Sunday, December 21, 2014

Nine things NOT to expect in a nursing home

"Oh, I can't wait to get into a nursing home! I have waited my whole life for this opportunity and it is finally here!" said no one ever.

While we can agree that expecting people to approach nursing homes with glee is not realistic. how about other expectations? Often facilities, family members and residents all have different expectations and that is where things can get challenging.

As someone who has had loved ones in nursing homes and has worked in the industry for years, I have pondered how we can all get on the same page. Wouldn't  it help if we all knew ahead of time what was realistic (or not) to expect from each other. Let's start with nine:

(1) Don't expect a one and one ratio.
Nursing homes exist to provide care to the residents they serve. But that care (and the funding for it) is not the one on one care families might have been able to provide at home to a loved one. Expect that help will be provided as soon as possible. If the call light is turned on, it might take a few minutes for someone to answer it, depending on what the needs of others residents are at the moment.

(2) Don't expect the same routine.
The  staff should ask questions about the resident's history and preferences and together arrange a routine that works for the resident Things will probably be a little different from how they were at home, but resident choices should by honored as much as possible.

(3) Don't expect that all medications will remain the same.
The nursing home is one of the most regulated industries in the United States. These regulations include the dosages and types of medications residents receive. For example while the hospital (or the family) may have been able to provide a sleeping pill to your loved one every night, the nursing home needs to try alternatives before doing this on a regular basis because these medications can increase the risk of falls.

(4) Don't expect perfection.
We all know there is no such thing as perfection in life and unfortunately it will not be found in a nursing home either. When they can improve on something please let them know. (We always try to do better)  Effectively advocate for the resident by calmly expressing your concern to the supervisor. A good supervisor will be thankful that the resident or family member shared a tip with them on how to improve the resident's care.

(5) Don't expect a large, private room.
Sometimes a family member ends up unexpectedly in a nursing facility. He may have fallen and broken a hip, gone to the hospital for surgery and is now in an unfamiliar place and needs rehabilitation or skilled nursing care.  Although a private room is possible, be aware ahead of time that one might not be available at that time.  However, when another rehabilitation or skilled care resident is discharged home the private room they vacated can be used for the family member.

(6) Do not expect that falls will never happen.
Speaking of falling, if your only reason to move your family member into a nursing home is to keep them from falling, you may need to pause. Facilities should evaluate the potential for falls and implement interventions tailored to each resident to reduce the chance of falling, but they are not always able to prevent all falls. Restraints, which include full-length bed rails, pose a significant
hazard to residents;thus many facilities are restraint free for the residents' safety.

(7) Don't expect the family's stress to fully disappear.
Watching residents struggle with Alzheimer's disease or the effects of a stroke may symbolize the potential decline and eventual  loss of their own family member and this can trigger guilt and grief. Additionally, adjusting to not being the main hands-on caregiver can also be a significant loss, even if that caregiver was tired and experiencing burnout. This stress  can be decreased by participating in support groups as well as receiving reassurance and evidence that the loved one's needs are being met.

(8) Don't expect all facilities to be a horror story.
Yes there are bad nursing homes and some staff members that do not care about the residents. However, there are also many very good facilities with employees who deeply care about the residents and go the extra mile. Most  people who work in nursing homes want to do a good job and have chosen to work there because they feel it is their privilege and calling to do so.

(9) Don't expect that residents will never adjust.
Understandably, it takes time for most people to adjust to a nursing home as well as for the staff to become familiar with the resident's personality and needs. While there is no guarantee that the resident will live happily ever after, I have known many people who have experienced a joyful, active and full life in a nursing home. Encouraging positive relationships, providing choices when at all possible and offering meaningful activities can facilitate adjustment and improve quality of life in nursing homes.

Esther Heerema, MSW

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