Nursing Homes: Perceptions and Realities
By Aprill Jones
Why is there so much misinformation and so many misconceptions when it comes to nursing homes?
Admitting a loved one into a long-term, skilled nursing facility is a difficult and extremely emotional decision for all involved.
Here we will address common misconceptions and cultural perceptions that may or may not be true, but nevertheless influence our decisions and thought processes when a loved one may need the 24/7 care of a skilled nursing facility.
When faced with the daunting task of choosing the best facility for the needs of the patient and the family, the process becomes overwhelming, frustrating and even frightening. It’s hard to know what to believe and what to dismiss. Research is imperative and will go a long way in making you and your aging parent feel good about your choice.
Many of us believe nursing homes are where people go to die.
From her 25 years of experience, Barbara Fordyce, R.N., Case Manager in Senior Resource Management, considers the belief that nursing homes are the last stop before the funeral home to be today’s biggest misconception about nursing homes. She finds this is especially true for those who were in adulthood in the 1930’s and 40’s.
That particular generation is living a lot longer than they expected, and really have no cultural cues in how to handle getting older than anyone else they ever knew. They’ve watched friends grow feeble, forgetful and die. It’s a frightening time for them, and the prospect of going into a nursing home may be an indication to them that their time is drawing to an end.
The fact is, even though many senior adults may require the 24/7 care of a nursing home after surgery, an injury, accident or health event such as stroke or heart attack, once sufficiently recovered, they may be able to return to their previous living arrangement or released to a caregiver for the remainder of their lives.
With people in the United States living longer than ever before, it is estimated that anyone over 65 years of age will have a 43% chance of spending some time in a nursing home. About 24% of these individuals will spend less than a year in residence at a nursing home. (www.therubins.com/homes/stathome.htm)
Even when returning home permanently is not an option, most Medicaid-certified nursing facilities will hold beds for patients during a short visit with family or friends. Each state has rules that vary, so check on how out-of-home visits are treated at any nursing facility your are considering.
I can’t help but think that if my loved one is in a nursing home, they will be miserable and I will feel guilty.
Our culture harbors the belief that when we have a loved one who needs the care of a nursing home, the result is guilt and sadness for the family, and the end of any enjoyment of life for the patient. However, that does not have to be true.
Doing your homework before a relative is admitted into the home is the first step to making you both feel good about your decision. The fact is, some ailing seniors are happy to go to a skilled nursing facility so that they no longer feel guilty about the burden they feel they have been to the caregiver.
Your loved one also may be relieved to receive the medical, rehabilitative and nursing care provided in the nursing home by health care professionals.
And while most nursing home residents may miss day-to-day interaction with old friends, family and even pets, most facilities are upbeat, positive places. Patients often enjoy eating in dining rooms rather than in their rooms, and activities and outings offered each day to stimulate and entertain patients mentally, physically and socially.
Also keep in mind that a nursing home is not like a hospital. There are usually no restrictive visiting hours and your relative may be able to go with you for visits, family events and holidays. Expect nursing facilities to try to be home-like – where people can feel comfortable, make friends, visit with family and continue life's activities appropriate to their age and capabilities.
Your research before admission and frequent visits with your loved one once moved into the facility will ensure that their time in a nursing home is beneficial and pleasant without any misery or guilt.
It seems all the residents lose their privacy.
Fordyce reports that many residents, in their first weeks in a nursing home may experience a shock at their loss of privacy if assigned to a semi-private room. While they are usually allowed some personal items and clothing that help keep their sense of identity and individualism, there is a certain loss of control that many people struggle with for varying periods of time.
You should expect staff to be considerate of the need for privacy and knock on closed doors before entering the room, respect clothing choices and personal preferences when appropriate.
If you have a mother and father who would like to live together at the nursing home, you should expect to find a facility where this is allowed and their privacy is respected.
We’ve come to believe all nursing homes smell bad.
It’s true that incontinence is a fact of life in most nursing homes, but today’s cleaning methods and prompt attention to any sanitary issue is standard in most homes. If you encounter bad odors, the situation should be reported immediately. But in today’s skilled nursing world, stale, lingering, unpleasant odors are no longer an issue that cannot be resolved.
We perceive that when in a nursing home, people lose their dignity.
Because in the past, we may have observed nursing home patients sitting in wheelchairs waiting to be taken to where they are going next, or people wandering the halls seemingly having discussions with themselves, many of us perceive that residents in a nursing home lose all dignity. But Fordyce reports that residents, on average, receive 2.5 hours of skilled nursing care every day. You can expect the staff to be constantly aware of resident whereabouts and needs, and if you feel this is not the case, you should report what you see.
It is true that a large number of nursing facility residents have Alzheimer's. However, in most homes, Alzheimer's patients live in distinct units where they can be among people having the same limitations and receive the specialized care they require in a secure setting.
In your loved one’s nursing home, you should not encounter lingering odors or signs of neglect or disrespect resulting in loss of dignity. If you do, exercise you option to report the conditions. You have every right to have your concerns addressed and a plan of action shared with you.
It only seems logical that private pay surely results in better quality of care than when paid through Medicare or Medicaid.
According to Hillary Kaylor, Regional Long-term Care Ombudsman in Charlotte, NC, there should be no difference in quality of care between Medicare/Medicaid payment vs. private pay vs. long term care or Worker’s Compensation insurance payments. Quality is not based on payor source, but rather from influences such as the administrator, the size and number of beds in the home, and how closely the services offered at the home match the needs of the residents.
Kaylor says that nursing home operations are usually run by private corporations, hospital systems, or, more and more rarely, a “mom and pop” type organization.
All nursing homes in the United States that receive Medicare and/or Medicaid funding are subject to federal regulations. (American Association of Homes and Services for the Aging). The nursing home industry is one of the most heavily regulated operations in the United States. Each and every nursing facility is expected to meet minimum government quality standards, and undergo regular inspections by state surveyors.
Kaylor states that as an employed ombudsman, it is part of her job to urge facilities to do better than the minimum. If a problem is found, a prompt correction plan is required. Most areas have an active, government-supervised Ombudsman program that advocates for patients and families in the case of oversight.
It IS true that nursing homes have changed!
Nursing homes haves changed a good deal over the past decade, according to Kaylor. They are no longer a place where grandma sits and waits for someone to change the television to her afternoon soaps and for her once a week visit from the family. With more and more focus on rehab and recovery, nursing homes often have a diverse population, which includes both younger and elderly people.
A good place to start making nursing home comparisons for your particular area, according to Fordyce, is through the Centers for Medicare and Medicaid Services, which provides a nursing home compare tool. Go to www.medicare.gov, go to “Search Tools” and click on “Compare Nursing Homes in Your Area”, or call 1-800-633-4227.
--------------------------------------------------------------------------------
Aprill Jones holds a B.A. in English from the State University of New York. A writer for over 15 years, she has experience with a variety of clients in the healthcare field, including neuro rehab, optometry, radiology, dentistry and pharmacy as well as work in health insurance. She lives in North Carolina.
--------------------------------------------------------------------------------
Resources
Nursing Home Fact verus Ficton
For a nursing home fact vs. fiction quick reference chart, go to www.commonwealthfund.org, from E. Carlson, "Twenty Common Nursing Home Problems and the Laws to Resolve Them," Clearinghouse Review Journal of Poverty Law and Policy, Jan./Feb. 2006.
Comments (1 to 20 of 20)
alzheimersideas
Sep 10, 2008
Suggest Removal
Very good article. People must understand nursing homes have changed and must adhere to certain standards as mandated by the department of public health
Susan Berg, author and dementia healthcare professional
PersonCareDotNet
Sep 10, 2008
Suggest Removal
This article about nursing homes is very accurate and timely. Similar to when you may have looked for a day care center for a child, the child day care center's director is the key. In a nursing home, the administrator/management is the most important part of a caring nursing home.
Bob, experienced professional in the healthcare industry for equipment/supplies
alzheimersideas
Sep 10, 2008
Suggest Removal
I think the director of nurses is also extremely important
Susan Berg
author and dementia healthcare professional
Cat
Sep 10, 2008
Suggest Removal
Sorry to burst your bubble, but this article is lovely, but not realistic - unless you have money and are a relative of the administrator. I notice that the only people commenting on this article are in the industry. Speaking from "both sides of the fence" the truth is that in a recent poll in LTC Magazine 90% of the vote on the question: I wouldn't want to be a resident in my own nursing home - be it SNF, LTC, Assisted Living, etc.
Where are these lovely nursing homes where everyone visits - eats in the dining room and plays games? In a movie? I haven't seen any in Los Angeles County that were not high-end private pay. Sorry - aren't out there.
As far as Medi-Cal versus private pay goes - it is very nice to say that there is no difference - and you are right, it is mandated that there be no difference in care - but there is. Regardless of where the blame lies, the industry is run as FOR PROFIT and with Medicare, HMO and Medi-programs cutting reimbursable amounts it is a perfect storm of problems, an aging infrastructure, low paying jobs and a patient population that is many times in no position to object. Yes there is an Ombudsman, but abuses do occur and it is impossible to regulate things like "not caring" -
I invite everyone to spend 7 days as a patient - in fact that is the only thing that will change the system.
momsdaughter
Sep 11, 2008
Suggest Removal
If at all possible, try to hire a live in before placing into a nursing home. My mom has been in 2 nursing homes
momsdaughter
Sep 11, 2008
Suggest Removal
My comment got cut off. Anyway, Mom has been to 2 different nursing homes and while there are caring CNA's & RN/LPN's, who do their job, most facilities are short staffed and residents receive minimal care & are ignored for the most part. Mom has lost 12 lbs in less than 2 months and her care has not been anything like what we were told it would be. I've had CNA's ask me if I knew how to transfer mom into bed because they weren't sure! Yes, it's been reported. After 2 failed attempts & her health in jeopardy, we are now hiring a live in and will have more peace of mind knowing she is at home where we can take care of her better than the nursing homes we've had experience with. Hiring a live in is actually saving us money - you have to do alot of reference checking & CORI checks, but we've had good luck in finding a few great, experienced people eager to help just by placing an ad in the local newspaper.
Mgrady1
Sep 11, 2008
Suggest Removal
I agree with Cat and momsdaughter- there is no such thing as a good nursing home. this article is very inaccurate and misleading.
there is alot of work that needs to be done about the lack of care and lack of humanity in nursing homes.
i do not have time at the moment to fully comment on this article, but i will at a later date.
alzheimersideas
Sep 11, 2008
Suggest Removal
That is really too bad. The nursng home I work for while not perfect is much better than you describe. The majority of our staff are kind caring people who work extremely hard to make things as comfortable as possible
There are some over demanding unrealistic family members out there that take up a lot of time. This is time away from the other residents.
I work for a non profit home. But we do have to meet expenses and upkeep.
I think the key is having an administrator who is kind and allows certain expenses
Also important is a top notch on the ball director of nurses and assistant director who keeps the nurses and CNAs in line. You need ones that know the residents, are not afraid to get their hands dirty and will work more than the 40 hours they get paid for
by Susan Berg
Cat
Sep 11, 2008
Suggest Removal
Dear Susan,
Thank you very much for your thoughts - I am wondering what city/state and non-profit your nursing home is - it sounds very nice. Does it take Medi/Medi? Are you also caring for someone directly yourself? I do ask that question kindly as you didn't identify yourself as such. I do ask the question kindly - it is not adversarial.
To reiterate what I said, yes, there are some caring people - and it is technically up to the DON, Administrator, Activity Director, SW, Facilities, Kitchen, Maintenance, Laundry, CNAs, Per Diem nurses and all of them. BUT this is a caregiver site and I believe that sometimes, it would be good to embrace the idea that we deserve *respect* and a safe place to talk about our opinions - including the good, bad and ugly of nursing homes.
I orignally had written more, but was cut off by the time before I had to log in again - so rather than start over - in a nutshell - if you are a caregiver, great. If not, perhaps you will learn more from our complaints and you can take those comments as honest feedback. My mother would have lasted about 3 months in a nursing home - but gong on seven years she is fine. Because caregivers do more than any staff would and they do it because.
Once again - rather than praising an outdated system of care - the SNF - LTC facililty - please recognize that we as family caregivers are not subsidized, paid, recognized or supported but we each do all of the work that it takes a facilty to do - on top of our regular daily lives. Perhaps if you want to be cutting edge at your facility, you will build some programs for low cost - or free subsidized respite for caregivers on a day program. we need it.
alzheimersideas
Sep 11, 2008
Suggest Removal
I hear what you are saying. We do offer respite care. Occasionally we even have contests so one family can have a weekend of respite care at no cost. I do recog nize what caregivers do. We welcome family members to come in as often as they like with certain guidelines. I think the ideal if your mother needs SNF care, is too be extremely involved in her day to day care. However, you do have the option to take a break every now and then to regroup and refuel.
No one said taking care of an elderly parent is easy.You know your loved one the best. I even wrote an editorial in USA Today last year about the positives of nursing homes
I think adult day care is great also if a loved one can tolerate it
Cat
Sep 12, 2008
Suggest Removal
Hello again - guess you did not "hear" what I was saying - or reply to my questions - but you did go straight some very self serving information about admitting for respite and what your nursing home does. I really don't care if you wrote a self-serving article about nursing home and are looking to develop "street cred" as an expert in all things geriatric - - to be blunt.....this is a caregiver support site - not a site for people to promote their businesses, or themselves.
I am unclear why people who are not actual caregivers participating for themselves, feel that offering their self-declared "expertise" is appropritate . It is not and is unwelcome - there are enough SW's and discharge planners and marketing reps in our areas - all of whom are in an INDUSTRY and are paid to promote their service. With due respect - please go peddle your services somewhere else - or troll senior centers for business. Or conversely, you could be honest and pay for advertising space on this site and tell us the name and location of your nursing home.
alzheimersideas
Sep 13, 2008
Suggest Removal
Dear Cat I am very sorry you feel that way. I am not trying to promote any business, but just give things from my perspective.You are lucky. You are able to keep your loved one at home and can give her all the support and attention she needs. Some people are not so lucky.Some loved ones require more than any family could possibly provide. Some people try to cheat the system which makes it harder for others to get the services they need. I think we can both agree that more financial support is needed for caregivers. Did you know that if you are the primary caregiver, you can get a stipend formcaring for your loved one at home. Granted it really only scratches the surface, but you may as well take advantage of everything out there.
Again I am indeed sorry if I offended you or anyone else.
Susan
Cat
Sep 13, 2008
Suggest Removal
Dear Susan,
Thank you for explaining yourself. I am very aware of how lucky I am. To put my comments into perspective this is my background: I had to fight to pull my mother out of a SNF after a younger sibling put her into the hospital / SNF with a DNR order. Long story short - I lived at the SNF, and did the 85% of work that was not done by staff. They billed for services not performed and when I saw enough there to turn me into an activist.
when I got her discharged to my care with the help of the Ombudsman and a very wearing fight with authorities, she was 84 lbs, incontinent, stage 3 bedsore and unable to communicate/verbalize. The administrator and DON basically told me I was wasting my time because she was going to die - they justified her state and refused to take responsiblity for her condition. Her doctor told me I was crazy to bring her home because it would "be too hard to handle" - I am a single woman - no help.
Six years and alot of work later, she is walking, communicating, continent and enjoying life. This is why I generally try to encourage people that their expectations about their loved one's care are generally self fulfilling prophecys.
I would like to find out about the stipend you mentioned - perhaps you can do a full article on that and how to access it.
Take care and I hope that you will encourage families not to default to a SNF simply because it is the easy way out. Our parents took alot of time out of their lives to raise us and change our diapers - time to return the favour.
alzheimersideas
Sep 13, 2008
Suggest Removal
Dear Cat,
Wow what a story. I am not happy about that nursing home. You must be an amazing woman. I cannot put my blog on with html so you will have to be diligent finding it dementiatips But you sound like one tough cooke. I also wrote an article about honoring caregivers on labor day also. I know how hard you all work.
I would like to tell your story
If that is ok, leave a comment
I will have to find the aticle about the stipend. You are obviously most deserving of it
Susan
Mgrady1
Sep 20, 2008
Suggest Removal
Dear Susan-
if you would look and you wouldn't have to look very far, you will find thousands/millions of stories like Cat's. I have a very similar story to hers. I had to remove my mother from "one the better" nursing homes. When i brought her home, all she could do was drool and her hands were in tight fists- she could not talk, walk or feed herself. My sister and I took care of her in my home and after a couple of months and alot of pain, she was finally detoxed and drug free. she could stand, walk and do crossword puzzles. my story is a long one and I will not go into details at the moment- my point is, nursing homes have not changed THAT much and 2 something hours per CNA per patient is NOTHING! In order for those hours to work properly, that means that a CNA cannot have more than 4 patients- please tell me of any nursing home where a CNA does not have more than 4 patients!
i am adding a link to a story that came out today. it is about a patient still trapped in a nursing home. Please read it and let me know what you think.
http://www.embarqmail.com/news/read.php?id=16397097
195Austin
7 days ago
Suggest Removal
Cat
I am very glad you are telling it like it is we are lucky in our area there are a lot of N,H.'s to chooes from and some hosp. are starting there own 20 day units for people who are not ready to go home when discharged so N.H's are looking for pt.s to fill there beds. I have noticed that the ones who hire locally are better then the ones who train and buss in staff. Keep up your commets about NH's people need to know what really goes on in these places more often then not. Also we need to report what we see going on at the time. Cat keep up talking about it.
alzheimersideas
7 days ago
Suggest Removal
Dear mgrady
That link did not work.
It is bad that you both have had such bad experiences. The home I work for is nonprofit and has a top notch staff. Maybe we are in the minority?
That is a shame because there are some people who have to be there
Susan
Mgrady1
7 days ago
Suggest Removal
Dear Susan-
yes, you are VERY much in the minority. the people in your nursing home are truly lucky. too bad it is not like that everywhere.
the link works when i click on it- maybe you can copy and paste it in your browswer?
Molly
GinaConte
7 days ago
Suggest Removal
I got paid to take care of my mother at home but I had to be a certified caregiver (in Arizona). Her insurance was through the state (she was low income) and she was qualified to get help 3 days a week. The pay was only $9.00 an hour but it helped! I also worked full time and went to college at the same time. She was in a nursing home for a few weeks and the care was horrible until I had a talk to the administrator about specific things the CNA's were and were not doing. They treated her better after that. I wish I had the resources to open up a comforting and stimulating
Day Care Home that would give caregivers peace of mind to work or play while their loved ones were being cared for!
By the way, CNA's and caregivers do NOT get paid enough. Thus, the turnover rates and lousy care, that's my opinion!
Cat
4 days ago
Suggest Removal
I truly wish that there were programs for day care at home here in California, the only way to qualify for that is if your parent/ loved one is on Medi-Cal (Medi-caid) and has a very small SS check. The way it has been explained to me they pay based on time per task - and at the minimum wage of 6.50 or so... Recently California has been in a budget stalemate with Legislature so no one in healthcare whether it be SNFs or HHA's have been paid.
Imagine the uproar if they did not pay police or firemen!
No comments:
Post a Comment