Archive for the ‘Nursing Home’ Category
Posted on December 14, 2011 - by Nurse Virginia
HOME SAFETY CHECK – ALWAYS A GOOD IDEA FOR THE CONFUSED ELDER BEFORE THEY RETURN HOME AFTER A STAY AT THE NURSING HOME
Bertha had been so sure she was ready to “go home.” Why anyone could see she had lost a considerable amount of weight since being in the nursing home. Even her doctor was calling the changes in her nothing short of amazing.
Bertha had come to the nursing home from the hospital following a fall at home. She lived alone, said she had been doing so “for years” and enjoyed it. Bertha had a small dog that was now with friends until Bertha returned home.
When Bertha arrived at the nursing home, she was a familiar face, having been a resident about 3 months earlier. At that time Bertha insisted on going home against medical advice and now because of her recent fall, was back in the nursing home.
So this time the staff didn’t want any discharge to home, to come too early, before Bertha was ready. So a trip home was planned for Bertha and two of her therapists, to hopefully see her in her home environment. Some of the things Bertha said about her home were technically true, however not totally accurate.
Bertha’s home environment:
- Bertha did have an elevator that ran along the stairway to the second floor; however it didn’t work, and hadn’t worked for some time.
- Bertha could now walk with a walker. She did have carpeting; however her carpeting was covered with small throw rugs and had electric wires running everywhere.
- Bertha did have a path from room to room, but it was just a path, the rest of the floor area was covered with ‘stuff.” Bertha wasn’t a true hoarder, but she did have a large amount of clutter to walk around.
- She did have a back door where she could easily let the dog out, but the evidence all over the floor in the spare bedroom told another story.
- Bertha did say that she needed some work done in the bathroom, grab bars and so forth. However what Bertha filed to mention was that her town house did not have a shower, only one small bathtub. She was going to need a large renovation, not just a few grab bars.
Now Bertha had a plan with goals. No, she wouldn’t be going home for some time, but when she does, with the help of the nursing home, she will be successful.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 31, 2011 - by Nurse Virginia
HOW DOES THE NURSING HOME DEFINE “ABUSE?”
Most people immediately think in terms of physical abuse when they hear the word “abuse.” Yet, there are several types of abuse identified in a nursing facility. There is of course physical abuse, but also mental abuse, verbal abuse, sexual abuse and involuntary seclusion.
Physical abuse includes the obvious; hitting, pinching, slapping, and kicking as well as controlling a person or their behaviors by punishing the person.
Mental abuse includes humiliation, harassment, threats or depriving a person of something they want as a way of punishment.
Verbal abuse includes threats of harm or saying something to a person with the purpose of scaring them. It also includes talking in a negative way about the person within their hearing regardless of their ability to understand or disability.
Sexual abuse includes sexual assault as well as sexual harassment.
Involuntary seclusion is separating the elder from other patients or confining the elder in his room against his will.
When residents in a nursing facility were asked what they though abuse was, their answers were very person-centered. They said “when the staff doesn’t know my name or who I am.” “When the staff member doesn’t give me any choice” and “when a staff member doesn’t treat me with respect”
Mark Twain once said – Kindness is the language of the deaf and the blind. Maybe that’s the answer after all. You don’t have to remember any definitions if you just stop and think – was that kind?
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 21, 2011 - by Nurse Virginia
WHEN THE PEOPLE ENTRUSTED TO GUARD THE PUBLIC TRUST ARE THE PROBLEM –THE INDIGNITIES OF LIFE IN A NURSING HOME
Just imagine being 87 years old, living in a nursing home and for the past 12 years you have been unable to walk. That is life for Faith, oh, the daily indignities. Imagine never sitting on a toilet, soiling yourself and suffering skin breakdown, redness and discomfort many times a day. Always waiting for someone else to take you somewhere, unable to get any where under your own steam.
Rose is dependent upon a mechanical lifting machine that operates as follows; when in bed Rose is rolled from side to side while a large sling is positioned under her, then the caregiver attaches the large loops on the corners of the sling onto hooks on the lifting machine, the machine is started and Rose is lifted off the bed into a cradling position where she hangs in the air, legs dangling and swung in the air to a position over her wheelchair, then lowered into the chair.
Now the State, in their role as keeper of the public trust, makes life just that much more difficult for Rose. The State determined that it was undignified for a resident needing that sling, used by the lifting machine, to be sitting on the sling when not in use. (Maybe someone might see the sling and know that Rose has to use this unfortunate piece of equipment) So now Rose has to be lifted out of bed in the sling, lowered into her wheelchair, and then jostled back and forth in the wheelchair while two nursing assistants pull the sling out from under her.
Then Rose is once again jostled back and forth in her wheelchair to get that sling back under her for the return trip to bed. This unnecessary activity, involving an elderly woman for whom every movement is a painful experience.
As so many decisions that are out of our control this one was made by bur crates hundreds of miles away, who have never set eyes on Rose. All you know for sure is that is doesn’t have to make sense, and rarely does. Somehow that litmus test, of making sense is never applied. Rose is now too confused to understand why these caregivers who she has grown to know and trust are now shoving her around.
No, it doesn’t have to make sense.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on May 19, 2011 - by Nurse Virginia
THE PAIN OF TYING DOWN THE ELDER – RESTRAINTS IN THE NURSING HOME
(PART II)
For the elder the pain of being restrained is going to be physical as well as psychological. The physical pain comes from:
- Decreased movement causing loss of appetite, sluggish blood flow, constipation from lack of movement, and a drop in blood pressure when standing
- Weakened muscles and bone structure
- Increased risk of developing pressure sores from sitting too much
- Increased risk of swelling in legs
The psychological pain will be from:
- Feeling badly about themselves because they are tied to a chair
- Less social contact with others
- Less participation in activities
- Increase in depression, anxiety and agitation due to the frustration of being tied in a chair
WHY WOULD A HEALTHCARE FACILITY WANT TO RESTRAIN A PERSON?
SAFETY – the nursing homes says they are using the restraint to prevent a fall or aggressive behavior and control the elder, especially the confused elder.
This is totally untrue, the facts are that the reduced use of restraints has resulted in fewer falls, and that in fact, restraints cause more injuries.
Using a restraint for an aggressive behavior demonstrates a lack of understand on the part of the caregiver. Behaviors are a way of communicating an unmet need and so the confused elder “acts out.”
SUBSTITUE FOR UNDERSTAFFING – the facility instead of staffing with enough caregivers to meet the needs of the elders, they resort to the use of restraints to control the elder.
FEAR OF LEGAL LIABILITY – the facility fears a fall that could result in serious injury or the confused elder that wanders from the facility and the possible legal liability.
Once again there is more compelling research that the use of restraints causes more injury then the failure to restrain an elder.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get to Know Me – Aging with Dignity and Relevance
Posted on May 18, 2011 - by Nurse Virginia
THE PAIN OF TYING SOMEONE DOWN – RESTRAINTS IN THE NURSING HOME
(Part I)
We all knew him, Bob Frank M.D. former director of the emergency department in a large urban hospital. While his life used to be full of “We need you here doctor!” Now his life revolves around the plea to “Sit down Bob.” Over and over all day long in the Alzheimer’s unit where Bob now lives, you can hear the words “Sit down Bob.” No one wants to restrain “Dr. Frank.” and tie him to a chair. How can you tie a doctor, a respected member of the community?
We can all understand why Bob stands up. When something happens, maybe another confused resident calls out, and Dr. Bob wants to respond. Dr. Bob wants to go and help the person crying out “Help, help me I’m falling.” Betty isn’t really falling she just has that sensation due to her dementia and so she calls for help and then Dr. Bob tries to go.
The staff knows Dr. Bob, and knows why he is trying to stand and respond, even though he is now unable to walk without assistance. Bob’s balance has been affected by Alzheimer’s disease and he doesn’t understand that it is unsafe for him to get up without that assistance. But tie Dr. Frank to a chair? No, that just isn’t going to be an option, not in this case.
Why not Bob? Why would that be just too painful for the staff to see, the good doctor tied to a chair? Other people are tied to chairs. Is it that even though Bob has dementia he remains respected and admired for who he was and what he has done. Even though Bob has dementia he still is that doctor in the minds of his caregivers.
Maybe that is the real answer to using restraints. If the caregivers really know the person and care about the person, they just can’t do it.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on May 9, 2011 - by Nurse Virginia
CELEBRATE NATIONAL NURSING HOME WEEK MAY 11TH – 17TH 2011
GIVE THE GIFT OF A GREAT VISIT
What is so hard about visiting in the nursing home? If the visit is lacking planning, it may deteriorate into an opportunity to criticize the nursing home and its staff. The visitor doesn’t understand their criticism undermines the confidence the elder has in their caregivers. It may also make the elder feel they themselves, aren’t somehow measuring up to standards.
The elder even if suffering from a dementing illness can understand tone of voice and body language, and understand when someone is being critical.
Many visiting families just don’t seem to know what to do. Families arrive with young children and nothing to eat, drink or do. The children stand there at attention while being introduced to great-grandma and encouraged to say “Hi,” then there is nothing. Once they are inspected for how much they have grown, there is nothing for them but to be told to sit down and be quiet.
The family may not have visited for some time but one there they may start quizzing the elder. “What did you have for lunch today Mom?” The family member hasn’t been there for the past three meals a day for several months, but today is all about today’s lunch.
Families will show their discomfort by standing around the elder – looking down on her – while commenting on how “good” she looks. The only other time a person will have people just standing around looking at them, is at their funeral.
Celebrate National Nursing Home Week by learning how to have a really good visit. Suggestions of things to do, things to make and eat, the how to of creating the comfort of a” family visit.”
Download:
“Come In – The Door’s Open”
Visiting in the Nursing Home
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on April 18, 2011 - by Nurse Virginia
GOING INTO A NURSING HOME DOESN’T ALWAYS MEAN THE LAST STOP FOR THE ELDER
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
Posted on March 18, 2011 - by Nurse Virginia
WE ARE NOT SO DIFFERENT WHEN CARING FOR THE ELDERLY HERE OR IN JAPAN
I had never thought of Japan as having nursing homes, yet there it was on the nightly news. Elderly people in a Japanese nursing home being taken care of within the disaster zone by staff that refused to leave their patients. Warnings to keep windows and doors closed, to stay inside; having no electricity and now the familiar statement “we are running out of food.”
I am struck and saddened by the contrast when visiting my mother this week. Mom is very difficult to wake up, and has limited conversation. But there she is looking comfortable and peaceful in her reclining chair. Her head resting on a small pink pillow she cross stitched herself some 30 years ago. Mom was covered in a hand stitched patch work quilt her sewing group sent her for Christmas. Mom has not been a member of that group for over 20 years yet they remember her.
I just know what Mom is wearing under that quilt even though I can’t see. She has on slacks, a sweater and colorful top with a matching necklace. I know this because of how carefully the nursing assistants dress her each and every day. When she wakes and I ask her how everything is she says it all in one word “perfect.”
I know that a very caring nursing assistant is sitting next to her three times a day encouraging her to eat, because they care if she eats. When she was more vocal she told me one day “they have someone follow me around all day just to cream me.” Because of her skin problems, related to kidney failure, Mom needs attention to her skin. What a comfort to hear that they are so concerned and Mom knows it.
I can see the caring in the nurses eyes when they tell me of the ways they have thought of to make Mom more comfortable.
Japan has a large older population with 21% who were over the age of 65 in 2010. The demand for care for the elderly far exceeds the supply and the country has been exploring many different solutions to the care of their elderly. It was a troubling situation before this disaster, now what.
One thing I do know, the staff in those nursing homes in Japan are hurting just as much as those elders, and those nurses wish they could make everything also “perfect” for their elders.
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
Posted on March 11, 2011 - by Nurse Virginia
WHEN THE LOSS OF MEMORY MAY BE SO KIND FOR THE CONFUSED ELDER
“Come to Grandma, come to Grandma,” says the elderly woman to the toddler, who was looking at the birds in the aviary, at the Nursing Home. The tiny child looks back to the trio behind her for reassurance. There sits the child’s mother, her “Gamma”, and her great grandmother “Oma,” who they were there to visit.
Although the tiny child had never seen this “Grandma” before, with the reassurance of her family she went to her. Margaret hugged the small child with a huge smile on her face all the time saying over and over “Come to Grandma, come to Grandma.”
What makes this scene even more unusual is that Margaret, not only is not this child’s grandmother, Margaret has never been a grandmother. Margaret had been a career nurse in the Army serving overseas in WWII. Her life had been nursing and the Army. Margaret had never married, had children or grandchildren. Now turning ninety, and in the end stage of Alzheimer’s disease, she lives in a nursing home.
Small children can bring so much joy to the elderly, who have the time to really enjoy the child. It doesn’t matter if they are related to that child or not. The little boy who is chasing his toy cars up and down the halls of the nursing home is a real pleasure. This little girl all in pink with bright eyes, and all excited about seeing the birds, can bring smiles to all who pass.
There was a time when people thought nursing homes should always be quiet and peaceful so that the elderly would not be disturbed. So a lot of energy was put into controlling the environment of the nursing home.
Now we know the connection between the elderly and children is of benefit to both. The elderly benefit from the laughter, giggles, spontaneity, and yes noise children bring to the nursing home. But most of all the elderly appreciate the youth and energy children bring with them.
The children benefit by developing a more positive attitude towards the elderly and a kinder heart towards those with disabilities.
Whether looking for a residence for an elder – or looking for a really positive volunteer opportunity, ask the nursing home staff about their Intergenerational Programming.
For now, how gentle the memory can be as Margaret gets to be “Grandma,” cuddling this small child.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 27, 2011 - by Nurse Virginia
HOW TO COMMUNICATE CHANGES IN A CONFUSED ELDER TO HEALTHCARE WORKERS
Family members see changes in confused elderly.
Family members aren’t always the recognized authorities on their loved one’s condition. Yet they are an invaluable resource for the nursing home staff. Family and friends have that one-on-one, usually for hours that the facility staff isn’t able to provide.
The right kind of communication.
I recently spoke at a family support group where a family member voiced her frustration with the staff. She said her mom “just isn’t right”, “something is wrong” and “this has been going on for over two weeks.” She repeated these phrases over and over, communicating nothing. What isn’t right, what is wrong, what have you seen for over two weeks?
What is a significant change in a confused elder’s condition?
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 patterns
- personality
- eating
- difficulty swallowing
- weakness or decreased use of an extremity
The elderly need to be watched constantly for anything that appears suddenly and is dramatically different from the norm for that person.
Communicating the change you see to Nursing Home staff.
- Don’t hesitate; voice your concern to the nursing home staff.
- Identify and talk to the staff that may be more pro-active in problem solving.
- Establish yourself as part of the team caring for the elder.
- Be willing to participate as part of the solution.
- Realize that seeing an unaddressed change in condition can be stressful. Try to communicate your concern without becoming overly emotional.
Book excerpt: Please Get To Know Me – Aging with Dignity and Relevance
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
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