elder-helper

FAQ's

"Why are so many seniors afraid to move into a nursing home?" - There are several reasons why some seniors
dread the day they move into a "home."

1. Loss of independence = Living by someone else's schedule is a huge change. For an elderly person who has lived their whole
life independently to be told what time to wake up, time to go to sleep, time to eat, when they may use the bathroom, etc. is a
nightmare scenario. They took their medication when they wanted to and now the medication is dispense by a nurse on the
nurse's schedule. Even over the counter medicine, eye drops, etc. Even if they are physically able to move about, they must live
by the rules of the facility.

2. Separation from friends and family = the nursing home may be miles from their previous home making it difficult for friends and
family to visit. The thought that they may never visit again is realistic as it does happen to some. I'm sure they have heard other
people their age mention this.

3. The food = Nursing homes are famous for poor food quality. Virtually nothing is fried, it is prepared in mass quantity and
usually lacks spice and variety. If you are assessed with a swallowing problem, your food may be mechanically altered. All
pureed food and fluids with thickener added at every meal is not very appetizing. Have you ever tried to enjoy a cup of coffee
with a spoon? Food served cold, eating in a dining area or room with strangers, lack of choice, pureed food; these are all real
reasons to want to avoid living in a home.

4. Myth that this means they will die soon = this is unfortunate but many elderly people still believe this. Nursing homes have
greatly improved just in the last 40 years. Some people even choose to retire in them. Not everyone is forced to live there as a
last resort. While it is true some people do enter a nursing home at the end of their life, not everyone who is admitted is expected
to die soon. If I had a nickel every time I heard a potential nursing home resident say, "Oh, this is where you go to die." I would
be a millionaire. The thought of spending your last days in a nursing home can be depressing. Just visiting a home can be
depressing. It helps to remember that the people that live there are being cared for and the staff that work there do so by choice,
because they love what they do.

5. Cost = Nursing homes are VERY expensive places to live if you do not have Medicaid insurance. People who pay with their
own funds will see their money vanish in no time. Room and board can range from $130-$500 per day based on geographic
location, private room vs. semi-private or ward, etc. Some medications are not covered by Medicare part D or private insurance
and must be paid by the resident.

6. Lack of privacy = Sharing a room with a stranger, being cared for by a stranger (dressed, bathed, toileted) and just living in a
facility promote a lack of privacy. Room and bathroom doors in nursing homes do not generally have locks for safety reasons.
The most privacy that you could expect will be the privacy curtain around your bed. Staff have legitimate reasons to enter your
room 24 hours a day to perform their jobs. Housekeepers, nurses, nurse aides, therapist, doctors, maintenance staff, social
workers, dieticians, activity managers, clergy, etc.

7. Lack of freedom = The inability to attend your own church, go on vacation, visit your personal barber or beautician, eat at
your favorite restaurant, drive a car, pay your bills or even go for a walk outside. All of these may be restricted or taken away.

8. Feelings of helplessness = Their debilities (inability to walk alone for example) are made obvious when others are required to
provide assistance for activities of daily living i.e. dressing, toileting, walking, personal hygiene, bathing, eating, mobility, etc. To
have a 19 year old girl tell you, "You can't" or "Not now" can invoke tremendous feelings of helplessness.

9. Feelings of hopelessness = some elderly people may think that placement into a home means their disease is progressing
(Parkinson's, Alzheimer's) and that they are no longer a useful member of society. They may feel, "this is the end of the road" or
"I will only get worse now that I'm here." When they feel they can't do for themselves what they once did and that their age or
disease process is nearing the end, feelings of hopelessness are common.

10. Adding insult to injury = If they lost driving privileges, a spouse, ability to walk, etc. this just adds more humiliation. Some
people are placed into a home after an injury, the loss of their spouse who was their care taker or due to their inability to safely
care for themselves. These losses plus the idea of living in a nursing home create the feeling that someone is adding insult to injury
or "kicking me when I'm down."

"Why do Nursing homes claim to be "restraint fee" yet when I visit, I see restraints being used?" - This is a common
occurrence. A restraint is defined as any object or drug that restricts a person's freedom of movement. A resident need not be
able to walk or transfer in and out of bed for a restraint to be considered a restraint. If a resident is able to lean, reach, stand, roll,
etc. and you restrict this movement, then you are restraining them. There are exceptions to the rule. The most common one being
that the device is used for safer and more comfortable positioning. If the nursing home can prove through documentation that the
restraint is being used for some other purpose, then it is no longer considered a restraint, even if the nursing home states that they
are a "restraint free" facility. Another exception is if the resident can remove the device when asked. If this is true, it is not
considered a restraint. Restraints require a lot of assessment and documentation so they are used sparingly. The most common
restraint that visitors see and may be bothered by are the seatbelt type of restraint that are usually used in wheelchairs. The 2
most common being the "self-releasing" and the "non-self releasing". The non-self releasing kind can never be considered not a
restraint as they attach underneath the wheelchair and are only removed by staff, which also means they are used the least. Other
restraints are vests, leather cuffs attached to the hands and feet and mittens. Some states consider bed side rails, beds placed
against a wall, recliners, etc. as restraints as they restrict movement. Restraints should never be used to control behavior or to
prevent wandering. Often, some families will request restraints for unusual reasons. "My mom calls us 15 times a day, can't you
restrain her?" "My grandmother fell out of bed and almost got hurt, can't you just tie her down? She might break a bone!"
Restraints are used as a last resort (or should be) because they are considered dangerous. Residents that are restrained are at
higher risk to develop bed sores, lose weight, have increased behaviors and have physical injuries due to falling from aggravation
of attempting to remove the restraint. State inspectors actually prefer that a resident fall and risk injury than be restrained to avoid
falling. Due to past abuse of restraint use, government regulators are very leery of restraint use.

"Do nursing home nurses get the same education and training as hospital nurses?" - This is a common myth, that
student nurses specialize in certain health care fields while in school. People who have never been to college will often say, "I'm
going to school to be a surgical nurse." You can't go to school to be a surgical nurse, OB nurse or ER nurse. You can only go to
college to be a nurse. You specialize by being hired to work in a specific field and then receive on the job training for that field.
Basically, by the time you graduate from nursing school you are qualified to work in any field. Some nurses pursue advanced
degrees and then specialize in one area such as business management, geriatrics, occupational health, etc. Nurse practitioners are
one such example. Nurse midwifes are another.

"Why do nursing home staff often complain of "working short staffed?" - There are situations when the staffing levels that
are scheduled for a particular day, shift or unit are less than expected. This can happen for a variety of reasons but is usually due
to someone calling in sick or because a staffer was fired and hasn't been replaced yet. Good nursing homes will do whatever they
can to replace the missing staffer but all to often the staff are forced to take on extra duties that day and work "short staffed." This
is usually a temporary problem. It is a source of frustration for the front line staff and they can be quite verbal about it.

"Why do nursing homes have so many restrictive rules?" - The nursing home industry is one of the most heavily regulated
industries in the United States. There are hundreds of federal regulations (commonly called f-tags) for skilled nursing homes that
they must abide by if they receive Medicare or Medicaid funds. In addition to federal and state regulations, they also are under
the jurisdiction of the local or county fire marshal. Nursing homes can expect annual inspections from the state inspectors and the
fire marshal. Federal inspections or chart audits can occur every 5 years, give or take a few years based on their billing practices.
(if the nursing home makes frequent billing errors or adjustments, they can expect more frequent federal audits) Nursing homes
have more regulations than hospitals, clinics, food processing plants or restaurants. The reason they are so heavily regulated is
because the residents don't just receive treatment there (like a hospital) they live there, it is their home. Also, the elderly and
disabled are more at risk for neglect and abuse than any other group. Most experts agree that the only industry that is regulated
more than nursing homes is nuclear power (Wikipedia.com). The reason is the terrible history of elder care, or lack of it, in the
United States for the past 200 years. See my link, nursing home history. There may be a lot of criticism regarding the quality of
care in nursing homes but compared to homes in other countries, the majority of nursing home residents in the US receive quality
care from caring staff members.

"Why are the majority of nursing home residents white or Caucasian?" Why are there so few minority residents? - This is
a great question that I hear often. The main reason is culture differences and the second lesser reason is money. If the population
of the US is 51% minority and 49% white, then why are 99% of nursing homes residents white? In my experience, I have only
known 2 Asian residents and 3 Hispanic but 1000's of Caucasians. I suppose you could pose this question to google.com and
receive 100 different opinions on this question, but I will give you my opinion based on 15 years of experience. On average (I will
use this phrase a lot to avoid offending too many people), minority groups have closer knit families and better support systems
than do white people. Asians, Hispanics and African Americans are typically very family oriented and provide for their own as
much as possible. I'm not saying that white people don't, I am white myself and my family is large and quite close. But on
average, minority groups prefer to take care of their own. I'll give you an example. On average, if an elderly woman, who is a
minority, breaks her hip and is hospitalized, she can count on her family providing her care post hospitalization rather than a
nursing home. Her family is more likely to be available and able to assist her with her care. Another aspect of culture differences
is trust. Nursing homes are perceived as being owned and managed by white people. This is basically true most of the time.
Some minority people are a little nervous having their loved one cared for by a facility that may not know their needs very well
and may not care for their quality of life as much as their own family would. This is not necessarily racism but more self
preservation. History is not on the side of nursing homes in general or white people of authority and power. There are many
examples in US history of powerful people suppressing and taking advantage of less powerful people. People have good
memories and elderly minorities pass on this knowledge of history to their children. Just go to google.com and search "Japanese
internment camps" or "Tuskegee airmen" for an example. The second lesser issue is money. Some homes only allow private pay
residents to live there long term. This is a small percentage but they exist. At an average room rate of $240/day, most people,
minority or not, would rather live at home. Unfortunately for white people, they may have come from small families or their
children have moved out of state, etc. Their opportunities to live with family can be worse than if they were from a minority
group. (Anyone who qualifies for Medicaid may enter a home that accepts Medicaid as payment and live there for life if a bed is
available.) Other lesser issues may be that the food is not culturally satisfying, not wanting to share a room with a stranger, being
cared for by staff that doesn't speak your language and activities that are not geared toward your culture.