Intensity Selector

ok im confused...if people are watching these patients why are they getting hurt...and if the did get hurt why wouldnt you take them to a reg hosp. not a room...

With little money provided for staffing from the state, the staffing ratios were usually very poor - sometimes 15 or more clients to one staff. Remember that many of the folks who lived here had functional skills at the infant-toddler stage. Remember also that with little consistent attention because of the low staffing ratios, people had to learn to engage in some exciting behaviors to get attention. As well, people with central nervous system problems often have impulse control issues.

When I have been at work I have covered for short periods of time where all the staff had to go do things and I was the only one on the floor with 15 folks I didn't know. These people have very intense needs, so if one client hits another and hurts them, in order to assist you have to ignore the other 13. Then bad things can happen because you are only one person. If someone else has a seizure while someone is trying to eat a latex glove while a third is trying to leave the area to go find cigarette butts to eat (not an unlikely scenario, by the way), how are you supposed to decide where the priority is when you are still trying to separate the first two who are literally at each others' throats?

You can't exactly blame the staff for being only human and being able to be only in one place at one time. You could blame Pennhurst, but they got their money from the government. You could blame the government, but they got their money from issues voted on and agreed to by the taxpayer. People who don't vote or don't support social services are your bottom line. And they generally only get involved when things go to hell in a handbasket and things become front page news, such as happened at Pennhurst. And then, only as long as their attention span lasts, which is until the next scandal hits. How many people who bitched about what happened at Pennhurst are out there making sure the same thing doesn't happen in the community? I can tell you. It's a damn sight smaller than those who were all agog and screaming when it first was publicized, as if it couldn't have been predicted from the pitiful amounts of money provided for services for folks with intellectual disabilities.

As far as why there was a physical medicine hospital on grounds, you have to remember that most institutions were originally built far away from towns because the "normal" people didn't want people who were different living near them. You can't blame that one on staff either. When you have a lot of folks who have central nervous system damage who live together in one place, the medical staff who work there become pretty skilled in dealing with issues that the general medical community sees very little of, such as the multiple anticonvulsants usually necessary to control a seizure disorder such as Lennox-Gastaut syndrome, issues with syndromes such as Down, Prader-Willi, Cornelia de Lange, etc.

When you take a client who lives in an institution to a "town doctor", for years we would get stared at, pushed to the back of the line, or they would order tests or medications that made absolutely no sense, given that they weren't familiar with the medical conditions that folks who live in places such as this are more likely to have. That is, IF you could get a physician from the community to see one of our folks. Often, as is still the case today, they couldn't even get a first appointment to be seen.

Having a fully equipped hospital on grounds makes it easier to deal with the multiple cuts, bruises, nicks, etc., that occur at a higher rate with folks who have problems with motor skills and have a high rate of injuries from falls, from seizures, etc. As well, the number one cause of death for people with intellectual disabilities is pneumonia, because so many of our folks are unable to walk independently and end up with pulmonary issues, just the same as folks who live in nursing homes. Therefore, it makes sense to have someplace for people to go when they are very ill where they can have people who understand concepts such as an order for prn pain medication DOESN'T mean you have to wait for the person to ASK for pain meds, because many of our folks are nonverbal.

I worked with a gentleman in an institution who showed one day by the very slightest signs that something was terribly wrong, signs that most people would ignore but his staff knew meant something was wrong. We hollered and hollered for help, and when they came to do the exam it turns out his stomach had perforated. Yeah, you BET that hurt. I went to visit him at the hospital (this was in a large urban city on the West Coast) two days later and found him tied to a bed, thrashing about in pain. When I asked about pain meds, the nurse told me they were to be given prn and he hadn't asked for any, so he hadn't received any.

JHC! >:-( Regular hospital, my broad behind!

Things are changing, but I am still reluctant at times to take my folks to "real hospitals" because they don't always seem exactly eager to see us coming. People in the community hoot and holler about how terrible institutions are, but as soon as you try to get a license for a group home or supported living you have every "responsible citizen" in the world playing "not in MY back yard" and screaming about property values.

Bottom line - it ain't the staff, it ain't the institution, and it's not the families who sent their loved ones here because no one would pay for home services - it's the culture that supported this when it didn't pay for adequate services and when it allowed people to live like this because they didn't care enough about them to pay decent wages.

And remember, "culture" = you and me.

That was the most informative, and insiteful post Ive ever read.

Dammit, I expected to see a "TURN IT OFF, MY GOD THE PAIN" intensity.

wow lynne- you sure do have a lot of free time to offer your thoughts on this stuff. interesting...

Lynne-where do you work?!?!

At a large ICF-MR in a southeastern state. How's that for discreet? ;-)

Very nice Lynne-
Like I said before Lynne and Serrena both work at Puff the Magic Dragon Buildings.
Puff = Psychiatric Health Facility.

Lynne, that post was incredible. Even if you've been someone who has needed mental health care previously, much of what you explained offers great insight. More than one perspective, certainly such a knowledgeable one, is greatly appreciated.

Look how clean the grout still is!

what is it

It's an intensity adjuster (aka dimmer switch) for a surgical lumenaire which is a light for use during a medical procedure utilizes a single optic fiber for providing a beam of light having an initial beam width and an initial beam energy. The width of the beam is adjustable without substantially decreasing the beam energy, and the beam of adjusted width can be directed onto a surgical field. A headband for mounting a luminaire is formed of a perspiration-absorbent cloth strip, has hook-and-clasp engagement, and includes a luminaire mount.

K?

Lynn, your post is most insightful and informative. Thank you for taking the time to educate. Ever think of becoming a politician? ( Meant in a positive way)

does any of this stuff still work like does the building still have electric at all?

no power is left at pennhurst, unless you are on the other part of campus where the national guard is. however, there is a lamp outside of the limerick building (L building) that used to flicker sometimes, but it finally died a couple of months ago. it was very eerie.

They performed Electro Shock Therapy on the patients here. Im pretty sure that switch has nothing to do with the light, but more with the amount of electricity getting pumped into the patients here.

Jesus, Motts, I just wet my pants! You owe me, bro. >:-(

And you know this because your aunts best friends mothers sister worked there and she said so.

:-)

In the only state in the country where special needs children are educated until 26, many great things are now happening for their future.

Many Institutions & "Insane Assylums" began as TB hospitals...thus the on-sight medical facilities & locations far from "urban" areas.

Lynn,

You also have to worry about aspiration pneumonia and all the other joys that can come with working in facilities like this. I have been in mental health for a while now and work in an out patient medical facility that serves under served populations so I don't have as many issues as you describe, but when I was doing my undergrad studies, I can remember working at a very well reputed nursing home for d.d. populations. Many times as an intern I was the only one there because they didn't have to pay me (ahh the joys of being young and foolish). We had a patient revolt at about 12:30 pm one night and there was always the risk of patients getting outside and freezing (many facilities have doors that lock behind you) and problems with people just plain not knowing where they were or needed to go if they get out of the place. A lot of places will have staff there for the overnight who are "sleeping staff", meaning they are mostly there for the emergency needs if the patients at the facility are fairly "high functioning". The facility I interned at was near a state college and a lot of the staff (including myself) were hired from the school. I can't tell you how many times I can remember people I was working with being under the influence on over night shifts. Often this was tolerated to some extent as the pay was low, the skills needed minimal most of the time, and the number of emergencies fairly low. In other words they were often just paying for a warm body to cover them legally should something happen or to take blame if something went wrong. After I left I know of at least 2 deaths due to issues with staffing. A lot of it is because with deinstitutionalization many of these facilities no longer have the medical facilities on site and the communities hospitals have had to pick up the slack (often farther away and not having doctors that have the experience with the patients.)

I've said this before: God, I miss Lynne!!

I just need to second what Larry D said, I miss Lynne too! I have loved reading her comments! I don't suppose anyone knows where she is...