Archive for the ‘Nursing Home’ Category

Posted on November 15, 2010 - by Nurse Virginia

SIGNS THAT THE CONFUSED ELDER IS SUFFERING FROM ABUSE IN THE NURSING HOME

Couple shows signs of Nursing Home abuse.

Every time someone walked by her, she flinched. Ella reacted as though at anytime she thought someone might strike out at her, and so she ducked.

Ella and Carl had come to us from a nursing home out of state. They arrived off the plane, both in hospital gowns, bathrobes and slippers. They looked like they had literally just gotten out of bed and got on the plane. No one had ever arrived like that before or since.

Many years ago, Ella and Carl had decided when they retired to relocate to a Southern state, with warmer weather. Their niece visited as often as she could, but as the years went by it became less and less frequent. Now, when she had gone to visit, they both were in a nursing home, and she decided to move them closer to her.

We soon realized during the admission process that both Ella and Carl had numerous bruises. Their niece confirmed that “It wasn’t a very nice place” she had taken the couple out of. Now it was our goal to give this couple, married for 62 years, the opportunity to enjoy their remaining years together.

Couple finds comfort in Nursing Home

Both Ella and Carl had a moderate degree of dementia. They knew who they were and recognized their niece, but had very limited verbal skills left. A plan was put in place to reassure and reassure them again, that they were “safe.”

How to approach the elder who has been abused.

• Always approach from the front where they can see you, don’t approach from their side or from behind them.
• Make direct eye contact when you approach.
• Smile – present yourself as a friendly, safe person.
• Say their name as you approach so they realize they know you.
• Never attempt to touch them and begin to provide care before you have followed previous steps.

Carl passed away soon after they came to stay with us. Ella lived for several years after losing Carl. It took four months for Ella to be totally comfortable and we no longer would see that flinch when people approached. Ella spent the rest of her days with frequent visits from her very caring niece as well as the staff that grew to not only care for her but about her.

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 November 8, 2010 - by Nurse Virginia

ELDERLY NEED HELP KEEPING IN TOUCH WITH FRIENDS AND THEIR COMMUNITY

Dad needed help with Christmas Cards and we didn’t know it.

So many times, moving into a nursing home can mean for the elder breaking ties to their community. I sadly remember when my Dad no longer could drive and moved into the Assisted Living area, of my Mom’s Nursing Community. His last Christmas, Dad cut up old Christmas cards that he and my Mom had received from previous years, and recycled them. These front flaps of old cards, he signed on the back and sent out that year in the only envelopes he had- letter size. Several family members commented on those cards that year. Saying” Dad seems to be slipping – did you see his Christmas cards?”

What I saw was how no one had taken the time to help him – taking him to the store to buy new cards with envelopes. He didn’t have the pretty Christmas stamps that year or nice holiday stickers; he just had his recycled cards, the best he could do.

When Dad died, we realized we now had to step in and keep Mom in touch with her community.

Keeping the elder in touch through correspondence or telephone.

Many times going into a nursing community means the elder is breaking ties with their long-time friends. That’s when the family can step in and bridge the gap of keeping in touch. They can:

• send cards or make phone calls.
• ask friends or other family members to keep the elder connected by mailing cards and pictures to them
• ask their Church to send the Sunday bulletin and monthly newsletter. If necessary, family members can read it to the elder during visits.
• Reading the local paper – most elderly people like to keep in touch by reading the obituaries and contacting the families

Sending out Mom’s Christmas Cards.

So since Dad died, the day after Thanksgiving there we are my sister and I, writing out Mom’s Christmas cards. She signs as many as she  can (when you no longer use your penmanship skills, you lose them). Reminiscing about the friends who are no longer with us, and how the list gets shorter every year. Eating Christmas cookies and visiting with the nursing home staff. We try to make the day a memorable event.

We include in the cards personal notes to people to encourage them to come by and visit Mom. And we include a sister’s phone number for them to call to coordinate a visit.  We want to be ready with lunch or a snack for her very welcome visitors.

When we are done with the cards and they are on their way in the mail, we think of all the return greetings that will come to her at the Nursing Home. All these cards will say to the staff, that people out in the community haven’t forgotten Mom.

Virginia Garberding, R.N.

Director of Education, The Wealshire

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on October 21, 2010 - by Nurse Virginia

ACCEPTING THE END – WHEN IT’S THE FAMILY MEMBER THAT CAN’T LET GO

“I know it is selfish, but you don’t understand, she is all I have, I will be all alone when she goes.” So says the son who is in his early 60s and unemployed.

“She” is 92 years old, and rarely gets out of bed anymore. She has terminal cancer, and is in constant pain. She, is no longer able to tolerate food and now is on a feeding tube. Having the feeding tube inserted was almost more than she could bear. Every time a decline in her condition comes along and she says she wants to say “Stop,” instead she says, “Whatever my son wants, I have always done everything for him.”

The son’s life revolves not only around his mother but around the nursing home. He comes in early every morning, seven days a week and eats his lunch and dinner at the facility. He never brings in any food for himself or his mother; he just takes his place in the salad line with all the residents.  His mom is now on a feeding tube, so he just gets food for himself.

He spends his day socializing with other family members, because his mom is sleeping now most of the time. Of course while he is socializing, he needs to mention all the errors he has observed on the part of the staff. He knows the name of every staff member, who likes working with whom, when the facility is working short of staff. He shares all he knows and  also shares freely with those other family members how selfish he is and how he will never be willing to let his mother go.

The days are long, and the time goes slowly while the conversation is the same day after day. The other faces change as other residents come and go, but the mother and son are still there.

You see, she is all he has.

Virginia Garberding, R.N.

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Posted on June 12, 2010 - by Nurse Virginia

CONFESSIONS OF A NURSING HOME NURSE, WHAT WERE WE THINKING?

(Part II)
When I look back twenty, twenty-five years ago at routine nursing practice then, my first thought is “What were we thinking?”  Thinking we were reorienting a confused person, looking for their mother, by saying “You are old, how old would your mother be? Your mother is dead.” We would physically tape elderly confused people to their side rails, to keep them in place, so we could do their wound treatments. Our practices certainly weren’t kind, why did we do it?

We thought we were there for our patients, in fact would have been very offended at any other suggestion. But the truth is we were there for the task. We were so task oriented, we talked about the jobs to be done and seldom talked about the person we were taking care of.

Routine wound treatment for bed sores -then:
Swabbing the open wound area with a betadine solution or some other solution to “dry” the area, which made the skin tough as leather – causing hard edges around the wounds that took long periods of time to heal.
Having the wound “open to air.” Which meant if the open wound was on your butt, (which it most likely was because we had you sit in the same position for long periods of time in a wet incontinent product) to have the area open to air every shift meant that you were laying in bed on your side with your bottom exposed for long periods of time.
If the elder had a deep open area – they routinely had an order for a “20 minute, heat lamp treatment every day.” This meant not only was your bottom exposed, we now highlighted that area by illuminating it, in case anyone passing your room walking down the hall missed what was going on in that room.  Privacy – no, no one has the time to sit with you and we need to check on you, so that door was staying open.
If you were confused or wouldn’t stay in place for your “treatment” we had an answer for that too – we just taped you to the side rail. Yes, we turned the elderly person on their side, bottom exposed, and propped them there with pillows. Then as extra insurance to get that job done, taped them on their bare skin, with long strips of paper tape to the side rail of the bed they were facing.
What were we thinking?

What if you had Alzheimer’s disease and woke up early every day looking for your Mother? The thinking of the time was to re-orientate the confused elder to the reality of the situation. So that elderly confused woman, was greeted each and every morning when looking for her mother, with the good news, “You are old, your mothers dead, how old do you think your mother would be if she were still living?” If the elder was insistent about looking for her mother, the kind caregiver would take the insistent elder to a mirror, to show her how old she was, and prove her point.  What were we thinking?

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
www.plesegettoknowme.com

Posted on June 10, 2010 - by Nurse Virginia

CONFESSIONS OF A NURSING HOME NURSE, WHAT WERE WE THINKING?

(Part I)

I fondly remember a wonderful nurse, some 25 years ago. She was the day shift supervisor, in a large facility, that was part of a well known chain. She “rallied the troops” every morning by going unit to unit saying “We’re in the trenches, everybody has to pitch in.” This might have been motivational, of a sort, for the staff. But with the benefit of time and a different perspective, it sure makes a person uncomfortable. I don’t know think what those nursing home residents must have thought.

Why the battle cry? Why was taking care of these elderly people thought to be a fight? Who really was the enemy?  If I ran into that nurse today I would embrace her as the good nurse and friend she was. She wasn’t a bad person; she was a nurse that came from a military background, as so many did then. And she really felt the need to rally the troops everyday.

I remember being uncomfortable so many times in those days, for so many things that didn’t seem right, so many years ago.

25 YEARS AGO – HIPPA – YOU MUST BE KIDDING
Private, personal information? We lined all the residents in rows around the nurse’s station, wheelchairs sometimes three deep, facing the nurses. Then we gave “report” on everyone, with loud voices and the nursing assistants in attendance. Everybody got the low down on themselves and everyone else. If no one had the courtesy to tell a resident the results of their lab test, you can be sure the results would be read loud and clear right in the middle of the nurse’s station, during the next shift change.

Someone died during the night? All the details were everyone’s business the next time the shift changed. Was it expected or unexpected, was the family there, did they donate the elder’s belongings, we knew it all and it all was shared.

I especially remember a wonderful woman in her early eighties who always sat “front and center” in that row of residents. Her name was Gertrude and she was a retired nurse. I always wanted the retired nurses close to us, because they so loved the nurse’s station. But, Gertrude didn’t let anything go by her. When she was unhappy with the “report” she would take off her shoe and with amazing accuracy throw it over the nurse’s station and hit the offending nurse with her shoe. No one seemed to notice, that I would then ask a nursing assistant to “help Gertrude put her shoe back on.”  The Gertrude’s in nursing homes still need to be heard.

Many things have changed in our society over the last twenty-five years, some for the better, and some not so much. But, life in the nursing home? There we are at least going in the right direction.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know You – Aging with Dignity and Relevance
www.pleasegettoknowme.com

Posted on June 5, 2010 - by Nurse Virginia

COMMUNITY LIVING – LOVED BY THE YOUNG, DREADED BY THE ELDERLY

(Part II)

When young people move into the academic community, it’s time for the family to step back; however, it’s the reverse when the elder moves into the nursing home. During entrance into the nursing community elders need the family to step forward. The typical picture of elders in the nursing community is one of hopelessness and helplessness. Often the family feels much the same way.

Through a lifetime of experience, many times elders have gone through the grieving process. The way in which they handled grief in the past can support them through this time of further loss and grieving. During times of grief and loss, the last thing they want is something new, and yet new seems to be all they have.

Many become angry or resentful. These are normal reactions to grief. Along with that is the need to find someone or organization to blame. It’s usually safe to blame family members as they express their anger, resentment, and frustration. Elders are wise enough to realize that if they express their frustration toward the nursing staff they may be perceived as being difficult.

Families can help new residents avoid being labeled as difficult. They can do that most effectively by taking an active role in the nursing community team.

Book excerpt: Please Get To Know Me – Aging with Dignity and Relevance
_________________________________________________________

I wrote this book because of the strong feelings people have towards nursing homes. Because of the many families I have seen, so uncomfortable visiting. The families, who don’t know what to say anymore to their Mom, except to quiz her on what she had for lunch. The families, who feel quilt about Mom being in a nursing home and so find fault with the staff.
Learn how to become an effective part of the team caring for your loved one 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
www.pleasegettoknowme.com

Posted on June 2, 2010 - by Nurse Virginia

COMMUNITY LIVING – LOVED BY THE YOUNG AND DREADED BY THE ELDERLY

(Part I)

Sometimes in our lives, most of us encounter the necessity of community living. We may look on those times with anticipation, excitement, joy, gratitude, and pride. It’s much like an eighteen-year-old leaving for college after she has earned her place through academic achievement and parental financial sacrifice.

However, entry into the nursing-home community is rarely met with excitement or happy anticipation. Elders seldom do it voluntarily.

Unlike the young college freshman, elders rarely anticipate the people they might meet, or relationships they’ll form, or value the learning opportunities before them.

The big difference is that elders don’t move on to the next upward step in their careers. They don’t see community living as preparation for the next step in life or as a desirable stage of life. For elders, this is the final step. Just the idea of the final step can be depressing and disheartening. Or, it can be an invigorating climax to a well-lived life.

Like college students, the elder may have roommates, their own share of personal space, and get used to community shower rooms. They eat many times in cafeteria style off a tray at a table with strangers. They can also make new friends and enjoy rich experiences.

Family members need to help the elders focus positively on such transition. Elders tend to see their entry into such communities as the end of a long line of experienced losses. They have lost homes and possessions accumulated over a lifetime. They’ve lost relationships and companionship through death, disability and frailty, and they no longer have the challenge of learning and growing.

Book Excerpt: Please Get To Know Me – Aging with Dignity and Relevance
____________________________________________________

One day many years ago, I was the nurse for an elderly woman who had just moved into the nursing home. Every night when I went in to check on her she was wide awake. I asked her why she couldn’t sleep. She then shared with me that at night, while in bed, in her mind, she went through her house. She mentally walked the rooms, opened closets looked at her clothes, opened drawers, and she could still picture where everything was. The elderly moving into a nursing home have suffered so many losses; we often forget the loss of their “things.” Tomorrow Part II of Community Living.

Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois

Posted on May 19, 2010 - by Nurse Virginia

NURSING HOME WEEK 2010 ***** JAIL – OR NURSING HOME?

As we end our annual celebration of Nursing Home Week, I received this email I would like to pass along.

Jail vs. 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.

The “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 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 May 17, 2010 - by Nurse Virginia

MAKING THE NURSING HOME A PLACE – “TO GO TO” – NOT A PLACE “TO END UP” AT

A family member came up to me at a conference and shared her greatest concern in her mother’s recent Nursing Home placement, “I don’t want my Mom to ever feel abandoned,” she said.  What would cause feelings of having been abandoned? Never being touched, never being spoken to, being ignored, and feeling forgotten.

The five senses

Touch: If you are never touched, how do you know your body still exists?  The elderly in general suffer from lack of being touched and elderly in Nursing Homes even more so.  Sometimes due to frailty or fragile skin, touching the elder may be limited. Or it might be that their caregiver just isn’t a touching type of person.

Maybe it was the elder who wasn’t much of a touchy – feely person themselves. But now they really need that human connection of touch to know that they are still here.  Studies have shown that increasing touching by holding, hugging, hand massage, back massage, holding hands etc, will increase level of socialization and decrease confusion and agitation.

Smell: The sense of smell when added to the art of touching, as during a hand massage, incorporates the use of two senses. If the caregiver uses fragrant oil, the combination of the two senses increases the elder’s responsiveness. Think of familiar and comforting smells. Everyone knows what just baked bread smells and tastes like. Cooking and baking are wonderful opportunities for familiar smells as well as opportunities to do something together.

Taste: As the person ages, they often lose their sense of taste. Sometimes it is related to medications the elder is taking; sometimes it is just the aging process. But the last taste ability the elder will have is for sweet things. So often a family member will say, “Mom, never really liked sweet things.” Yet there she is eating almost everything after it has a little sweetener added to stimulate eating. Because the taste buds for “sweet” are usually the last that the elder still experiences.

Hearing:  Music is universal, it makes us move, relax, remember, feel energized.  Music can be such a stimulant and healer all at the same time. Even though music is so wonderful, the sound of the human voice is still the most comforting sound. Talking to a baby can comfort them and talking or reading to the elderly can be just as comforting.

Vision: As the elder ages, vision is of course one of the most obvious loses. Having regular vision test as well as hearing helps the elder to better understand their environment. Vision and hearing especially help the confused elder, giving them cues as to what is going on around them. Anything that helps the elder still enjoy seeing nature, their family members, their pets, their pictures, and their life – is so worth preserving.

The world around us includes many sensations, not just the normal five senses we think of. We also experience change in temperature, the pull of gravity, where we are in space and so on. The options of incorporating more senses into your elder’s day are only limited by your imagination.

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 May 13, 2010 - by Nurse Virginia

PAIN – THE MOST UNDERREPORTED PROBLEM IN NURSING HOMES

Pain is the most underreported problem in nursing communities. This applies to the general population and even more so for those with dementia. Sometimes the elders can’t express their pain with 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, holding a body part, or a sad facial expression. Or it may be a language issue.

One day I walked through a unit for people with dementia. A patient named Edna moved around all the time, so we sat her in a rocker. She rocked for hours at a time, and yelled at anyone who came near her.

We heard her words but we couldn’t understand her language. We didn’t even know what language she spoke. During the first two weeks after her arrival, we asked bilingual people to help us. We asked all through the building and we also asked visitors to listen and see if they could identify her language. No one could understand her. Edna had no family to help us communicate.

One day as I walked through the unit, an elderly gentleman, a neighbor of Edna’s, had come to visit. He walked over to the nearest nurse and asked, “Don’t you know Edna is in pain?” The nurse said no one understood her words.

“She’s from Yugoslavia and she is calling out in Serbian, the language of her childhood.”

Just to know that information helped us to give her better care. Even more important, we were able to do something to control her pain. Her neighbor came by often, and he also gave us a list of Serbian words she used to express her pain. If only someone on the staff had been able to communicate with her, Edna could have been given something to relieve her pain. That’s an isolated case, but it reminds us that we have to learn the language of pain, especially when we deal with those with dementia.

Book excerpt from: Please Get To Know Me – Aging with Dignity and Relevance

By: Virginia Garberding, R.N. and New York Times Best Selling Author Cecil Murphey

www.pleasegettoknowme.com