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What is 'reasonable' care at assisted-living home?

By STEWART ELLIOTT
Scripps Howard News Service

Published: Tuesday, 05/31/05, The Tennessean

Unable to care for him any longer at home, Bill recently placed his father in a nursing home. Now he wonders if what he is observing is normal care. With no experience, he is groping for answers. What is normal, what should he expect? It is a reasonable question and there are reasonable answers.

His father's needs do not change just because he changed where he lives. A well-managed home endeavors to change the resident's lifestyle as little possible. Whether he wears a shirt and tie or stays in his pajamas all day is up to him. Of necessity, meals are served on schedule, but he may eat in his room or in a dining area. For the sake of mental health, he will be encouraged to eat and associate with the other residents and to get exercise within the limit of his ability. All this is normal. Now check the surroundings.

The air should not "smell like a nursing home."
If it does, then some action is called for. Probably, residents with soiled clothes are not being changed promptly. That is not normal. Dirty floors also are not normal. Your resident is entitled to a clean environment.

Most employees at every nursing home are dedicated to their tasks, but their personalities vary as much as that of the residents or of the general public. The biggest challenge faced by every home today is that of hiring and maintaining a competent staff. Nearly every home is understaffed, at least part of the day. Some are understaffed by choice, but most just can't find enough workers, so understaffing is "normal."

It is amazing to me just how quickly most seniors adjust to their new lifestyle in a nursing home. We are supposed to be less flexible when we get old, but that theory doesn't hold up when you are surrounded by others your age who are going through the same adjustment.
Of course, it is normal to have some problems at first.

Bill should teach his father to use the "call" button without hesitation. Call lights are supposed to be answered within five minutes. More than 10 minutes is not normal. It is normal, however, to be told that everyone is busy and you will have to wait a few minutes. Waiting more than 10 or 15 minutes is not normal — it is poor service, unless there is an emergency in progress. An emergency is when someone falls or suddenly becomes critically ill.

Bill chose a good home for his father. I know the facility by reputation. But even the best are still operated by humans, and none of us is perfect. So we need to let everyone have a little "wiggle room." All of the staff should address his father by name and treat him with respect. When performing a task for him, the staff should give him the full attention he deserves.

The most frequently violated rule is when aides or nurses are doing something for resident "A" but are still talking about "B," or something else, and ignoring their current resident as though he were deaf and speechless, like a potted plant. Nurses have so much on their minds it is hard for them to avoid this. Still, it is not normal for a resident to be addressed in any disrespectful manner.

For their own benefit, residents are encouraged to do as much for themselves as possible. Aides are not servants hired to do our will. They are trained assistants, available to help us with any necessary tasks we can't do alone. It is not normal to give them orders, but rather request assistance with "please" and "thank you." They have a tough assignment and deserve our respect and common courtesy.

The quality of life in any nursing home depends entirely on the quality of management. I am aware that we live in one of the very best homes in Indiana, but the home has no monopoly. Bill found another good one, whether by luck or carefully searching. Regardless, I suggest he drop in unannounced at various times during the week.

The staffers are very human. If they know you always visit on schedule, they will try to have your resident looking his best at that time. Surprise them.

Published: Tuesday, 05/31/05

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