Archive for the ‘Nursing Home’ Category
Posted on May 9, 2013 - by Nurse Virginia
NATIONAL NURSES WEEK – FIVE TRAITS THAT MAKE A NURSE OR ANYONE ELSE GREAT
I just read an article called the 5 things that make a good nurse. In reading the list I realized these 5 things would be good traits in anyone, especially anyone caring for an elder.
5 – Traits that make a great caregiver:
1. Compassion – the ability to really see you’re elder and take action. Whether it is providing pain relief because you know the elder so well that you know when they are agitated they are in pain. Or the caregiver who realizes the elder is upset because they just can’t make any sense out of the environment or their situation, and the caregiver provides a comforting presence. The caregiver that realizes this isn’t what that elder wanted for themselves or expected in their life.
2. Empathy – The Oxford Dictionary defines sympathy as sorrow at someone else’s misfortune – however empathy is the ability to share and understand another’s feelings. I remember a day many years ago when I needed to “call-in” to work. Something I rarely did, but it was worth it for the words my Director of Nursing said to me that day that have stayed with me. When I explained that my arthritic knee was acting up to the point that I quite literally couldn’t stand, she said, “My knee hurts for yours.” That was empathy. Instead of saying “I’m so sorry you hurt, she said “I hurt for you.”
3. Selflessness – putting someone else and their concerns above your own. The private caregiver who just can’t go home on time because her elder isn’t doing well today. The caregiver who misses meals and hardly dashes away for a bathroom break.
4. Self-aware – knowing your strengths and weaknesses is important in a caregiver. No one is great at everything, knowing when you need to call for help doesn’t indicate weakness it shows self-awareness. Knowing when you need to step back and take a break is strength.
5. Thirst for knowledge – new ways to care for the elderly are discovered every day. Becoming part of a support group and attending educational opportunities to learn about new approaches for different disease processes, promotes better care. Sharing with other caregivers also rejuvenates the caregiver. A person who is always seeking new information is never a dull person.
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 2, 2013 - by Nurse Virginia
NURSING HOMES – THE FUTURE OF SENIOR CARE
(PART IV)
Is it a spa, a cruise ship or a nursing community? The focus of the future in senior living will be on wellness programs, living green, cyber learning labs, themed restaurants, green environments, senior living design, wellness and healing gardens, therapy pools, and aquatic centers. Having life long learning will be very important in nursing facilities in the future.
The future may not be a nursing home, but perhaps a “smart home.” A home that has all the latest in technology, connecting the elder with their caregiver through wireless means. Tele-health technology, geriatric assessment through technology, and non-medical services to promote quality of life are all possibilities right now. There are beds that document how often you get up during the night, can take your weight, and body temperature. How about a toilet that will test your urine, as well as measure the amount of your output. Technology used to create safe environments, automatic light sensors when you get out of bed at night to show you the way to the bathroom.
New terms to know will be aging in place, which means staying in your home and having services and technology come to you. Aging in place could mean going outside your home to adult day care as well as bringing services into the home.
Green spaces, are long-term care settings which have small group residences instead of large institutions. A green space may have 6 to 10 residents instead of 100 to 200 residents. It would be a small home setting, self contained and organized around normal living routines and a sense of community. An activity director in this setting would now be called your life care coach.
Of all the choices, it seems that aging in place will continue to be the first choice of many.
Virginia Garberding RN
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on May 1, 2013 - by Nurse Virginia
NURSING HOME – TODAYS NURSING COMMUNITY MORE OF A REHAB FACILITY THAN LAST STOP FOR ELDER
(PART III)
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 April 26, 2013 - by Nurse Virginia
NURSING HOME CARE – A LITTLE DIFFERENT WAY OF LOOKING AT IT
(PART II)
Jail or Nursing Home? – Food for thought.
Let’s put the seniors in jail, and the criminals in a nursing home.
This way the seniors would have access to showers, hobbies, walks, and they would receive unlimited free prescriptions, dental, medical treatment, wheelchairs etc. and they would receive money instead of paying it out.
They would have constant video monitoring, so they could be helped instantly, if they fell, or needed assistance.
Bedding would be washed twice a week, and all clothing would be ironed and returned to them.
A guard would check on them every 20 minutes, and bring their meals and snacks to their cells. They would have family visits in a suite built for that purpose.
They would have access to a library, weight room, spiritual counseling, pool and education.
Simple clothing, shoes, slippers, P.J.’s and legal aid would be free, on request.
Private, secure rooms for all, with an outdoor exercise yard, with gardens.
Each senior could have a P.C., a T.V., a radio and daily phone calls.
There would be a board of directors to hear complaints and the guards would have a code of conduct that would be strictly adhered to.
Back In the nursing home “criminals” would get cold food, be left all alone, and unsupervised.
Lights off at 8pm, and showers once a week.
Live in a tiny room, and pay $5,000 per month or more, from their savings and have no hope of ever getting out.
Justice for all.
Virginia Garberding R.N.
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.pleasegettoknowme.com
Posted on April 24, 2013 - by Nurse Virginia
NURSING HOME CARE – THE “IT WON’T HAPPEN TO ME” REACTION
(PART I)
The Associated Press had a story this morning on how Americans are in denial about the need for long-term care insurance. Even those who have already provided direct hands-on care for aging family members, seem to think getting old and needing assistance won’t happen to them. But maybe what they think is that they won’t be living in a nursing home one day.
The article stated that Government figures show that nearly 7 out of 10 Americans will need long-term care at some point after they reach the age of 65, whether from a relative, a home health aide, assisted living or a nursing home. The older people get, the more preparations people take. Just 8 percent of 40- to 54-year-olds have done much planning for long-term care, compared with 30 percent of those 65 or older, the Government poll said.
If you are looking for answers in this article you won’t get much. It came down to “family conversations are crucial,” and start planning early. All good advice, but what is the “plan” supposed to look like? One of my favorite jokes has always been – If you want to give God a good laugh, tell Him your “plan.”
Today’s plan can’t look like yesterday’s plan, too much has changed. If you should need to go to a nursing facility following a knee or hip replacement, you will still receive the initial 20 days paid by Medicare A, but following that, depending on your supplemental insurance plan, they may pay the 20% co-pay for the next 80 days, or they might refuse. The rules have changed, and appear to be changing daily.
Are you non-compliant with your treatment plan? That isn’t going to be alright anymore. Nursing homes will soon be judged as hospitals now are, on how successful their treatment has been. This is determined by re-admissions to the facility. Medicare now pays according to results, not quantity of services provided. If you keep being re-admitted for the same thing, it looks as though the facility didn’t do a very good job.
Your plan needs to include healthy eating, exercise, no unhealthy habits like smoking. While the individual’s plan and goals change, so also will healthcare change.
Nursing homes in the future will look more like cruise ships than the current idea of an “old age home.”
Virginia Garberding RN
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on November 7, 2012 - by Nurse Virginia
ELDERSPEAK – HONEY, SWEETIE, GRANDMA – WHEN THE CAREGIVER JUST DOESN’T TAKE THE TIME TO LEARN THE ELDER’S NAME
Everyone’s name is important to them. There can be power in a name. There is power in the name “Jesus”. I remember when it was in the news that Elvis was performing in a concert and a row of girls held up a banner saying “Elvis is King.” Elvis stopped the concert and said “No, Jesus is King.”
A person’s name and title are important to them. Does it become unimportant just because you are now old? Andy Rooney once said on 60 Minutes that he didn’t like the nickname Andy. He ended the piece saying “Just call me, Andrew.”
When a caregiver hasn’t taken the time to learn an elder’s name (or like Andrew Rooney their preferred name) and calls that elder “sweetie,” the caregiver is indulging in ageism. They would not call that elder’s visiting daughter or son “sweetie.” It just wouldn’t sound right, or be right. But somehow once you reach a certain age – or enter a nursing home – all of a sudden it’s OK to call everyone by some generic term assigned to the elderly.
How much more dignity would be directed to an elder if you used their title – Mr., Mrs., Pastor, Doctor, Judge, – whatever title they have earned. When you see elders lined up in a row of wheelchairs, how is the elder supposed to still feel like an individual? When the staff knows, and uses each elder’s name and title, every woman goes from “Grandma” to Mrs. Peterson, or Dr. Jones.
My Dad told me once it was hard for him when he moved into Assisted Living to have everyone there call him Martin. He was only “Pastor” to a few visitors and when he attended Church, from then on. He felt bad losing that title he had carried for over 60 years.
I can imagine a day when it just doesn’t sound right to call every elder “sweetie.” When caregivers take the time to learn an elder’s name. When the elder feels empowered to say, “Just call me Mike, that’s what everyone calls me.”
When you hear someone using ”elderspeak” – be proactive – stop the concert – and tell them how important a name is.
Virginia Garberding, R.N.
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on August 2, 2012 - by Nurse Virginia
TURNED AWAY AT THE NURSING HOME-NO ROOM FOR HER IN THE INN
Her grandma Lilly was 82 years old. She had been living alone and really doing quite well till about a month ago. Lilly started talking about having a “full feeling” around her abdomen. This became progressively worse until she was having trouble keeping food down and the doctor put her in the hospital for tests.
Two days later grandma Lilly has a diagnosis of end stage liver cancer, and they aren’t going to treat it. The hospital recommends that Lilly go to a nursing facility. The family agrees because there is no one available to take care of grandma, so the family comes to pick her up to take her to the local nursing home. Only to find out once at the nursing home that yes Medicare benefits pay for 100 days of nursing home care, but only after you have spent 3 nights in the hospital.
Now Lilly’s granddaughter wonders how many of the hospital staff who saw Lilly knew this information and never said anything. Couldn’t they have kept her that one more night which would mean so much to Lilly now? Lilly doesn’t have 100 days of life left; it would have been nice to be taken care of by healthcare professionals her last days instead of feeling like a burden to her family
Lilly is a real grandma, but in healthcare we are seeing more and more Lilly’s. And now there is yet another consideration that families need to be aware of. Hospitals are answerable to new regulations that frown upon re-admissions. Hospitals are in danger of losing major funding if they have a bad record of re-admissions. So they now are bringing more and more seniors into the hospital for “observation.”
You could literally be in the hospital several days and not be considered admitted because your status is observation. Those days of observation do not qualify for the 3 over nights necessary for Medicare benefits in a nursing facility, you must actually be admitted
Looks like there will be many more Lillys, Berthas, Vivians, Edgars, Ralphs, and so on that will need to be taken care of by their families.
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 July 19, 2012 - by Nurse Virginia
LIVING IN THE NURSING HOME WITH JOY
I was met at the door of the nursing facility by the director of activities. She greeted me with “You should see your mother today; she woke up this morning singing and hasn’t stopped.” She went on to tell me that my mom was so enthusiastic about her singing that the director sent someone to accompany mom with a guitar while she sang. She said mom and her accompanist have been having a great time together all morning
Sure enough when I entered her dining room there was a young caregiver smiling into mom’s face. Every time she gave mom something to eat, after mom swallowed she would once again pick up her happy song just where she had left off.
I was more than surprised; mom had just experienced a year of decline. Most of that time she had been rendered mute. She also during that time had lost most of her teeth, most of her vision and finally her hair. If someone had told her years ago that she would live to the age of 89 she certainly wouldn’t have pictured life like this.
Yet here she is, not only surviving but with joy. Singing out loud and strong “Joy to the world, the Lord is come.”
You see that is where her joy is coming from. She might not know that she is in a nursing home. She might not know that the sweet young woman who is taking care of her is not related to her but an employee of the nursing home. That the days, months and years are passing and so is her grasp on this life.
But what she does know is that her Savior has come and her mission spirit remains, to tell everyone about it.
Virginia Garberding R.N.
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on May 23, 2012 - by Nurse Virginia
CONGESTIVE HEART FAILURE MAY CAUSE CONFUSION IN THE ELDERLY
I RECENTLY RECEIVED THIS EMAIL:
My mother was independent 2 weeks ago, living on her own. She went to the doctor and he said she had congestive heart failure and to go to the hospital. She went and is now in a skilled nursing facility and is highly confused with every aspect of the daily world. They say she has not had a stroke. It started the day after she was admitted to the hospital. The doctors say she is just confused. They won’t give us an answer as to what happened to our mother. When she was in the hospital nursing home her O2 stats dropped dramatically and she almost died of carbon monoxide poisoning. Could it be that her levels had been so high that her brain was starved from oxygen? Please help us to understand what has happened.
Ideas from a distance:
When congestive heart failure is advanced, there is a low level of oxygen exchange in the lungs which may affect the brain causing the elder to experience confusion. As well as confusion the elder may also exhibit changes in behavior due to the low oxygen levels. At this point, even if the elder is given oxygen therapy, the lungs ability to effectively exchange oxygen is impaired and the behavioral changes and confusion may not necessarily improve.
So saying that the build up of fluid from the CHF “starved” her brain of necessary oxygen and caused her confusion may be true. The fast intervention on the part of the doctor certainly indicates an emergency situation as well as the hospital admission.
Finding a physician who is a good communicator would really be helpful for you right now, to help your family with realistic expectations. The brain is a wonderful and in many ways, still a mysterious place. Don’t give up on your mother – let go, let God.
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 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
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