© Imelda Maurer, cdp September 29, 2009
The following is taken from a blog: http://www.mybetternursinghome.blogspot.com/ and was posted on September 10, 2009. The blogger is a psychotherapist.
What struck me about these topics shared with a therapist is that these topics are the stuff of ordinary life. Do nursing home residents need a therapist because they have no one else to talk with? Is there any intent anywhere within the nursing home organizational structure to create community? Carter Catlett Williams, noted advocate and social worker, tells us in her book “The Red Book”: relationships are not only the heart of long-term care, they are the heart of life. And life ought to continue, wherever we live.
Directly from the article:
Have you ever wondered what nursing home residents discuss with their shrinks behind closed doors? Here I solve the mystery, revealing the types of conversations I've had with residents over the years.
-- Feelings about leaving home and being ill.
-- Issues around loss of control and being dependent on other people, with a focus on gaining control over what they can.
-- Ways to work with the staff to get their needs met.
-- Roommates, and how to cope with them.
-- The reaction of family members to their placement and illness, including ways to help adult children understand that Mom or Dad can't be there for them in the same way because Mom or Dad is sick and needs help themselves, and ways to help adult children understand that just because Mom or Dad is sick, it doesn't mean they can't go off campus every once in a while.
-- Issues around dying, including concerns about the afterlife and worries about how the family will get along without them.
-- Ways of making the most of the time they have left, including getting more involved in nursing home activities and the life of the nursing home community.
-- Their lives, choices, accomplishments, and regrets.
-- Stuff that interests them that they don't get to talk about with anyone else, just to be their regular selves again instead of being a patient.
Personal P.S.
Words reflect our concepts and form our concepts. In the case of this author, the use of the word "patient" to describe elders living in nursing homes. Defining a person as a patient, defines him/her solely in terms of physical illness or limitation. If physical needs are the only concerns being dealt with in a nursing home, it will be a dreadful experience for the resident and for the staff.
Monday, September 28, 2009
An analysis of the Five Star Nursing Home Rating System
© Imelda Maurer, cdp September 28, 2009
When a nursing home touts its five-star rating, it may mean something positive – or not. A five star rating may indicate that the nursing home really is a place where the residents are provided good holistic care, live in a home environment, experience person-centered care, make choices about significant issues in their day and in their care – when they get up and when they go to bed, when and how they are bathed, etc. -- and where staff are empowered and happy in their work.
That same five star rating may not reflect the reality of perhaps, institutionalization with its depersonalization of residents and staff, high turnover with its implications for continuity of good care, poor staff morale with implications for residents, etc.
The government website itself states the limitations of the rating system. (http://www.medicare.gov/NHCompare/static/tabHelp.asp?activeTab=6) noting that the information is for one point in time (snap shot ), that it is self-reported and that the Quality Measures and Quality Indicators measure only a few of the many aspects of care.
An article in today’s Los Angeles Times states, “Although the Centers for Medicare and Medicaid Services created a website called Nursing Home Compare in 1998 . . . the site's usefulness has been criticized since its inception. “
The entire article can be read at: http://www.latimes.com/features/health/la-he-nursing-homes28-2009sep28,0,5321203.story
Nationally, this article reports, 40% of persons over the age of 65 can expect to spend some time in a nursing home. Our own self-interest pushes us to learn more about these issues and to advocate for those living in nursing homes and --- for ourselves.
When a nursing home touts its five-star rating, it may mean something positive – or not. A five star rating may indicate that the nursing home really is a place where the residents are provided good holistic care, live in a home environment, experience person-centered care, make choices about significant issues in their day and in their care – when they get up and when they go to bed, when and how they are bathed, etc. -- and where staff are empowered and happy in their work.
That same five star rating may not reflect the reality of perhaps, institutionalization with its depersonalization of residents and staff, high turnover with its implications for continuity of good care, poor staff morale with implications for residents, etc.
The government website itself states the limitations of the rating system. (http://www.medicare.gov/NHCompare/static/tabHelp.asp?activeTab=6) noting that the information is for one point in time (snap shot ), that it is self-reported and that the Quality Measures and Quality Indicators measure only a few of the many aspects of care.
An article in today’s Los Angeles Times states, “Although the Centers for Medicare and Medicaid Services created a website called Nursing Home Compare in 1998 . . . the site's usefulness has been criticized since its inception. “
The entire article can be read at: http://www.latimes.com/features/health/la-he-nursing-homes28-2009sep28,0,5321203.story
Nationally, this article reports, 40% of persons over the age of 65 can expect to spend some time in a nursing home. Our own self-interest pushes us to learn more about these issues and to advocate for those living in nursing homes and --- for ourselves.
Friday, September 25, 2009
Drugs and Dementia Care: Unnecessary, Ineffective and Costly
© Imelda Maurer, cdp September 25, 2009
Isn’t it amazing how often compassion and common sense aren’t validated until there is an official study or series of studies that address the issue involved.
Within the past year or so there has been one news report after another indicating the prevalence of nursing home residents with dementia being prescribed anti-psychotics. This exists in the face of Black Box Warnings by the FDA indicating that elderly residents with dementia are at an increased risk of death when certain anti-psychotics (Seroquel is a big one) are part of the drug regimen.
Recent Research
A study in Australia was reported in the September issue of Caring for the Ages. The residents in that study all had progressive dementia “with persistent behaviors that made it difficult for staff to care for them.” One group of caregivers was provided two-day training in person-centered care with dementia residents. The residents were tested with scientifically valid check lists to indicate their level of agitation at the beginning of the study and then at four and at eight months after the beginning of the study.
Results
After four months, those residents with dementia receiving “usual care” showed an increase of agitation of almost 9 points on the scales that were used. By contrast, those residents who were cared for in the person-centered care model, showed a decrease of 9 points on the same agitation scale.
So there’s the scientific proof --- medical professionals refer to it as “evidence-based” approach to care –
Drugs prescribed for patients with dementia are not always unnecessary. But it is clear that reaching for a prescription pad the moment a symptom is noted is not good medicine even though it is a prevalent practice in too many nursing homes. Dr. Al Power is a geriatrician and certified medical director who practiced at St. John’s Home in Rochester, NY. He has a book that will be published in the early part of 2010 on this very topic of non-pharmacological approach to dementia care. In his own nursing home practice, Dr. Power told me, an average of 6% of his dementia patients at St. John’s were on anti-psychotics. That’s a wonderful contrast to the national average among nursing home residents with dementia of 28%
The call to liberate our elders
When this evidence-based, person-centered approach is used, these elderly residents have been set free from the shackles of unnecessary drugs. Let the work go on!
Isn’t it amazing how often compassion and common sense aren’t validated until there is an official study or series of studies that address the issue involved.
Within the past year or so there has been one news report after another indicating the prevalence of nursing home residents with dementia being prescribed anti-psychotics. This exists in the face of Black Box Warnings by the FDA indicating that elderly residents with dementia are at an increased risk of death when certain anti-psychotics (Seroquel is a big one) are part of the drug regimen.
Recent Research
A study in Australia was reported in the September issue of Caring for the Ages. The residents in that study all had progressive dementia “with persistent behaviors that made it difficult for staff to care for them.” One group of caregivers was provided two-day training in person-centered care with dementia residents. The residents were tested with scientifically valid check lists to indicate their level of agitation at the beginning of the study and then at four and at eight months after the beginning of the study.
Results
After four months, those residents with dementia receiving “usual care” showed an increase of agitation of almost 9 points on the scales that were used. By contrast, those residents who were cared for in the person-centered care model, showed a decrease of 9 points on the same agitation scale.
So there’s the scientific proof --- medical professionals refer to it as “evidence-based” approach to care –
Drugs prescribed for patients with dementia are not always unnecessary. But it is clear that reaching for a prescription pad the moment a symptom is noted is not good medicine even though it is a prevalent practice in too many nursing homes. Dr. Al Power is a geriatrician and certified medical director who practiced at St. John’s Home in Rochester, NY. He has a book that will be published in the early part of 2010 on this very topic of non-pharmacological approach to dementia care. In his own nursing home practice, Dr. Power told me, an average of 6% of his dementia patients at St. John’s were on anti-psychotics. That’s a wonderful contrast to the national average among nursing home residents with dementia of 28%
The call to liberate our elders
When this evidence-based, person-centered approach is used, these elderly residents have been set free from the shackles of unnecessary drugs. Let the work go on!
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