Nursing Homes-Why Do We Need Them?

Nursing homes go by various names. They are called skilled nursing facilities, nursing and rehabilitation centers or any similar variation. They do this since they have RNs, LPNs, CNAs, social workers, dietitians, physical therapists, respiratory therapists, dialysis technicians working in them. Not all nursing homes have all but these are skilled workers offering skilled services. Some are short term services and some are long term.

When you enter into a nursing home, they become responsible for your safety. You are unable to to come and go as you please. One of the biggest complaints of residents is that they are like prisoners in jail. Residents with families can go out with their family if they sign them out, in essence taking responsibility for them. Others hire companions or have friends who accompany them out. Though Nursing Homes do give certain residents permission to travel on their own. This loss of control can be hard to take for people who have been independent all their lives.

I have heard people say that they worked hard all their lives and were looking forward to retirement and never expected this to be where they ended up. No matter how hard we try to plan our lives, we can't control everything.

Many residents of nursing homes have problem sleeping anyway. We often hear about how patients can't sleep when they are in the hospital. That is different, hospitals are mostly short stay. I have had patients say to me they can't wait till they get home to their own bed. For some, nursing homes are their homes and they are there for long term if not forever. If they can't sleep it is a very big deal.

Being in a facility means there might be rules and regulations you need to follow. Many people still smoke even with the knowledge of the health risks. It is an addiction and is hard to quit. Many nursing homes are becoming no smoking facilities. There are many reasons for this. Primary is the ongoing health issues to the smoker. Residents need to be monitored while smoking because of the danger of fire. There is the problem of second hand smoke with other residents and staff. Second hand smoke has been linked to lung disease, heart disease and even dementia. Some elders have smoked most of their lives and resent the fact that they cannot smoke at all in the facility or outside.

Complaints about bad food is rampant in nursing homes. Institutions are not known for their cuisine but nursing homes are even the butt of jokes by stand up comics about their bad food. Part of the problem is that many of the residents are on restrictive diets so the food has to be something most can eat. Also budget can be a factor, they buy reasonably priced food and certain foods that are too expensive are never seen. Much of the food is pre-cooked and just gets reheated. Cooking from scratch with an experienced cook in the majority of the places is a thing of the past.

Even though some residents may be able to afford a private room, most must share a space with one, two or three others. They are unable to take most of their possessions and must live in very limited space with very limited privacy. A major problem can be roommates getting along. Some like their space cool some like it very warm, some people are neat others not so much. Some residents are there because of hoarding problems or squalor syndrome so they will have problems with keeping their area free of clutter. The ones living with squalor syndrome will also have a problem keeping themselves clean. The nursing homes do try and match people if possible or move residents to different rooms if they really don't get along. Roommates can become fast friends and look out for each other. I've seen cases where the family will visit one and end up bringing food and things for both residents in the room. This is especially good if the other roommate gets no visitors.

One of the most obvious is noise level. Residents share rooms with others with differing habits. The neighbor might want a television or radio on loud or have late night guests. Lights are very bad for sleep hygiene. Lights stream in from the hall or are turned on when staff comes in to work on someone.

The television and radio are other bones of contention in such close quarters. Some residents keep their televisions on all day and all night. Some families even insist that the radio or television stay on all the time. One residents family insisted on playing one favorite VCR tape all night, another insisted on one song which they said had religious significance. This can be very annoying to a neighbor. The roomie might just want some peace and quiet without radio or TV.

Technology can help, they can use small personal speakers or earphones. Then there is the lights and noise. These can be annoying but can be dealt with also.

Scents can be another issue. As we know scented candles, perfumes and air fresheners can be triggers to people who are allergic or just irritating. Some people only want to smell sweet smells. Unfortunately if a resident is asthmatic or has COPD it can cause them problems in breathing. Nursing Homes like other facilities have to lean towards the safety of their population even if it makes some unhappy. Hospitals have a better understanding about smells as irritants and allergic triggers. This also goes for heavily scented staff or visitors to a room

Family and friends can better the quality of life of the nursing home resident. I have seen families integrate their visits as a natural part of family functions. Different family members come at different times. Ones who can't visit personally visit through skype or another voip service. On certain holidays they descend with balloons, food, party hats, and celebrate with their love ones and include the staff. Wedding parties with pictures taken have been seen to the delight of residents and staff.

Loved ones can act as advocates for the nursing home resident. Besides having resident councils, some nursing homes have family councils also. Individual family members can make sure the facility is acting in accordance to the law. If lets say they notice that their loved one is losing a lot of weight they can be instrumental in getting to the bottom of the problem. They can go over care plans and medical records with the permission of the resident to give input or to ask questions. They can involve themselves to make sure that their loved one is compliant with medication and therapy. Caregiving doesn't necessarily stop at the door of the long term facility. There have been instances where family has been instrumental in uncovering irregularities and reporting and changing the course of care due to research and perseverance.

Some family members can have a negative influence. Nursing homes have to follow court orders not allowing certain family members alone with the resident. The resident themselves can determine if they want to allow certain people to be involved with their care or not. They may determine if certain people are not allowed to visit at all.

Families can also cause problems for the other person in the room. With such small spaces they can hear pretty much everything that is said even by the doctor and see more than they should, usually there is only a curtain between occupants of a room. In many places they can visit at pretty much any hour, and some do.Late night visitors can disturb a roommates sleep. The noise might be a factor or the idea of people, possibly of the opposite sex in your room while you are trying to sleep. Nursing homes also allow visitors to stay overnight in the residents room. Some have been known to practically live in a relatives room.

Homeless relatives have been known to camp out in the nursing home room bringing their clothes, food and clutter. Others have spent all the hard earned money of the fragile person leaving them destitute then placing them in a facility. The situation might then come to legal action when they then refuse to pay the nursing home.

Unfortunately once some people go into nursing homes they lose touch with family members. They cannot just go out to visit and family and friends either never visit or visit rarely. It is very sad to hear folks comment on all the family they have and that no one visits them. Other residents get to go on family outings or spend the holidays with loved ones. They see people come and bring food and flowers yet nothing is for them. Some do get phone calls IMs or emails while others don't even get those.

People enter nursing homes with long term chronic diseases. They need to be taken care of by the staff. One thing that is immediately noticed is that the staffing levels are less than in a hospital so even basic care is less intense. Ongoing discussions have been going on about what is the appropriate staffing level to take care of vulnerable residents. Nurses give out medicines, dress wounds, start and take care of IV's, give tube feedings. Certified nursing assistants (CNAs) feed the residents, dress them, clean them, take them out of bed, take them to rehab. The majority of personnel you will find in a nursing facility will be CNAs. You have doctors who evaluate the patient and write orders to be followed by other staff. Some facilities have residents with tracheotomies and ventilators. Respiratory therapists who take care of that may be involved. There are also the rehab staff, social workers and dietitians. Most staff are involved with discharge planning.

The various workers of course need to be trained and skills updated by the facilities. Training takes time and time equals money. Unfortunately in many facilities the proper training of the employees might not be as frequent or intense as it could be. Also, with facilities depending on casual or per diem workers many do not get the training and updates they would get if they were full-time workers.

In this economy all businesses are trying to do more with less. And as we know running a nursing home is a business. There is alot of downsizing going on due to monetary reasons. Contrary to what they might tell you it does impact on the resident's well being. It is obvious that if they do not have enough staff to do the work properly then the residents of the nursing home will suffer and some could die. Some facilities will never use the term staff shortage, they will just pretend that there is no problem. There is also the problem of biting off more than what you can chew. Some facilities like to advertise that they can do lots of thing almost like a hospital. What you might find is that there really is not enough staff to do all the work claimed and that what staff they have is under trained.

Many health care facilities have employees do work load statistics to better understand how much work there is to be done and the best way to organize it. Others do not, and tasks are given out without thought as to the time needed. It really is ludicrous to give an employee on an eight hour shift enough work for twelve hours and expect it to be done well. Insurance and other third party payers have the reasonable expectation that what they are paying for

There are business management strategies like Six Sigma and Qualpro that are purported to be able to help the facilities be more efficient, the problem is you have to utilize it and not just have employees take the classes. What happens in many types of businesses including healthcare is that managers think they know where the problems are. Sometimes they are mistaken, and these strategies are supposed to pin point where the real issues are.

Doctors are usually physically available during administrative hours. Now again, depending on the home they might only be there on certain days. That is usually Monday through Friday somewhere between 8AM to 6PM. They are not usually there on holidays and week-ends. Now some more medically oriented facilities might have more physician or nurse practitioner hours. I saw an advertisement for a nursing home that said they had a doctor on staff 24 hours but this would be very unusual. They are on-call and can be reached by phone. Some nursing homes share physicians. A doctor might be responsible for two or more nursing homes, duties at their hospital and a private practice.

It is your right to see a physician. Sometimes being so busy they might not see all the people they should on a visit to the facility or you just might want to discuss your medications in between visits. The staff should get in touch with him. If you don't want to wait you or your family can call him directly. You can have a discussion or make an appointment to meet. He is your physician, he reads your chart with all your information, you can have access to his phone number. Do not feel like you are imposing on him. You have a right to be apart of your medical care.

There unfortunately have been cases where physicians will be unscrupulous in their behavior towards the residents. An eye doctor was cited for doing unnecessary eye surgery on some residents for the reimbursements. The zyprexa case where dementia patients were given this expensive drug even though it is not for dementia and is a atypical anti psychotic. There are lawsuits by the government in order to recoup some of that money. Some years back they had cameras in a facility and arrested a doctor for false charting. He documented he did an evaluation but was not in the residents room long enough by clinical standards.

It is mostly older people we think of when we talk of nursing homes. Younger people are now finding themselves living in these facilities more and more. Some come because of health issues that makes it harder or impossible for them to be home. Complications due to obesity including diabetes and heart disease are being blamed for some of the increase in admissions. With type 2 diabetes on the rise with younger people it is believed it will only become more so. Other reasons include traumatic brain injuries from violence, accidents or worsening of congenital issues.

At this time around 10% of residents are under sixty-five years old, in New York State it is more like 12.5%. Nursing homes have to accommodate the needs of the younger person which can be different from the older residents. Some long term care facilities now are getting residents in their teens and early twenties that have no other place they can go. The disabilities of these young people might make it impossible to be cared for at home.There are no family members that are willing to take up the responsibility or they just have no family at all. The activities that they like are different and they do not like being around older people constantly. Education might need to be continued and they need to have a way to do it.

Some people don't really understand the difference between a hospital and a nursing home. The purpose of a nursing home is not to cure, it's to maintain someone at their optimal health. If there is a cure it will be done at a hospital. As everyone can tell there are more staff in hospitals than nursing homes. There is an entity between regular hospitals and nursing homes, it is called LTACH or Long Term Acute Care Hospital. As the name implies these places offer medical treatment to patients who have long term acute illnesses. These patients might otherwise be transferred to a nursing home which might not have the ability to care for them properly.

Residents in nursing homes have various health issues. A large portion because of heart disease, diabetes, COPD, dementia and other mental problems. There are around 16,000 nursing homes in the U.S. and about 1.5 million residents in them.

Nursing homes offer rehabilitation but some places are better at it then others. There are some specialty centers that are on the cutting edge of their field and there are others that want you to think they are. You need to make sure that if rehabilitation is needed you know exactly what is really being offered. And you want to see it in writing. Be careful when you look at web pages. They are advertisements and you might not recognize the place when you visit as the same place you read about on their web page.

Nursing homes are not free, they are usually expensive. They can be paid for by long term care insurance Medicaid or cash. Regular health insurance and Medicare will only pay for short stays. The problem with long term insurance is that the daily room rate of the nursing home might be much more than what the insurance will pay. And the resident is still responsible for the difference which sometimes could be a significant amount.

Anyone in a nursing facility receiving Medicaid has to contribute all of the income they have to the nursing home that includes pensions and social security.. They are allowed a small monthly allowance of approximately $50 dollars depending on the state you live. If they have a spouse at home then some of their income will go for support in order to help pay mortgage or rent, food, utilities and other necessaries and the spouse may continue to live in the home.

Sometimes it is unavoidable to go to a nursing facility, but sometimes there are things you can do to avoid it for as long as possible. All situations are different. Aging in place is one way. This obviously means you will live out your life where you are. This usually means some planning and home modifications.

Get rid of clutter. Start early to get rid of things you don't need so you wont be tempted to hoard. It is easier to maintain an uncluttered home whether it is you who is doing the cleaning or someone else. An uncluttered house also is safer, less chance of falling and becoming incapacitated. Clutter brings dust which harbors dust mites which can influence your health. Roaches and other vermin thrive among clutter. If you need to go live with others it is easier if you travel somewhat light. Bed bugs can be a game changer. They are easy to get yet hard to get rid of. It is almost impossible to control them with lots of clutter around.

Down size- This might mean going to a smaller house or apartment. One that is easier to take care of, one that you can manage

Move- It might be better to move in with children or near them. You might want to move closer to transportation, health care facilities and activities.

Don't Move- Age in place, stay in your home and receive different types of services.

Don't alienate friends and family and stay sociable.

Deal Locally- It is easier if you have local connections. People can visit more often if they are not far away. If you go to a local religious institution it will be easier for you to continue than to worry about how you will get to some place farther.

Don't retire from life- You might be retired from your job but it is a bad idea to not stay involved with your surroundings. Do not feel that you no longer need to be involved with your daily business. Do not leave it to your spouse or children.

Take care of your health- Medication nonadherence is common among older people. There are many different reasons why people do not take their prescribed medication but it can lead to worsening of their health.