Good! Maybe She'll Wake Up! Part 2 of 3

Yesterday on this blog I ended by talking about the essential role as “advocate” for anyone who has some responsibility for an elder in a nursing home through some appointed position or because of the bonds of relationship. I promised to answer the question of where one goes to gain that knowledge necessary to be an effective advocate.

I offer the following as a partial fulfillment of that promise. My day gave me the opportunity to address the concept of advocacy in a way I wish I did not have to do. My sister-in-law has found herself in a nursing home following a fall which resulted in a fractured hip and subsequent surgery. That fall happened over a month ago. My sister-in-law is in a kind of limbo because she needs rehabilitative therapy, but that cannot be provided until her surgeon says it is okay to put weight on the affected leg.

So her three adult and devoted children are looking for a nursing home that is closer to them rather than to the surgeon – one that will provide the best rehab therapy, provide the best services for their mother who needs increased support in her daily life, one that will honor her dignity, her individuality, her needs and her preferences. The three of them are visiting nursing homes closer to their home. My nephew called today with that news and with information about a couple they were looking at. I offered to provide some things they should look for or be aware of as they visit these nursing homes.

I include them here as issues that any good advocate should be cognizant of for any nursing home resident for whom they hold some sort of responsibility through appointment or the bonds of love and loyalty.

I told my nieces and nephew to look for and be aware of these things. And this is just an initial list:

1. Are there ‘slumpers’? These are elders who slump in their wheelchair, sleeping or totally unaware and unengaged in their environment. BAD. They have escaped an intolerable environment and gone to their own inner world. (Not my analysis. Read the book OLD AGE IN A NEW AGE by Beth Baker.)

2. Are there elders lined up in wheelchairs or circling the nurses’ station? BAD. It means there is no meaningful engagement for individual residents.

3. What is the tone of the relationship evident between the staff and the residents? Does the staff even see the resident? Does she meet their gaze, address them? Is it patronizing or is it genuine, expressing a sense of mutuality in their relationship?

4. What is the tone of the caregivers (CNAs and licensed nurses) when they are interacting with the residents? Is it person-to-person or is it more impersonal, task oriented, and schedule-bent?

5. If you are able to be there at lunch time you can observe how the serving staff and the kitchen staff interact with the residents.

6. Are residents “parked” in the dining room for a long time (30 minutes is a long time) waiting for the scheduled meal time to take place?

7. Does everyone wear a bib? DON’T LET THEM DO THIS TO YOUR MOTHER! As your instinct will tell you, this is a dignity issue. She has the right to say no. Or better yet, Hell no.

8. Is there any conversation at the individual tables or is there a sense of disengagement or low level depression expressed in utter silence and isolation?

9. How is the food served? Is it appealing in color and arrangement on the plate? Would you consider the style of the meal service more like a restaurant, a home or a hospital?

If these events or the ambiance within the nursing home are present, the residents need good advocates who will address these issues. Knowledge of the regulations, called the "Minimum Standards of Care" are important. But there are some things that are so obvious that when we see them we know they are not right. In my beginning days within the traditional nursing home culture, I was troubled by much of what I saw. Because I was totally ignorant of 'the system' I thought, "I guess that's just the way it is." I learned soon that the words of an early mentor rang true and still ring true: "If you think it is not right, it probably isn't. Never get used to poor care."