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

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

 

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

NURSING HOME PATIENTS ARE GETTING YOUNGER – NO SURPRISE

The conversation around the conference table was familiar. Why are our patients getting younger and younger we asked each other?  I had heard this many times before, but this time it was different. The speaker, who was so questioning about what could possibly account for this, was herself only twenty-five. Kelly was concerned for her parents and grand-parents. She said she was regularly going home and telling her Dad, “We just had another patient come in today, who is so much younger than you are.” Why is this happening she asked, “aren’t these people supposed to be old?”

We talked about the fact that these people didn’t just have one diagnosis that brought them to the nursing home. No, they had led a life that led to multiple systems breaking down.

Proven life choices that keep the elder out of a nursing home:

  • exercising and maintaining an active lifestyle
  • getting enough sleep
  • spending time outdoors, enjoying sunlight and fresh air
  • having satisfying, close relationships
  • being a life long learner
  • minimizing stress in your life
  • being of service to others
  • having employment (or volunteer positions) that use your talents and skills
  • maintaining a spiritual life – remaining close to your faith
  • eating a balanced (a variety of foods) and nutritious (focused on vegetables/fruit/protein) diet

Yes, patients in the nursing home are getting younger and younger. At the same time nursing homes are getting better at providing all the therapies, social service counseling, diet counseling, etc., to help the elder turn around their health. So much better for Kelly’s dad to make these choices now, before he has fewer options.

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