WHEN NURSING HOME PLACEMENT IS DIFFICULT

“Dad really had to go into a Nursing Home,” Janet, the daughter told me. She then told of how difficult it had become for her mom to take care of her dad.  Her dad Jerry had been diagnosed with Alzheimer’s disease several years earlier. Since his admission to the Nursing Home, Jerry had been constantly demanding that his wife take him home. After one month of this, her mom was starting to say she would bring him home.

Janet said it had been so very difficult for the family to take this step, of nursing home placement. That it had been done for her mother’s health and welfare as much as for her dad’s. She was dreading, yet one more difficult conversation with her mother. Of course she could just not say anything and let her mom go get her dad, even though she knows this would not end well for either of them. Avoiding a difficult conversation, is always choosing temporary peace over certain conflict.

This time Janet chose to open up to her mother and tell her what this would mean to Janet, if her mother brought dad back home. She began thinking through; what do I want, what do I want for mom, and what do I want for dad?   She then made  a date with her mother, when they could both enjoy some time together without distractions.

Janet began her conversation with her “I want” statements. After some discussion about what she wants for herself and the life she pictures for her mother, Janet talked about her dad. ” I want dad to be safe, well cared for, happy and living among people who aren’t strangers but really know him.” She told her mother she had just read this book that she would like to share with her, that will “help us get there.”

Please Get to Know Me – Aging with Dignity and Relevance, is the story of my journey during the 14 years my mother lived in a nursing home following a stroke. Offering the reader specific ways to help families continue to provide quality of life for their loved one  while helping their loved one, form connections with the nursing home staff.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

SHOPPING FOR A NURSING HOME – WHAT DOES PERSON-CENTERED CARE LOOK LIKE?

PART III

Having regular access to the out of doors has been found to be necessary for happy and healthy living.

  • A protected outdoor space, garden or patio where residents can come and go independently.
  • Outdoor garden spaces are provided in raised beds so persons in wheelchairs as well as standing residents can participate in gardening.
  • A safe outdoor walking or wheelchair walkway that is not part of the city landscape.
  • Over head paging is used only in emergency situations.
  • Children are welcomed into the nursing community on a regular schedule
  • Community groups are invited to use space within the home and residents are welcome to join the community events.
  • Home has guest rooms available for residents out of town visitors.
  • Home has a cafe or restaurant on the campus available to residents and visitors.
  • A kitchen is made available to famlies with a refrigerator, stove and sink.
  • Staff are scheduled to work with the same residents on a regular basis.
  • The regular nurse and nursing assistant are included in the quarterly care conference.
  • The staff wear street clothes not uniforms.

While touring a nursing community be aware of how often you are greeted by nursing home staff. Just as when staying at a fine hotel, and employees greet you asking if there is anything they can do for you. A nursing community should display that same feeling of sincere welcome.

Great questions to ask staff as you tour are “how long have you worked here,” and follow up with “what do you enjoy about your job here?”  Happy people will want to tell you all about all of the great things about their job and nursing community. Happy and enthusiastic staff will be the most important item on your checkoff sheet.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

HOW TO CHOOSE A NURSING HOME FOR A PERSON WITH DEMENTIA Part III

A term that has gone out of use in the nursing home community is “custodial care,” and with good reason. The current term for care is “person centered care.” These terms are the difference between living and existing.

With custodial care you are existing but do people only want to exist? Existing means to; be present, to be alive, to be in existence, and to be surviving. Custodial care meant that the nursing home was protecting the elderly. They were charged with safe keeping and at times total guardianship of the elderly in their care. As was frequently said at that time, patients were kept “clean, dry and visitor ready.”

With time, thinking changed in the nursing home community, and people started to think about how they would like to be taken care of. Being clean, dry and visitor ready didn’t seem all that appealing. Now the thought is, if you look at all of your favorite activities over a period of time, and realize that you will never again do those things, how would you feel?

Take Ann who is now in her early seventies. Ann loves to cook, especially she likes to make soup. She makes two different soups every week. She likes to bake, making her favorite pumpkin muffins often, freezing them and eating them infrequently for a treat. Ann was a school teacher for many years and now works as a teacher’s assistant three times a week. She really enjoys staying in touch with the school atmosphere, other teachers and of course the children. Ann loves music, she sings in her church’s praise choir and she enjoys playing the piano. Ann also loves to knit and does her own small art projects making bookmarks as gifts for friends. She enjoys getting together with family and friends as often as she can.

Going to a nursing home in the future where she would only exist wouldn’t work for Ann. Living compared to exiting means; continuing your life style, maintaining your habits and activities, remaining active and relevant through being busy. Having dementia or not Ann would want to continue to; enjoy being with children, having her favorite foods, doing art, listening to music, being social, and remain connected to her faith.

Finding that nursing home that understands “person centered care,” and the concept of living over existing, is the best choice for a nursing home, for a person with dementia.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

HOW TO CHOOSE A NURSING HOME FOR A PERSON WITH DEMENTIA Part II

The choice of a nursing home has everything to do with the needs of the person with dementia. Look closely at what the reason is for the placement. Has this person just begun behaviors that the current caregiver can no longer handle? Is this person in another nursing facility that is just not meeting their needs? Is this a very large person, and the caregiver can no longer physically handle the work involved in their care?Match the reason to the services that the nursing home offers.

If the patient is always trying to walk away, question nursing home personnel about their security measures. They should have electronic monitoring systems that assure families that patients cannot leave the nursing home unattended. There should be hourly safety checks in place on all three shifts, so that a staff member is actually seeing where this patient is and what they are doing. There should be a picture of this patient at the reception desk as well as an alarm at all doors, connected to the monitoring system. The staff should indicate to the visiting family, where the security cameras are as well as who is monitoring the cameras.

If the patient needs placement because they have become more agitated and physically aggressive. Ask detailed questions about what kinds of medications the nursing home uses for behaviors. Ask what kinds of other non-drug related ways they work with the difficult patient. What does the activity program look like, and how many activity staff does the nursing home employ. There should always be an emphasis on the use of activities and getting to know the patients likes and dislikes (person centered care). The nursing home personnel should verbalize that they only use medications for behaviors as a last resort. Those types of medications should be reviewed  on a regular basis with ongoing plans for medication reduction.

If the large size of the patient is a consideration, ask about the nursing home’s equipment. Look at the size of the beds, and types of mattresses. A very large person will tend not to re position themselves  in bed as often as a slim person. This lack of movement as well as the additional weight of the person can be a cause of skin breakdown. While asking about available mattresses is an important question for any patient, it is even more so for the very large patient.

There are as many reasons for placement in a nursing, as there are patients needing placement.  Most families tend to not relocate their loved one once a choice has been made. Finding that right place where not only the patient feels comfortable but the family as well, is all important for a sucessful placement.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

HOW TO CHOOSE A NURSING HOME FOR A PERSON WITH DEMENTIA Part I

Choosing a nursing home for the person with dementia, is about where the person is in their disease process, as well as what their finances are and will be. The competition is currently very high for nursing homes caring for persons with Alzheimer’s disease.  This climate has brought forward many, very innovative programs. Programs that include plants, animals, special menus and dining options, activity programs for special interests, art, music, and the list goes on.  When a person is in the early stage of Alzheimer’s disease, they are more able to make use of special programs. Later in the disease process the person will have less interest or ability to participate in such programs.

Because many of the high end programs are usually found in private pay facilities, when assessing the elder’s finances, it makes good sense to use those resources when the elder can most enjoy them. Knowing that there is a progression to this disease, and that there is a slow decline, helps in planning. In the early stage of the disease, more funds should be available not only for the nursing facility but also for community events.  Going on outings, shopping, to a movie, out to lunch, to the zoo, etc., these opportunities need to be available.

When visiting a nursing home ask to see the activity calendar. Look for not only internal opportunities but for those outside events. Ask how they are funded, does facility have their own van, do nursing assistants accompany the elders as well as activity staff.

I well remember a nursing home that sponsored an outing to the zoo for its patients. The patients who participated were in early stage of Alzheimer’s disease.  Everything was going fine until the first patient went to sit down on a park bench and missed the bench falling to the ground. About 30 minutes later a second patient did the same thing. (both without injury)  The nursing home administrator decided it was time for this group to return to the facility. Thereafter a group never went out without a member of the nursing department, trained in Alzheimer’s care, in attendance.

Ask if there is a special memory loss unit? Is there a director of that unit? Interview the director and inquire not only about their program but also how they assess their patients for activities. The director should use terms like “person centered care” as well as vocalize an interest in your loved one’s history and “favorites.” Favorite foods, beverages, sports, music, any art interests, and more questions that would help the facility to design a program for your loved one.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing