What's Wrong with this Picture?

One of my e-subscriptions is to a quarterly newsletter published by the Missouri Department of Health and Human Services. In their current issue, there is an article with the title, “Missouri Nursing Homes Have Happy Clients, MU Researchers Say”. I have been unable to successfully access the URL listed for the entire article, so I can’t critique the research as such. But so many red flags waved brazenly as I read the article. But my first response when I read the title of the article was WHAT?!!
The whole system of traditional long-term care is sick, dysfunctional and “lethal to both resident and staff” (quote is from Steve Shields, culture change leader). Those deficits are reflected in the newsletter article.

1. Who of us wants to be seen or to be considered a “client” if we are living in a nursing home? Do any of us consider those with whom we live “clients”?
2. The survey may well have been valid and reliable for what it tested, but consider these facts:

a. Residents and family members are usually extremely uninformed about the minimum standards of care in a nursing home. So if the resident sits at the table for 45 minutes before a meal is served, does she or the family even know to complain? If the resident is awakened each morning and prepared for bed each evening at the convenience of the staff, rather than at the time she chooses, does she know her rights are being violated? I could go on and on.

b. For the most part, family members can sense the good will among caregivers. Perhaps that is why they and the resident think life can’t be any better in a nursing home. That’s where hopelessness seeps in.

c. I can’t think of a single family member who would say, “I intentionally put my mom in a third-rate nursing home.” Rather, we so often hear, “Mom’s nursing home is the best one in town.”

d. Jude Rabig, Ph.D. did a fascinating study that I regret has not received more recognition. Rabig interviewed residents of a “good”, traditional nursing home about their perception of their quality of life. The residents rated the nursing home highly. This nursing home undertook new construction, providing the same number of beds but with the architectural environment of households. (Household model, public space and private space – person-directed – transformative culture change – global workers – etc.). Six months after these same residents had moved into the household nursing home, Rabig interviewed them again about their quality of life. It is not surprising that they rated their quality of life as very high. It is quite revealing, however, that from their new home (not homelike, folks, HOME!) they looked back on their life in the “good” traditional nursing home as a very negative experience. “Incarceration” was one term used to describe life in a “good” nursing home before culture change.

So for 90% of Missourians to say that things are good, may well reflect that there is no concept that life can be better in a nursing home. (Oh, how I’d love to talk to the 10% dissident population! Perhaps they are the dreamers who won’t accept the overhead call system, the restraint alarms going off constantly, the deadened “activity” schedule, the uncertainty of never knowing who your caregiver will be today.)

3. Roughly 95 – 97% of the nursing homes in the United States are still run by a schedule that reflects task-first, person-wherever-she-fits-in philosophy. This reality, as horrendous as it is, does not exist because caregivers are selfish or unfeeling. It exists because this is the “system” in which they were trained. It is this lethal system that is responsible for the extremely high turnover in nursing homes, especially among direct-care staff.

One of the researchers is quoted in the article: “Nursing home administrators have worked diligently throughout the past decade to improve the quality of care delivered to residents and to make care settings more homelike.” Undoubtedly, that is true. But two points:

1. As long as the work is to improve a system that is dysfunctional and lethal to all who are touched by it, the energy is misplaced. The system must be turned on its head! Everything must be seen through eyes focused on person-directed values. Every practice and policy must be evaluated in light of the analysis of, ‘how do we do this at home?’

2. The touchstone of life in a nursing home is NOT the care. I wish I could remember the source of this statement that I read during the past week: “How is it that even when the care is superb, nobody wants to go to a nursing home?” Of course clinical standards must be met. But it must be provided through the prism of person-first, not task-first.

The touchstone of life in a nursing home is honoring the individual, being there in service. There’s a world of difference between “caring for” and being “in service”. How do most of us respond if someone says, “I’m going to take care of you.” We don’t want to be taken care of. If we need services, we want those services provided in a dependable, compassionate and competent manner. But “taking care of” reflects a lot of things that are the topic of another post on this blog.

To read the entire article, visit: http://munews.missouri.edu/expert-comment