OK, so...I have worked as an Occupational Therapist for 13 or so years now. The majority of my work (not by original choice) has led me to working with the elderly population. I say "elderly" meaning 75-103 years old. I work with anyone from 18 and up, but especially the last 7 years my population has been elderly. I work mostly in Skilled Nursing Facilities, Long Term Care (Nursing Homes) combined with Hospitals (Acute care, Rehab units and outpatient). I want to talk specifically about Long Term Care (what many of you know as nursing homes). I have a lot of teachings in my head, and feel like it's about time I get them out to the general population. I don't call myself an "expert" in the area, but let me tell you, I think I know enough to give some sound advice and suggestions. I hope to post about a lot of things I have learned from my job, but today..I want you to take some advice about placing your family member in a Nursing Home.
I feel like there is a huge misconception about what exactly a Nursing Home has to offer people. If you look at the brochures at any facility you will see some happy, smiling "elderly" individuals playing cards, laughing with friends, eating a meal that looks like it was made for the king of England, and generally living life to the fullest. Folks, those pictures may be true to a very...VERY small percentage of the individuals in that Nursing Home, but don't fool yourself into believing it's the norm, because it isn't. I am not here to judge you and your family's life decisions. We all do what we can, when we can, and how we can. I do want to tell you, there are some things you CAN do to make your family member have the best experience possible, which requires a little work on your part.
First off..Nursing homes are understaffed, almost always. Not understaffed as in, people called in and no one could cover, but I'm talking the ratio of nursing caregivers to patient is terrible. I don't know the laws, I don't really care what they are, all I do know is, the amount of people a CNA has to care for in a day vs the duties is not good. Imagine you are caring for 20 children ranging in age from 2 to 15. Of those 20 kids 4 can walk and care for themselves with only need for supervision (like a 15 year old). 5 can get around in a wheelchair or walker and may need help with getting a few things done in the morning (like an 8 year old) 7 of those people are like 2-3 year old, they need help with every aspect of their care, able to help a little, but not much, and the other 4 are like infants, requiring full care. Now, you have 2 people throughout an 8 to 12 hour day caring for these people. How much could you really attend to each individual with having to care for 20 people in almost every aspect of their lives. Really....how much time? In all the nursing homes I have worked in, as a therapist, in the last 13 years I have only seen once when the staff to patient ratio was better than 2 to 20-25 people. So, keep that in mind as you look for a place. What is your family member able to do on their own? Toilet? Dress? Walk? Eat? because they have to rely on 2 people caring for 20 other people to help them.
So, I could just sit and complain about this, or I could come up with some suggestions about how to make this a better situation, which is what has been swimming in my head for years. How can I make this poor situation better? The answer...Help to teach families better ways to help their loved ones survive in a Nursing Home. So, here are some suggestions, taken from my experience, as well as after talking to some LTC residents. This list is not even close to the extent of my suggestions, but it's a start. Hopefully I will one day take the time to sit down and write an extensive list, maybe even teach a class, but for now, here's a beginning.
1.) "Even though you are surrounded by people, you feel alone" a direct quote from more than one patient. Nursing homes are filled with people, however, I would say 80% of these people are sooooo, sooo lonely. The majority of the people in nursing homes can't interact like the "normal" person living at home. Thinking they are all sitting around chatting it up and enjoying life is not a true. My advice...don't rely on the other individuals (workers or patients) to provide the companionship needed to prevent loneliness, it just doesn't happen that way. You, as a family member, friend or loved one need to help your family member make a plan to prevent loneliness. Set up a schedule of visits and visitors, put people in place to call on a daily or weekly schedule, take your loved one on outings, visit them weekly (at least), bring them meals, games...just provide them with visits of any kind. This is their home, but it is often a lonely one. One patient told me "If someone tells me they are coming to see me next Thursday, I often feel like I can survive the next days only because I have something to look forward to"
2.) The Nursing Home should not smell. Now I know the bodily functions are stinky things, but if taken care of in a timely fashion, in a proper fashion and with respect, those smells should be incidental only...I'm not talking about your occasional yucky odor, I mean that stale urine smell that sits in your nose the rest of the day. This to me is the first indication that people aren't doing their jobs, or that cleanliness is not addressed well. Stinky does not have to be the main smell. That being said, provide your loved one with a plug in for heaven's sake, and reconsider placement in a smelly facility, this says more then you will ever, EVER know.
3.) Residents in a nursing home, on average, get two showers a week. Is that really enough? That doesn't mean a shower twice a week with sponge baths daily...it means a shower OR sponge bath 2 times a week. But guess what..you can request(although I would prefer DEMAND) that your family member get more showers, and...knowing that ratio I talked about..it's not going to be easy, but the more active you are in their care the better care they get. I will repeat that "THE MORE ACTIVE YOU ARE IN THEIR CARE, THE BETTER CARE THEY GET"
4.) If your family member can't brush their teeth alone, it won't happen. This one is extremely disturbing to me as a daughter of dentist. I really don't have much else to say, it just doesn't happen, it's one of those things that isn't top on the priority list as the 2 staff members are dressing 20 patients in 30 minutes. So, make a plan, put up reminders for the patient and staff that "Elsie" needs her dentures soaked each night, or to help "Elsie" brush her teeth before breakfast. Also consider an electric toothbrush for easier ability to brush. This is one problem I just haven't found a great solution.
5.) Make your family member's room as homey as possible. Bring in furniture from home, put up pictures, flowers, organization bins (as the space you are provided is super small most of the time) lamps, (as overhead lighting is brutal first thing in the morning) and beg for a window side. Who wants the side of the room with no window? How depressing...If they don't get the window side suggest that the roommate who does share their light, and if they won't, request a new room.
6.) Get them outside. I have patients who haven't seen or felt the outdoors for years...YEARS. Those 2 staff members don't have time to get the patients outside, because who would help the bed bound patients, or the sick patients or the ones who don't want to go out. Check before you pick a place, that there are weekly (at least) opportunities for your family member to go outside, and then make a chart and ask your family member, or staff to mark the days they get out. Can you imagine life with no fresh air, or sunlight? Bring in lunch and eat outside, have your conversation outside, if it's hot find a shady spot and cold bring a blanket. Just get outside!
7.) If your loved one has a T.V. and their roommate also has a T.V. do you really think they will be able to hear their program? Wireless headsets...they need them!
8.) Keep up on your family member's medication. The average amount of medication a nursing home resident takes is something like 20-40 pills a day. Seriously?? just be proactive, medications interact with each other and often with some close investigation several pills can be eliminated. Many times patient's personality changes because they are over medicated. Know your medications!!
9.) Spend a day, a full day, in the nursing home. Sit in the dining room, sit by the nurses station, watch what happens. A 10 minute tour tells you nothing. I think so many people don't want to do this because it's so easy to turn a blind eye on the negative things. Think in positive terms, what happens here daily and how can I make the things I don't like better for my loved one?
10.) If your loved one is unable to be their own advocate, (which is usually the case if they are going to a nursing home) you have to be their advocate...and a loud one. Get to know all the nurses, CNA's, social worker, administrators...everyone...if they know you they will care for your family member better. (usually) I don't even mean, make a nasty fuss, give them small "thank-yous" for caring for your loved ones. The CNA's are especially under appreciated. Small up-lifters will not only help them be better at their jobs, but I always say "A little sugar goes a long way"
I think this could go on and on. This is only a start. I am not trying to discourage anyone from doing what they need to do to care for their family member. I am saying that you shouldn't kid yourself. A nursing home is not a "fun" place, it may be a necessity, but take responsibility. Really look inward and ask yourself "Am I doing everything I can for my family member or am I walking away?"
We all are in this life as our own, and hopefully as a family we can become a team. I don't judge anyone for utilizing nursing homes, they are needed, and as long as you are really...and I mean absolutely, doing everything you can muster, or give up, to support your family member, then that's the best you can do. Just remember, these people need love, physical touch, compassion, conversation, and outdoor air. Don't turn an blind eye and get caught up in the make believe world that all is good, because it's not. These people have lived your life...they were once young, active, working, taking care of kids, running errands, and living and you may one day be living their life. Make your future by living in their present.
