WHY DOES AN ELDERLY PERSON NEED A NURSING HOME/REHAB FACILITY?

Why do people need to go to nursing home or rehab facility?

  • they need nursing help with bathing, eating, dressing, or walking
  • they have just come out of the hospital and are not ready to go home
  • they are unsafe and can no longer take care of themselves
  • they have dementia and and forget how to take care of themselves

Why do these people need so much assistance?

It may be for a medical condition that they are recovering from, or the nursing facility has the equipment or human assistance they need to recover. It can be that they are recovering from an infection and need medications better delivered at a nursing facility. It maybe that they are just too weak to live independently, or they are frail due to advanced age. The elder with poor vision can have a hard time shaving, dressing, even difficulty eating independently much less shopping for food and meal preparation.

The elder with dementia may not even remember how take care of himself, even how to brush his teeth:

  • he may not remember that he needs to brush his teeth
  • not remember that he hasn’t brushed his teeth
  • not remember what equipment he needs to brush his teeth
  • not remember how to brush his teeth, what to do first and what to do next – the entire process of brushing teeth

How much should you help a person with dementia?

“Why do you make my wife brush her own hair?” a husband asks the nursing assistant. “Isn’t that your job?”

  • the confused elder feels better about themselves if they do as much of their own care as is possible
  • the elder who participate in their own care remain healthier and stronger
  • the job of the nursing staff is to teach the confused elder how to take care of themselves
  • it is the responsibility of everyone in a nursing community to help their patients be as independent as possible
  • always support ability not disability, provide just as much assistance as the person needs

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

8 TERRIBLE DAYS OF REHAB AT HOME – HE SHOULD OF GONE TO A SKILLED NURSING FACILITY

I ran into Shirley at the local grocery, and while we were only the most casual of acquaintances, Shirley clearly had a story to tell and wanted to talk.   Her husband George had just had a long over due, knee replacement. Planning for this surgery didn’t seem to include a plan for his recovery. The story Shirley had to tell was how the hospital personnel had let her down, coordinating George’s recovery. It seemed that the discharge planner had not fully informed George of his Medicare benefit, that would cover care in a nursing facility. Instead she urged him in the most aggressive terms, to recover at home.

Shirley said, this “hospital woman” talked to them for over an hour, and all she said about skilled nursing facilities, is that George would be in “great danger” of getting an infection. The hospital woman had many scary stories to share with the elderly couple. Stories, about how nursing home personnel had made mistakes and the horror of infection lurking everywhere.

So this fragile, elderly woman drove her husband home after discharge. Now instead of having young hands ready to help at the push of a button, it was only Shirley. She shared that what followed were eight days of arguing, yelling, pain, crying, and anxiousness. Yes, home therapy came, but that was only one hour a day. The rest of the time it was Shirley who was on duty.

George was very qualified under Medicare to go directly to a skilled nursing facility. The major Medicare qualifier, is that you have been admitted to a hospital for 3 days. If you go for an emergency and are only under “observation” that time does not apply to the 3 day rule. You must be admitted for 3 days. As well, the day you are discharged from the hospital, does not qualify as one of the 3 days.

Medicare provides 100 days of coverage in a skilled nursing facility.  Days 1 through 20 are at 100%, days 21 through 100 they pay $161 a day and your coinsurance picks up the balance. After day 101, Medicare no longer pays.  This coverage is for a semi-private (shared) room, includes nursing care, therapy, meals, activities, and all of your medical supplies.

Following those 8 difficult days, Shirley drove George to their local nursing home and he was admitted for 2 weeks. Shirley couldn’t say enough about how wonderful those weeks were. George loved the  meals, therapy, staff and other patients he met there. George is now happily gaining strength at home.  When fully recovered, George is now planning on volunteering at the nursing home, to keep in contact with those kind people who had helped him. And he also wants to give encouragement to the many other “Georges” he will meet.

I was more than sorry to realize that I didn’t know Shirley well enough for her to have called me, and ask about this surgery. We might have been casual acquaintances, but now after seeing this glimpse into Shirley and George’s life, this won’t happen again, we are now trusted friends.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing