DEMENTIA CARE – DRESSING FOR CAREGIVING, USING COLOR

The traditional color for healthcare workers has been white. There are good reasons for this. Many times when I have walked into a bedroom of an elderly confused person to check on them, if the elder wakes they immediately say “nurse”. I would reassure them that everything was alright, but that white uniform said much more.

White of course reflects and stands out in a dark room making the caregiver easier to see. White is connected in everyone’s brain with good, pure, heavenly, and clean. This perception doesn’t change when a person gets old or confused.

On the other hand when an athletic team wants to intimidate their opponent they will wear black. A team dressed in all black will look larger and more dangerous. Add a little red to that athletic uniform and red adds the message stay away, danger.

Any clothing in very dark, almost black, colors might be difficult for a confused elder to see, and they may only see black. Happy colors are in the yellow family. Also light green is considered a color that improves mental functioning. Green has been shown to improve test results with students, and light blue is shown to be a stay-awake color. The combination of white with yellow, light green or light blue is the perfect combination for caregiving.

Archive pictures show Florence Nightingale in her familiar uniform of long black dress. But that dress was softened by her white lace collar and lacy cap. Even pictures in her old age showed her in the same combination with the addition of a white lace shawl. However, for many years the color of healthcare has been white.

Every time research is conducted on what profession people think is the most trustworthy, nursing rises to the top. So dress the part, especially if you provide care at night, wear white and you will hear your elder say “nurse.”

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

NURSING HOME RESIDENTS WORRIED ABOUT EBOLA

“Did you hear that the man in Texas died,” said Grace to her companion at the nurse’s station. Seems like everyone coming out of the main dining room after breakfast, was talking about what they heard on the news. Listening to their conversation, I soon realized that the news media had once again scared these residents.”

Nothing in the news report had told these people that the people dying of Ebola, so many thousands of miles away had been very malnourished people. These diseases strike the most vulnerable, the weakest among the population. Even though nursing home residents may be considered among the weakest population in the U.S., compared to third world countries these residents are eating like kings. If at any meal they do not like what is being offered, one of the dining room staff can make a call to the kitchen, and one of the many alternative meals can be quickly brought to the dining room.

Infection control? Ebola is spread though droplets (not air borne) so anything that is contaminated and touched can spread the disease. So in the case of someone who does have a disease spread by droplets, what is referred to as “contact precautions” are used. Routine contact precautions in a nursing facility would include using gloves, and a protective gown, possibly a mask if there is a danger of body fluids splashing a caregiver.

This particular organism, like many others is contracted through mucous membranes, eyes, mouth, nose, and you get it just like the flu. Washing surfaces with a disinfectant and even with a chlorine solution kills most anything. But as always, the way to stay healthy is washing hands. In this nursing home every resident room has a sink and soap dispenser. Not only are there numerous places throughout the building to wash your hands, there are hand sanitizer stations everywhere. The folks in Liberia would not believe this if they could see it. If pharmaceutical companies could come up with anything that is as effective as washing hands they would be even wealthier than they are today.

Ebola deadly, yes. But knowing Graces so well, I thought she should be worried more about those 5 packets of sugar she grabbed off the coffee cart, as she does every morning. Grace who has already lost one leg to diabetes and is in renal failure from a life time of eating coffee cake, donuts, cookies, cupcakes, and talks about how she just loves bread and can’t give that up. Grace who serves as the informal leader of this elderly community. No, if you want to scare Grace, there are better ways to scare her, don’t scare Grace with Ebola.

 

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

MARIJUANA, GENES AND SCHIZOPHRENIA IN THE NURSING HOME

Mary is the latest admission to the nursing center, the latest with a diagnosis of schizophrenia that is. Mary is 58 years old and comes to the center because of a broken hip. She has orders for pain medication, something for a reflux problem and an anti-depressant which could be explained away by her current inability to be as active as a 58 year old woman would most likely be. But there it is, two big guns, major anti-psychotic medications and that terrible diagnosis of schizophrenia.

Mary once was a normal teenager, but she experimented with marijuana and has been paying for it ever since. Years of; having hallucinations, hearing voices, getting directives from her television set, trying new medications, living with her parents, never having a job, never having her own family, and missing out on so much more. No, Mary hasn’t experienced normal for many years.

What is the link between marijuana and schizophrenia? It depends on your gene pool. If you are one of those who has a gene that gives you a propensity for schizophrenia, the research tells us that even a onetime use of marijuana can cause a schizophrenic episode and a life time of grief. Mary didn’t have a family history of schizophrenia, but she also didn’t have a family history of drug use either. If no one in her family had ever experimented with illegal substances, how would they know that this gene was in her family?

Once again the states seem to be trying so hard to be current, to be in with the latest item of public interest. But this one could be life changing for so many. It was for Mary’s life. As the television networks are reporting how close the states are to making marijuana legal, no one is talking about all the research out there linking marijuana with schizophrenia. No one seems to be trying to educate the public. No one is talking about how many more Mary’s there might be in the future.

 

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

NURSING HOMES BEFORE CONFIDENTIALITY

I fondly remember a wonderful nurse, some 30 years ago. She was the day shift supervisor in a large facility that was part of a well know chain. She “rallied the troops” every morning by going unit to unit saying “Were in the trenches now, everybody has to pitch in.” This might have been somewhat motivational for the staff. But with the benefit of time and a different perspective, it sure makes a person uncomfortable. I don’t know what those nursing home residents must have thought, when they heard about those trenches.

 

Why the battle cry? Why was taking care of these elderly people thought to be a fight? Who really was the enemy?  If I ran into that nurse today I would embrace her as the good nurse and friend she was. She wasn’t a bad person, she was a nurse that came from a military background as so many did then. Yet everything she and we did was loud, nothing more so than shift to shift report.

 

CONFIDENTIALITY? – YOU MUST BE KIDDING

Private, personal information? We lined all the residents in rows around the nurses station, sometimes three deep, facing the nurses. Then we gave “report” on everyone, with loud voices and the, nursing assistants in attendance. Everybody got the low down on themselves and everyone else. If no one had the courtesy to tell the resident the results of his lab tests, they would be read and discussed loud and clear right in the middle of the nurses station during the next shift change.

 

Someone died during the night? All the details were everyone’s business the next time the shift changed. Was it expected or unexpected, was the family there, did they donate the elder’s belongings, we knew it all and it all was shared.

 

I especially remember a wonderful woman in her early eighties who always sat front and  center in that row of residents. Her name was Gertrude and she was a retired nurse. I always wanted the retired nurses close to us, because they so loved the nurses station. But, Gertrude didn’t let anything go by her. When she was unhappy with the “report” she would take off her shoe and with amazing accuracy throw it over the nurses station and hit the offending nurse with her shoe. No one seemed to notice that Gertrude was making a statement. I would just ask a nursing assistant to “help Gertrude put her shoe back on.”  But, Gertrude must have been offended, and needed to be heard.

 

Many things have changed in our society over the last thirty years, some for the better, some not so much. As for life in the nursing home, with confidentiality and the right to privacy.  There at least we are finally getting it right.

 

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

THE NURSING HOME – THE WAITING ROOM

Nancy was 94 years old when she went to live in the nursing home. She was one of the few who didn’t come directly from a hospital bed due to an infection, injury or disease process. Nancy didn’t have any dementia, in fact she read the Wall Street Journal regularly as well as her periodicals she so loved.

No, as Nancy put it, she was lonely. Most of her friends and contemporaries had died. She had buried her parents, husband, siblings and even one child already. Going to live with her remaining daughter wasn’t going to be a good option, so she chose a nursing home.

Now at the age of 99, not much has changed for Nancy. She still takes care of herself, oh she may be a bit slower, but she does it. Nancy will tell you that the people around her aren’t really “friends.” But as she says “they are people,” and Nancy likes to be around people. Being around people and staying interested in people is what probably keeps Nancy going, and yes the care she is receiving from a nursing home.

Nancy balances her day with quiet time reading in her room, attending the activities she is interested in and enjoying her meals. These are the things she doesn’t miss; shopping for her food, cooking, cleaning, and washing clothes. If she wants to go to the beauty parlor, it is right down the hall. The doctor and dentist come to the nursing home and if she seems to be getting a little weak; the nursing staff refer her to therapy right away. Being in therapy every few months now seems to be her way of life.

Is Nancy happy?   She would tell you, she is as happy as she can be. Nancy often says the nursing home is just like a waiting room; people get old and go to a nursing home to wait.

But instead of sitting alone in her quiet apartment, Nancy chose to wait where there is a lot of life going on, the nursing home.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

IS THERE AN ELDERLY HOARDER IN YOUR NEIGHBORHOOD

Shirley looks like anyone’s grandmother, always friendly, greeting everyone who walks by as she sits reading in a corner in the Nursing Home.  The problem is, she never was married, has no children or grandchildren and when she goes home who will watch over her? Now when her therapy is ended and she has gained strength and better balance, should she go home?

If you look at her bright eyes, quick smile and how steadily she walks around the facility, sure – why not, discharge her to home.

As Paul Harvey used to say, “Here’s the rest of the story.”

You see Shirley had been living in a Condo she had owned for years. Her neighbors called the police because of the terrible odor coming from the condo. What the police found was the typical apartment of a hoarder with stacks of saved magazines and newspaper. In addition the apartment had mouse droppings all over, human feces on the floors and carpets, a refrigerator and freezer that no longer worked filled with rotting food and a very thin Shirley who hadn’t eaten for some time.

Now, Shirley having been taken care of for the last 60 days in the Nursing Home, eating regular meals, working out with therapy twice a day, looks like she is ready to leave. After talking to Shirley’s direct care givers we learn that despite how great Shirley looks she is incontinent of urine and stool and doesn’t seem to be aware when she has an incontinent accident.

While Shirley can have a great conversation with anyone who stops by, she needs some help finding back to her room. Shirley was driving a car before she came to the Nursing Home but the staff notices a constant twitching of her right eye and they question if her sight and judgment are good enough to drive.

No family but she has us – the Nursing Home family.

While it seems her options are limited she has many people who care to help her sort this out. From calling a brother out of State to make sure he is aware of her situation to calling Home Health organizations, the facility staff are here to help.

Whether Shirley and her brother decide to have her stay in the Nursing Home or get help into the home, Shirley is no longer alone. The real question is, how many Shirley’s are out there, all alone, counting on the neighbors to notice?

Virginia Garberding, R.N.

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

HOW TO FIND THAT GREAT NURSING HOME

Do your homework!

Just as in every other major decision in life – you have to do your homework. When my children were picking a college – we traveled, toured, asked questions, looked at dorm rooms, and met as many students as we could – we did our homework.

The same holds true with picking out a Nursing Home, maybe even more so. That caregiver you passed in the hall may be the one who will give your mother her bath – wash her hair. You want the caregiver to know how in her later years your Mom was afraid of getting into the bath tub and so took a “sink bath.” Many elderly people “wash up” at the bathroom sink. You want that caregiver to know what kind of soap your Mom has used for the last 50 plus years you have known her. And you want to provide that soap (do they allow or welcome that here, if they look at you strangely for even asking, think again, this home is not on the culture change journey).

See: blogs on “Person-Centered Care” – for information on “Culture Change”

Visit and visit then visit again.

Visit, visit and visit some more, truly this is the age of the consumer. If it is important to your parent to have activities late into the evening hours because they have always been a night owl. Don’t settle for the Home with the super nice Admissions Director. That person won’t be there when your Mom is bored to tears every evening with nothing to do. Ask to see the Activity Calendar, and when you stop in next see if those advertised activities are really happening or is it just on paper? Are the activities in one large room where most of the residents are sleeping in their wheelchairs? Or are the activities conducted in small groups where the activity is geared to the interests of the participants.

If food is very important to your Dad, stop in at meal times and see what’s cooking. Be bold, and ask if you could sample the meal. This is the time to find out if the Nursing Homes entire budget went for that great reception area you just saw and not much for dietary.

Be that knowledgeable consumer you would be if you were buying a new home, new car or new boat in this buyer’s market.

See: Caregiver Tips: Choosing a Nursing Home for your elderly parent (Part III) June 12, 2009

Virginia Garberding, R.N.

Director of Education, The Wealshire

Author: Please Get To Know Me – Aging with Dignity and Relevance

With Cecil Murphey of 90 minutes in Heaven

NATIONAL NURSES WEEK – FIVE TRAITS THAT MAKE A NURSE OR ANYONE ELSE GREAT

I just read an article called the 5 things that make a good nurse. In reading the list I realized these 5 things would be good traits in anyone, especially anyone caring for an elder.

5 – Traits that make a great caregiver:

1.      Compassion – the ability to really see you’re elder and take action. Whether it is providing pain relief because you know the elder so well that you know when they are agitated they are in pain. Or the caregiver who realizes the elder is upset because they just can’t make any sense out of the environment or their situation, and the caregiver provides a comforting presence. The caregiver that realizes this isn’t what that elder wanted for themselves or expected in their life.

2.      Empathy – The Oxford Dictionary defines sympathy as sorrow at someone else’s misfortune – however empathy is the ability to share and understand another’s feelings. I remember a day many years ago when I needed to “call-in” to work. Something I rarely did, but it was worth it for the words my Director of Nursing said to me that day that have stayed with me. When I explained that my arthritic knee was acting up to the point that I quite literally couldn’t stand, she said, “My knee hurts for yours.” That was empathy. Instead of saying “I’m so sorry you hurt, she said “I hurt for you.”

3.      Selflessness – putting someone else and their concerns above your own. The private caregiver who just can’t go home on time because her elder isn’t doing well today. The caregiver who misses meals and hardly dashes away for a bathroom break.

4.      Self-aware – knowing your strengths and weaknesses is important in a caregiver. No one is great at everything, knowing when you need to call for help doesn’t indicate weakness it shows self-awareness. Knowing when you need to step back and take a break is strength.

5.      Thirst for knowledge – new ways to care for the elderly are discovered every day. Becoming part of a support group and attending educational opportunities to learn about new approaches for different disease processes, promotes better care. Sharing with other caregivers also rejuvenates the caregiver. A person who is always seeking new information is never a dull person.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegetoknowme.com

NURSING HOMES – THE FUTURE OF SENIOR CARE

(PART IV)

Is it a spa, a cruise ship or a nursing community? The focus of the future in senior living will be on wellness programs, living green, cyber learning labs, themed restaurants,  green environments, senior living design, wellness and healing gardens, therapy pools, and aquatic centers.  Having life long learning will be very important in nursing facilities in the future.

The future may not be a nursing home, but perhaps a “smart home.”  A  home that has all the latest in technology, connecting the elder with their caregiver through wireless means. Tele-health technology, geriatric assessment through technology, and non-medical services to promote quality of life are all possibilities right now. There are beds that document how often you get up during the night, can take your weight, and body temperature. How about a toilet that will test your urine, as well as measure the amount of your output. Technology used to create safe environments, automatic light sensors when you get out of bed at night to show you the way to the bathroom.

New terms to know will be aging in place, which means staying in your home and having services and technology come to you. Aging in place could mean going outside your home to adult day care as well as bringing services into the home.

Green spaces, are long-term care settings which have small group residences instead of large institutions. A green space may have 6 to 10 residents instead of 100 to 200 residents. It would be a small home setting, self contained and organized around normal living routines and a sense of community. An activity director in this setting would now be called your life care coach.

Of all the choices, it seems that aging in place will continue to be the first choice of many.

Virginia Garberding RN

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

NURSING HOME – TODAYS NURSING COMMUNITY MORE OF A REHAB FACILITY THAN LAST STOP FOR ELDER

(PART III)

 

The usual move into a Nursing Home is often looked at, as the last home for that elder. But that is not always the case. When the elder has been living at home and now moves into the Nursing Home they gain many services.

 

Myrtle brought Bill into the Nursing Home in a wheelchair because he had had several nasty falls. Bill had also recently lost quite a bit of weight. He had a diagnosis of Alzheimer’s disease and was now in the mid-stage of the disease. After Bill started falling at home he just seemed to go down hill.

 

The Nursing Home has many resources available.

 On admission the nurse did a full assessment of Bill’s condition and the Therapy department completed an assessment as well. The dietitian followed his meal intake and provided supplements. Bill started working with physical and occupational therapies twice a day to build strength and increase balance.

 

The elder will have a personal diet developed for them while in the Nursing Home. The nursing assessment will include a total body assessment looking at the skin for any thing unusual. The Nursing Home may even have a wound nurse on staff trained in healing the most stubborn wounds with the latest treatments.

 

Whether it is a psychological problem which is identified by the social worker’s assessment or a foot problem noted by the nurse, help is not far away. Nursing homes have access to physicians from dentist to podiatrist.

 

Bill goes home.

Much to her surprise after only two months Myrtle received a call from the Nursing Home saying Bill could go home in three days.

 

When Bill left he walked out next to Myrtle, his balance problems resolved at least for now. His appetite was back and they said they would be stopping at his favorite hamburger place on the way home.

 

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com