Monday, September 29, 2014

"They stole my heart"

Nursing homes, no matter what the cost or the promises of services provided, are not places most would choose for their final days and yet that's where many will end up.  Either there or in some variation of a step-down facility that provides three levels of care as the need arises. Some older adults will have incredible resources but lack any family members or caregivers who will take them in.  Others, like the tiny woman who danced in silent films, will have no funds and no family left. She will share a room with another woman who refuses to talk to anyone so her bedtime hours will be spent in silent solitude whether she wishes that or not.

A totally different resident in the same upscale nursing home, where wine is served with Sunday dinner, dominated the dining room from a table placed strategically in front of everyone. She was seated alone at her table which provided a view of the entire room and gave the appearance that she was either a teacher or a head mistress of sorts. Although she didn't speak to the other residents, her presence was noted and there was a certain of deference afforded to her. She was, after all, the widow of a successful healthcare professional. Other equally well-connected women, however, neither sought, nor received this type of attention.

The years came and went and she retained her position until one day when she would be found tearfully bemoaning her fate in her private room. "They stole my heart," she implored anyone who entered. Was she experiencing a psychotic episode, a medication side effect, a bout of dementia or what? Oh, not her actual heart, but an item of jewelry? An immediate search of the entire room was made and every nook and cranny was poked, furniture was shifted, drawers were examined, but all to no avail.

What had happened? When she could calm herself, she explained. For her 50th wedding anniversary, her husband had purchased a solid gold, finely engraved heart that was almost the size of a Mound's candy kiss. It hung on a delicate gold chain around her neck and she never removed it.

This day, in an especially rushed evening (nursing homes are thinly staffed after the afternoon shift), staff had tugged a bit too hard as they pulled the knitted sweater over her head and the chain popped. The heart must have flown across the room. Where was it? No one could find it. What do you suppose happened? It was never found.

From then on, she began to lose some of her former self-assuredness and feebly called distant relatives she hadn't seen in over 30 years. No one came. In time, she would be found lying peacefully in her bed and her attorney would be notified regarding her "arrangements" and her room would be emptied. It was truly a sad ending for such a wonderful, feisty woman. All she ever wanted was to go home but there was no longer any home to go to.  Her apartment had been sold to fund her residence fees.

Both of these illustrations point up the fact that anyone who is considering either a nursing home or an assisted living facility for someone or even for themselves at some point needs to do quite a bit of research. In addition, it is highly recommended that you make an off-hours, unscheduled if possible, visit to the facility. You don't want one of those carefully planned guided tours which will only point up the sterling qualities of the facility, not the true reality. Great to have beautiful, enormous exotic fish tanks in the lounge, but if no one ever goes there or is ever taken there, of what use are they?

The search may seem mind boggling initially, but there are websites that can help. One provides information on the "Five-Star Quality Rating System" and it contains information not only on services, but inspections and insurance among other considerations.  I, for one, would not just stop at one of the sites that states it lists "the best" nursing homes, docs, etc. because I think it's best to do your own research.

You might pick out three sites from one of these "best" raters, but then go deeper on your own. Many things are brought into consideration when these lists are compiled and points for you may not be points for them. Do your own research.  In fact, even the site has been seen as flawed in its rating system, so take the time and, as always, let the buyer beware.

The National Institute on Aging offers quite a bit of information and pamphlets on inspections, types of facilities to consider and services provided. AARP also provides information on care and how to evaluate it. And don't forget, if the person is frail and has many medical problems, they require much more care and medical services in addition to care being given to provisions for advanced care directives specific to that state, in case it is needed. Here's a good question for the nursing home: Who is the medical director and is he/she on site all of the time or do they just stop in weekly? Some homes employ medical residents with little experience in treating a geriatric case load.

New rules and training are becoming evermore necessary to keep up with technology and to help staff meet state standards. California appears to be in the forefront of the action in this one.  Too many residences employ aides with little training in terms of psychiatric disorders of the residents which can complicate care significantly, especially where medications are concerned. Even prescription medications for medical conditions can bring on unexpected psychiatric symptoms.

Staff needs to recognize a reaction when it happens and be prepared to get appropriate assistance.  Not recognizing this condition can cause prescribing of inappropriate psychiatric medication which, in turns, begins a cycle of iatrogenic illness and, in some cases, death.  Guidelines cautioning prescribers against the use of psychiatric medications in the elderly are constantly being updated and staff needs to be aware of this. Where are the training certificates for staff displayed and can you see them?

Consideration can also be given to engaging the services of an eldercare provider who knows the ins and outs of the various systems and insurance reimbursement rates. They can also help with the types of legal issues that may arise and help to put plans in place for most eventualities. It's always hopeful when you have experienced people helping you and none of us comes to this with very much knowledge. In fact, most of us will learn, by trial and error, what is possible and what is most frustrating.

When do you begin to plan? What would be the problem with beginning right now? No one knows what tomorrow holds and having plans in place can be very reassuring in an emergency.

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