical grad.......
  15. vontabago

    vontabago Member

    I have started doing market research for nursing homes. The lowest price I found was being charged was six pounds, the highest was twelve. I belive the nursing homes do not see the differance from a foot practioner and a podiatrist, I also found the service I was offering did not matter, as long as they got there nails cut . frustrating but very true.

    I found practioner where not keeping medical records, (HPC will strike you off for this) they used towels, so cross infection was garanteed, the nursing home managment had not identified whether they had a podiatrist or foot practioner, it apeared there both the same thing. CRB checks had not been caried out.

    We all need to play a part in education, spelling out to nursing homes there duty of care to protect the residents. what we do as podiatrist, what value we offer to them.

    Also podiatrists need to start acting like profesionals, if you are HPC registered and work for six pounds per patient, maybe you need to start stererlising your instuments, keeping patient records and monitor patients vascular status, you might also need to increase your price to pay for your CPD, profesional fees, your holiday pay, your pension, your auto clave servicing, dressings, sharps disposal, stop using the same towel to prevent cross infection, purchase gloves and aprons. Or you may find your indeminty insurance is void, thats if you have any.
  16. Kahuna

    Kahuna Active Member

    These are interesting views, and my expereince of nursing and residential homes is also fairly negative! Tired residents and tired staff make for a tiring domicillary session!!

    However, as a few have said, if you approach any residential home contract with a 'rigid' and 'clear' set of rules, the homes will comply (or you should just leave!!)

    We're recommended to give the home/manager a pack containing our qualifications, contact numbers, protocol for treatment, etc. This effectively forms our contract with the home, which shows that we come as a visiting professional (like the attended dentists and GPs that they need to call out too). I also explain in my pack/literature that I need facilities like the Dentists and GPs, ie, greeting on arrival by a trained carer, access to their patient records, dedicated and private treatment room, etc. This works, and the home appreciates the professionalism, even if the 'ground rules' are more demanding than the previous 'nail trimmer' they had !!!

    I also explain that I want to watch the resident walk to the treatment room (gives chance to provide a basic gait assessment). In fact in one case recently, it enabled me to pick up on a dislocated hip in a resident (which had been missed by the GP they called out 5 days before!!) Once I'd noticed that and dealt with the necessary referral, I had the respect and full attention of the home and staff.

    Oh, and also, I never reduce my price for 'bulk'. I explain in my pack that due to sterilisation procedures, travel costs and professional time, there is no margin for bulk buy (the dentists don't, so why should we!?)

    Finally, as a note for anyone who is considering the nursing home business model..... A Pod in Australia has built a very successful "nursing home only" practice which is so nicely designed and approached that he now has a waiting list for Pods wanting to join his team! He pays up to AU$100,000 per year for a full time salaried nursing home pod!! Check his style out at www.AgedFootCare.com
  17. Disgruntled pod

    Disgruntled pod Active Member


    “We all need to play a part in education” we can educate to our heart’s content, BUT..........if the management of these homes won’t listen and are ONLY interested in getting it done at the cheapest price, we are simply knocking our heads against a brick wall!

    “and monitor patients vascular status” are you having a laugh/being realistic? This is well and truly a professional skill, yet the cheapskate managers don’t want to know, or, will say that the residents can’t afford for that to be done.

    The best thing would be for inspections to be done for these homes, with patient records being inspected once a year/checks made that a steriliser is being used.
  18. Catfoot

    Catfoot Well-Known Member

    I have read all these replies to the OP with interest.

    I would say that it depends on the individual nursing home as to what they are prepared to pay and what they will do to help you.

    In my experience the smaller private "family" nursing homes are the best. If they are part of a chain then it is very difficult to obtain co-operation from them and/or a reasonable fee as they are very profit-motivated.

    I only have one small nursing home that I visit and won't take on any more.

    I went to visit clients at one small nursing home as arranged and found they had all gone out for the day in the mini-bus ! I put in a complaint to the CSCI and never went again.

    At another I was "sacked" over the 'phone in preference to an FHP who was cheaper. They also wanted me to pay for my own CRB check, which I refused to do.

    A colleague of mine went as arranged to a nursing home to find that it was closed and boarded up !!

    If you really must do nursing homes then, as another poster said, start as you mean to go on. Charge a fee commensurate with your training and experience and have clear procedures for getting paid. Make sure they know that unpaid invoices will be subject to a surcharge if not paid within 28 days (don't all our chiropody suppliers do just that?) and stick to it.

  19. Suzannethefoot

    Suzannethefoot Active Member

    I too have turned up to homes and found that patients have gone out for the day. I went to the office to hand in my invoices one day, to be met with, 'oh don't ask me to pay you, I'm too busy!' I also had the relatives of one patient try to refuse payment, because,' his feet didn't look any different.' Luckily, I had a carer to back me up when I informed them that his inch long nails, (no exaggeration), did in fact look much better and were no longer twisted round and cutting into his skin.

    It is up to all of us in our profession to insist on respect from all of our patients. We must not allow ourselves to be bullied into accepting shoddy treatment from the homes. Perhaps we should all get together, to draw up a minimum standard agreed from the podiatrist, (see the link to the Australian care home pods) in exchange for a minimum standard of treatment accepted by the home. If we all insisted of the same standards, our position would soon improve.
  20. vontabago

    vontabago Member

    Education means informing them what you do, protocols you follow such as steralisation 134 vacume packed instuments, aseptic procedures. CRB check, indenity insurance and so on.

    I know your not getting paid to do vascular tests but if you sence something is wrong you have a duty to investigate and refer them on with your findings.
    if that means checking there vascular status, doppler, burgers elervation test, hands on, the six Ps ect.

    Also the money they spend comes from the resident, by law they get a minumum of 22.50 per week. they spend this mostly on hairdressing and chiropody, also sweets and bits bobs. hence why the prices are low.

    I have been looking at this tread with interest, I am soon going to be writing to the Care Quality Commition, who regulate Care homes. I have identified when they inspect there homes, they mention in there reports if the home has chiropody. So they need to be made aware they should not use the title if a HPC registered podiatrist is not going in to the home. If more people lobby them, they may feel a need to take action and check who is going in to the home and whether they are on the HPC register before they claim chiropody.

    after all they are there to protect the residents. we all needs to start acting like profesionals and protect the residents from cheap dangerous pratice.
  21. cornmerchant

    cornmerchant Well-Known Member


    With respect, you have the enthusiasm of a newly graduated pod, however there are ways of going about things and you must accept that you do not have the experience behind you to judge everyone else- you havent even met them, you are making generalisations.
    You cannot expect to barge in and get things changed overnight- maybe with time you will develop a little more diplomacy which is far more conducive to protocols which suit both sides.

    Yes there are failings in nursing home foot care provision, however you cannot throw away comments that residents are all at risk or receiving 'dangerous ' treatments. There is no actual evidence of this .

    Do you really think that this is the way to earn respect of the nusing home managers or your colleagues?

  22. vontabago

    vontabago Member



    Please lets not start a twelve round tit for tat fight on here. I think your right, my choice of word was not politicaly corect, sorry if I upset anybody. gulp! but I have come across on a number of times unsafe pratice.

    I know I am not going to change things over night. but what is wrong with trying to improve care for the elderly, and raise the profile of podiatry.

    I would not use an aproach with a nursing home without diplomacy, there are ways and means of geting your message across, however my concern as a health profesional is with the patient, my duty of care is towards them.
  23. Suzannethefoot

    Suzannethefoot Active Member

    Antidote to Nursing Home Blues

    I have read all the replies to nursing home blues with interest and think that something ought to be done about it.

    I would like to produce a brochure, which would set out the standards of practice which a care/nursing home can expect from a practitioner, AND, the standards of treatment/facilities/payment etc. expected from the care/nursing home. The brochure would be available to download by all pods and chiropodists to show to homes who ask for their services.

    If we could come up with a set of standards on both sides, with which we could then approach the HPC and all the different associations within our profession, to advertize, we could start to change the expectations on both sides.. For too long, we have put up with being the poor relations of the health care professions, I would like to see that change and intend to make a start at affecting that change myself.


    I need your help.

    I am only one person and cannot claim to speak for the whole of our profession, so, if you could all contact me with your ideal standards on both sides, I would be happy to collate the information and produce the brochure etc.

    I hope to hear from a good many of you to try and get this project started.

    Many thanks in advance,

    Suzanne Edge
  24. Catfoot

    Catfoot Well-Known Member

    Hi All,
    Vonty, I think you raise some interesting issues in your posting.

    If nursing/care homes advertise "Chiropody" as part of their package then it should be Chiropody and not an FHP, which is just plain misrepresentation. In addition, residents should have the right to be able to make informed choices about their foot care services.

    I have raised this issue politely with more than one care home who have tried to fudge the issue by saying that the person is "fully qualified and insured", which was not my complaint. They may well be "fully-qualified an insured" but they certainly aren't a chiropodist !

    The CSCI is the next port of call along with Trading Standards who I have found to be very effective. If care homes don't take us seriously then we must be prepared to "go up the gears". The more people that do this the better and then hopefully we can get a fair deal for these elderly vulnerable residents.

    I have just noticed your posting and would support what you say in principle. However, I don't think we need to re-invent the wheel here, as SCP has some very clear guidelines for Dom visits on it's website. What do you think?
    Last edited: Aug 6, 2010
  25. Catfoot

    Catfoot Well-Known Member

    Just a correction to my last post - the CSCI is now the Quality Care Commission, but as far as I am aware has the same function as before.

  26. shimmer

    shimmer Active Member

    I have done nursing homes in the past and just become totally fed up with them. They seemed to ask me to call because they had advertised the home as having a Chiropodist in attendance rather than because they felt they needed to care for the patients feet. I was told only to cut the patients nails because otherwise I would not be able to do enough in one morning. I only attended twice and then gave up. It was just too stressful.
  27. footsiegirl

    footsiegirl Active Member

    and perhaps protect from practitioners who cannot even SPELL?...
  28. Catfoot

    Catfoot Well-Known Member

    I think it is an excellent idea for you to write to the CQC as you suggest. If more of us did this we might be able to educate nursing/care homes about the need for Chiropody/Podiatry. I have just written them re one care home in my area that advertises "Chiropody" in their brochure but has an FHP visiting. I have also copied my letter to Trading Standards, who I find are a lot quicker to act in these situations.

    I am appalled that you allowed the nursing home to dictate to you how you treated your patients. We are autonomous practitioners who are totally responsible for the acceptance, treatment and discharge of our patients. This is what we trained for isn't it? Since when have we been handmaidens to administrators or nurses?

    Are you honestly saying that, on their instruction, you only cut nails no matter what other conditions the patient presented with?

    If so, I hope you asked them to sign a disclaimer?

    You are trivialising a good interesting discussion.
    I know some excellent podiatrists who are dyslexic
    Are you by any chance an FHP?

    Last edited: Aug 14, 2010
  29. footsiegirl

    footsiegirl Active Member

    Well, in answer to the Q directed to me- its in my profile.

    Actually, it is an interesting debate which I should not have trivialised- so, apologies...

    However, it isnt necesarily the case that a cheap practitioner, offering substandard work is an FHP. I know of a Chiropodist, who is known by the GP surgery for whom I used to work, for her £10 sessions which then result in a District Nurse visit, to put right the problems she has caused. My own patients also tell me stories of how she conducts her practice in her home- obviously anecdotal stories - I for one would like to ask everyone here at what point does anecdotal evidence become a basis for reporting malpractice, as I do feel that it is unacceptable practice, despite her reported affable nature...:confused:
  30. Catfoot

    Catfoot Well-Known Member

    Apols, footsie I had not read your profile when I responded to the post.

    I am always sad to hear all these stories aboout c£&$ chiropodists, as it brings the whole Profession into disrepute.

    I think the problem here is - and I am ducking to dodge the volley of brickbats - is that too many Grandparented were taken onto the HPC register without a test of competance.
    Now we are reaping the fruits of that.
    I know of one nursing home near me that has dispensed with their grandparented Chiropodist as they were "below standard" and have opted to engage FHPs. It seems they do not realise that they are getting the same practitioner in a different guise.

    The HPC exists to protect the public, therefore we need to report these instances of poor performance if we have absolute proof. If we don't then we could soon find ourselves in hot water legally.

  31. footsiegirl

    footsiegirl Active Member

    That said: what would you do, knowing as I do, the Chiropodist's reputation, given that the information on her practice is largely anecdotal?
  32. Catfoot

    Catfoot Well-Known Member

    The short answer to your question is nothing.

    As I said before, unless you have persons willing to make statements to the HPC you have no proof that this person is anything other than an upright HPC reg pod.

    Be careful. Don't repeat gossip and remember that as everyone has their own agenda you don't want to be caught up in it all.

    The only good point about this is that, if this practitioners is as c£*$ as you say and a steady stream of hatchet jobs are coming to the attention of other Healthcare Professionals that they will be soon out of business.


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