by Tyra Phipps, Ed.D. (tyra.phipps@gmail.com)
There is a pattern for visitations in long-term care facilities. Ms. Dale Kromroy, a Gerontology Counselor talks about how visitors flock to the new resident
and bring flowers, or food. Over time, there are fewer people stopping by to see the resident until it dwindles down to just a couple of family members. Friends call a resident and say they will drop in for a visit soon, but too many times the
friend never stops by. Perhaps the flurry of visitors when someone makes the transition to assisted living or nursing is helpful, but the promises of visiting and then not showing up can give way to feelings of loneliness, or depression. The expectation
that someone will show up and then is a no-show is quite a disappointment. This happens anywhere in life, but it is ever so troubling to witness in long-term care facilities. Maybe you have thought about visiting someone who resides in assisted
living or nursing care units and wondered what to bring with you.
Flowers are something to rethink. With dementia patients, flowers become more than just a vase
with water, or basket with a colorful display. Keep in mind that these places are notoriously understaffed, and no nursing aide has time to care for flowers. The dementia patient may want flowers watered in the middle of the night. That particular
resident may want to keep these flowers longer than they were alive or meant to be kept in the room. The water in the vase has turned stagnant, smelly, and discolored. The resident will not allow the nursing aide to throw out the flowers that are
dying, nor the water because it came from the son or daughter during a visit on Mother’s Day. Not only do many people have allergies to flowers, but in a one room living space the smell of a flower can turn from fragrant too overpowering even when
the display just arrives and is fresh and beautiful. The suggestion instead of flowers is edible fruit.
Consider bringing a loved one replacement items. In residential care facilities, there are industrial washing machines without delicate care cycles. It might
be nice to replace a worn-out blanket, or washcloth and towel, or any item that you know is used on a daily basis. Replacing a hairbrush, comb, toothbrush, disposable razors, moisturizers and skin conditioners that are fragrance free can really help
a resident feel better about grooming and appearance. Most long-term care facilities do not have in-house drugstores or places where residents can get sundries of any kind. A resident who is no longer shopping and does not know what is available
in a drugstore or variety store can really appreciate items such as soap, deodorant, toothpaste, or mouthwash. What most people get very easily at a grocery store is a treat for someone tucked away in nursing, assisted living or dementia units.
There are residents who work jigsaw puzzles, and do all kinds of word games. The supply of a paperback booklet of word puzzles is always welcome. The DVD of a movie
for those who have the players in their rooms can make for a great show time. Consider adding an individual microwavable bag of popcorn along with the DVD. For residents who like to read, books are always welcome. Try to find large print
books as these can be passed around to other friends in the long-term care facility or donated to the facility library.
On the fun side, there are real big tic-tac-toe
games. The board is actually cloth, with the 0 and X big enough for even the most arthritic hands to hold. A rule of thumb is the simpler, the better. A one pound weight or a theraband can help the resident with exercising. The important
thing is not to add clutter. Stuffed animals, additional decorative pillows, chairs, and tables may be nice, but crowding a room is a prescription for an accident. Everything needs to be maintained. That means dusting, washing, or cleaning,
and that can become more work for the nursing aide. Maybe another way of looking at what to bring a resident or patient in a long-term care facility is asking, Is This Item Practical? In other words, can it be utilized or used up? If the
resident can eat it, drink it, or in some way wear it or be more comfortable with it, then it is a good item to bring along with your smile.
On the behavioral side,
visiting someone in a long-term care facility is not the place to vent all the frustration of your own life. The resident may appear to be a captive audience with limited mobility, but that does not mean the conversation needs to focus on each and every
one of your physical problems, problems with your children, or other family members, or your job. “Restricted living” is the description that Mr. Wayne Seth, Biomedical Engineer, August 10 2014, gave long-term care facilities.
Try to find a way to bring good news to the resident who is restricted in lifestyle, or unable to fend for oneself.
What if the visit reveals something more serious may be going on within the facility? Stacy visited her grandfather in a personal care home located in Accident, Maryland only to find bruises on his back. Upon investigation, she was told that he fell on the doorway. Stacy was quite suspicious because the bruises were not vertical as one might expect for a resident who fell against the door frame. Another surprise visit just weeks before the death of her grandfather, she saw his two front teeth were missing. She was told that he fell again. She said she knew there was more going on. She did not know what to do.
On July 23, 2014, Mr. Garth Clark commented, “The unfortunate truth is that places we believe to be professional and caring can end up being nothing more than herding pens.” In addition, on August 1, 2014, Dr. Maureen Connelly, Ph.D., MSW, Professor Emerita of Sociology and Social Work, wrote: "My mother lived for three years at what I termed assisted living for those who need no assistance." So what does this mean for someone who visits anyone in long-term care? Be mindful. Notice the forearms, or face, posture and positioning of the resident. Is the resident favoring anything that is hurting? If someone is in total care time or bedridden, look at the heels and elbows. Is the skin breaking down? As much as it may be uncomfortable, look for bedsores or the start of an area on the body that may be wearing down. It is sad to say that with dementia patients, nursing aides can reposition someone every two hours, who is in a bedridden state, but that patient can get right back onto the sore area causing further breakdown of the skin. In these cases, respecting the good staff while inspecting the loved one helps everyone involved prevent future problems or a worsening of the pre-existing condition.
A very nice thing that anyone can do for resident is tidy up the room. Even with housekeeping, the smallest messes are so annoying for someone with limited mobility or coordination. Offer to do a little dusting, or washing out a favorite cup, cleaning the comb or brush, or even cleaning out a one cup coffee maker. The business of daily living and chores are so complicated for people with restricted movement. It may be that you see a lot of dust under the bed, but think what that resident is breathing. Make a nuisance of yourself and get a dry mop to clean the dust on the floor. Report that the room is not clean and be sure to document your findings. Make your voice heard when you find problems in the room.
There are good places. On July 23, 2014, Ms. Marsha Southerland Schrank wrote,
"I am privileged to be associated with an outstanding CCRC [Continual Care Residence Community] in San Antonio, Texas. Morningside Ministries is a faith based nonprofit organization that has been providing high quality care for over 52 years. Their commitment is to care for those who have cared for us. However, we are also aware that not all facilities are as good. It is critical for families to be knowledgeable on what to look for and at when considering a placement."
In the July August 2014 AARP Bulletin, Ms. Jan Goodwin reported there is a better way.
Fortunately, a growing number of nursing homes have begun to look for more effective — and more humane — ways to care for patients. Better training for caregivers is key, according to Cheryl Phillips, M.D., a geriatrician at LeadingAge, an organization representing nonprofit services for older people.
Another success story is the Beatitudes facility in Phoenix, which dramatically changed its way of handling patients with dementia based on Mr. Tom Kitwood's book, Dementia Care Reconsidered:The Person Comes First. "What happens here is not for our systems, our convenience, but for the people we care for," says Ms. Tena Alonzo, the Director of Education and Research at Beatitudes. "People with dementia have disturbances in their sleep/wake cycle, so we let them be comfortable and decide when they want to sleep or eat, or not. Or how they want to spend their time," she says. As a result, patients stop resisting care, and the facility runs more smoothly.
The Beatitudes' philosophy is now being taught to a growing number of nursing homes around the country. "We've created a softer, gentler approach, acknowledging that we are not in charge of a person's life — they are. In allowing them to retain their dignity, and adopt a comfort level of care, we've had better outcomes," says Alonso. That paradigm shift has not increased operating expenses, or required a higher staff-to-resident ratio. "We discovered that better care was better business," Alonzo says.
In skilled nursing or assisted living, dementia is prevalent. However, looking out for a loved one requires vigilance whether that loved one is in a personal care home, a small, medium or large size continual care facility. Even a nonprofit facility needs money to keep operating and that can mean cutting corners. Minimizing expenses should not affect the quality of food, cleanliness of the facility, or adequate staffing. What is most important is treating each resident with dignity. The visit to a long-term care facility should be pleasant for the resident and welcomed by members of the staff. If ever there are problems that are apparent during the visit, rest assured those problems are worse than appear on the surface. Help the resident and quickly call attention to any problem. You can also be sure of one thing after you leave. The resident will talk about The Visit for a very long time.
Questions for Consideration:
1. Visit unannounced. Try to see a loved one at times that are not expected. Frequently, people visit loved ones on holidays or the weekends, but try to stop by during a morning or afternoon on the weekday and just observe. Are the members of the staff meeting the expectations of caring for your loved one?
2. Use your cell phone camera. Stop in the public bathroom, or the lounge area and if it is not clean, take a picture. Bring that information to the attention of the administrator.
3. Wash your hands after entry to the building and before visiting your loved one. Be sure that nursing aides have taken care of fingernails of your loved one. Make sure they are clean under the fingernails. Even without making it obvious, try to be an Inspector General. Many times things like fingernails, ears, or feet and soap under toenails can be very telling for how a loved one is being treated.
4. What do members of the staff look like when you visit? Are they wearing scrubs or uniforms that are clean? Do they look professional? Do you see them frequently washing their hands? Is their hair clean and off of their face? What is the expression on their face? Do they smile?
5. Is there an administrator on site? Does
that administrator make herself or himself available? Be wary of administrators who hide. Be leery of an administrator with a big smile and posturing that does not fit the picture of a caring individual.
July, 2014