Once again the flu and cold season is rolling around. Not only at your local drug store will the pressure be on to get a flu shot, but all of those people in nursing homes will be vaccinated as well.  While try as they will, the pharmaceutical companies cannot get those significant numbers that prove that vaccines prevent flu. However the proof is easy to obtain that regular brushing of teeth, can prevent infections.

I was recently told by a speech therapist that a Japanese study proved that dental hygiene was twice as effective against pneumonia than medical intervention including antibiotics.

When teeth are not brushed regularly, a slime starts to develop on the teeth and gums. I have heard it compared to the slime that collects on the water in a vase, once the flowers have passed their prime. Poor dental care is one of the most upsetting situations for the family visiting in the nursing home. When Mom or Grandma is unkempt, smells of urine or has dirty teeth and nasty breath, she just doesn’t seem like Grandma.

Many times for the elder in a nursing home, they have medications that impact on their dental hygiene. The medications may cause excessive saliva or dry mouth, either condition impacts the ability to keep teeth clean. There are several products available for dry mouth and dry lips, Biotin works well.

For the elder with excessive secretions using a suction machine with an adaptive tooth brush attachment prevents the build-up of secretions at the back of the throat. The brush can have a small smear of tooth paste or be dipped in mouth wash or Biotin. This works well with the elder who is no longer able to clear and spit secretions independently, or is unable to follow directions from the caregiver to do so.

For the confused elder I always recommend a children’s toothbrush. The smaller size is less invasive in the elder’s mouth. When the elder is no longer able to rinse and spit, the use of a children’s toothpaste is also recommended. These are made for someone who will most likely swallow the paste. By far the usual favorite is grape flavored toothpaste over the minty ones used by adults.

The most important thing is to just get started. Being accustomed to the feel of a toothbrush, as well as the feeling of clean teeth should never be allowed to be forgotten.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Many people only think of activities in the large sense. Activities like; painting a great picture, a trip to the circus, working with clay, throwing a party or seeing live entertainment. All of these things are great, but day to day activities are just that, normal things you do every day. These activities are called “normalization activities,” and these are the activities of good dementia care.

Normalization activities help the confused elder with dementia feel that they are participating in daily life.  Participating in normal chores; dusting, setting the table, folding wash, gardening, washing dishes, raking, vacuuming, all of these are everyday activities. Activities that take the elder back in time are especially good. Instead of using the dish washer, let the elder wash dishes by hand. Polishing and shining shoes is a great activity for a man, especially if he served in the armed services.

Normalization activities give purpose to the elder’s life. Many years ago when the destitute elderly were housed in “poor houses” or “poor farms,” they were given jobs to “earn their keep.”  And as always seems to be the case, the pendulum swung much too far in fixing that issue. In today’s nursing home communities, it is very much frowned upon to “make residents work.” And so residents of nursing communities are to be cared for and occasionally entertained.

Normalization activities give the elder in the home, or the nursing home, an opportunity to have social interaction with others. They can have that special feeling of satisfaction doing a job together, and being part of something. Normalization activities provide a routine to the day, opportunities for pleasure, improved self-esteem and improved quality of life.

Some time ago I asked the activity staff of a nursing home, what gave them work related stress. One brave young woman said she felt that she wasn’t doing her job, if she wasn’t providing a three ring circus all the time. Three ring circuses aren’t the stuff of everyday life, washing dishes is, and washing dishes can also be, just great.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing










Part II

Preventative care under the ACA is offered by the insurance provider – but when is it free? When isn’t it free?

There is a list of 15 preventative services that are recommended by the Affordable Care Act. These are things like blood pressure screenings, testing for cholesterol levels, mammograms, colonoscopies, vaccines and so on.

These recommended preventative services require no; co-pay, out of pocket payment or meeting any deductible. The goal here is to offer these screenings/services to catch a disease process before you have any symptoms.

So what isn’t considered preventative and so isn’t free?

Any change in your health that is found through the preventative screening, requiring follow up testing and treatment, is not free. This could include lab work or other testing to manage or treat a condition. Medical treatment for a specific health condition and any on-going care is not included in “preventative” care. Any future diagnostic care or treatment is not part of preventative care.

Once a condition is identified, that will require any on-going or future treatment, it now is covered under your health care policy with the deductibles you selected.

Wellness checks serve an even greater purpose through organizing your healthcare. Instead of the burden being placed on the patient, to always know what is significant to report to the doctor. The wellness check will now ferret out those facts. If you are uncomfortable bringing up unusual bowel movements with your doctor, the wellness check will bring it up for you.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


Please, please can’t you open the ice cream parlor now?” the elderly woman begged the activity aide. Once again the young activity aide explained to Hannah, that it was 8 o’clock in the morning, and they don’t open the ice cream parlor till 2 in the afternoon.

The pain was easy to see in the elderly woman as she was turned away. Anyone who has experienced cravings can understand how she felt. Sugar craving is nothing new to millions of people with diabetes and pre-diabetes.

The craving for sugar is physical and so mental. For the elder with dementia and sugar cravings the time of day doesn’t matter. The fact that she had just had breakfast doesn’t matter. The fact that this tiny old lady just couldn’t be physically hungry doesn’t matter.

Hannah doesn’t remember that breakfast she just had. She will clearly tell you that no body feeds her at the nursing home. Because she believes it. Hannah knows what it feels like to be hungry and right now she is craving some ice cream and so she must be hungry.

For persons like Hannah it might have been the toast loaded with “sugar free” jam that triggered this craving. Or the large bowl of corn cereal she had with the toast. Maybe the 5 packets of sugar substitute she insists on putting in her morning coffee.

Loading up on a breakfast with empty carbs and sugar free products – served up by kind hearted nursing assistants, wanting to make all those Hannah’s happy is her problem.

Would she go back to her unit in the nursing home angry? Of course she did.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



(Four things to notice when visiting an elder in a nursing home, cont.)

2. Observe the elder’s skin. Skin is the largest organ of the body. In the average person, the skin stretches about two square yards and is about 15 percent of the individual’s weight. We consider the skin the first line of defense against environmental factors. Skin is also a barometer of health. We want to be aware of any redness, warmth, or swelling. It is perfectly appropriate for family members to ask the nurse or nursing assistant “Does Mom have any skin breakdown?”

When elder sit for hours in a wheelchair or are unable to move themselves independently, they may be at risk for skin to break down because of decreased circulation. Nursing homes may provide special pressure-relieving mattresses to prevent skin breakdown. A special pressure-relieving gel cushion is an excellent aid for wheelchair-bound elders.

3. Report any significant change. The rule of thumb is that a dramatic change in any body system must be reported to the physician immediately. This includes an abrupt change in:

  • Behavior
  • Difficulty arousing the elder
  • High fever
  • Dizziness or unsteadiness
  • Sight or hearing
  • Ability to communicate or speech pattern
  • Personality
  • Eating
  • Difficulty swallowing
  • Weakness or decreased use of an extremity

Book excerpt from: Please get to Know Me – Aging with Dignity and Relevance Available on Amazon.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing



When a family member or friend is visiting the elder in the Nursing Home, here are four things to look for:

1. Be aware of the elder’s pain. Pain is the most underreported problem in nursing communities. This applies to the general nursing home population and even more so for those with dementia. Sometimes the elders can’t express their pain in words, so those who know them need to be alert and able to read their body language. Signs of pain in elders with dementia may be increased restlessness.

Elders with chronic pain should have routine orders for pain medication. Orders for pain medication written “as needed” are not appropriate for chronic pain. When the order is “as needed” for someone with arthritis, that means we have to rely on the nursing assistant to notice that when they bend the elder’s knees and observe a grimace, or the joint may be swollen or warm to the touch, the elder is hurting.

When elders suffer from any kind of chronic pain they don’t sleep well. Fatigue is another symptom. Or they may not eat well or start to withdraw. A nursing assistant is there to assist, and it lays a heavy responsibility on them – for which they’re not trained – to observe and communicate pain accurately to the nurse.

This is when the family can be of tremendous help and support to the staff. When the family members observe signs of pain, they can communicate effectively by stating the behavior, area of the body, and provide any history the nurses need.

I noticed that Mom is rubbing her knees,” a daughter might say. “She has had problems with arthritis in the past and it must be bothering her again.” The daughter might have said that after spending hours with her mother. Nurses saw her mother only at brief intervals.

Book excerpt: Please Get to Know Me – Aging with Dignity and Relevance available at Amazon.

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing