If you know anything about me, you know that I’m all about living life to the fullest. Many of my blog posts have been about children because caring for children and being in their lives has been a very big part of my life. Make no mistake, however. I care just as much about the later years of life as I do the earliest and feel that wonderment and whimsy need to encompass the lives of every individual regardless of what stage they may be at in their life’s journey. Here’s a little nugget of info about me… I spent most of the years of my early adult life working in retirement homes or, for the purposes of this post, long-term care facilities. Beginning as a Certified Nursing Assistant (CNA) then as a Restorative Aid (RNA) and finally as an Activities Coordinator, I enjoyed my time and the lessons learned working in these capacities as I earned my undergraduate degrees. Why am I telling you all this? Well, I feel that my afore-mentioned experience, in addition to my education as an MSW lend themselves well to the below blog post.
“Livin’ It Up Long-Term”
For many of todays individuals and families in the United States the idea of placing a loved one in a long-term care facility can be an overwhelming reality, riddled with emotion and anxiety. Twelve years ago, this reality of placing a family member into one such facility was an unwelcome necessity for my own family. Having been there, I know some of the pain and other emotions associated with such an overwhelming decision. To alleviate some related anxiety, allow me to lean on some of my own experience and training (insider knowledge, if you will) for some tips to add to your arsenal when attempting to take this sometimes, all consuming, step.
Just to clarify, long-term care facilities differ from convalescent homes in that convalescent care involves recovering from an illness or an operation whereas long-term care facilities provide ongoing care with skilled nursing and other services for individuals (often the elderly) needing such resources. Maybe it’s my experience, or maybe it’s the way I’m wired, but I look for services provided in a long-term care facility to answer the quality of life question. What type of quality of life is the given facility able to provide for the resident? According to the National Association of Social Workers (NASW) “a resident is defined as the recipient of care who resides in a long-term care facility.”(NASW, 2010).
To best answer this question, one must have a clear understanding of the level, and nature, of the care and resources the resident needs. Many long-term care facilities provide differing levels of care based on level of need. Some facilities provide what is called “independent living” where meals are provided, laundry services or facilities are available and residents are able to enjoy regular apartment living in a retirement home setting.
Assisted Living is often the next level of care needed. As an example, Volunteers of America describes its Assisted Living Program as “designed to help residents remain in their apartment homes and independent for as long as possible. These programs provide participants with around-the-clock supervision by nursing and other professional staff, as well as assistance with “Activities of Daily Living” (ADLs) provided by universal caregivers onsite”(www.voamn.org).
The next level of care would be provided in a skilled nursing department. “Nursing homes provide what is called custodial care, including getting in and out of bed, and providing assistance with feeding, bathing and dressing. However, nursing homes differ from other senior housing facilities in that they also provide a high level of medical care. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care is available on site, usually 24 hours a day” (www.helpguide.org).
There is a history of concern regarding quality of nursing care provided in skilled nursing facilities. I am no expert and this is just an opinion, but having been a Nursing Assistant, I recommend a mid-morning or mid-afternoon visit to really gain a good understanding of day-to-day living within a skilled nursing facility. Why these times? Allow me to give you a briefing of a nursing resident’s day. From the moment the day-shift goes on duty, they are 100% focused on the task of getting every resident ready for breakfast, which is usually around 8 or 8:30AM. Residents then usually want to rest for about an hour after that. Lunch is usually around noon. After lunch, residents usually want to nap. This is also usually around shift-change. After dinner, most residents want to go to bed. The question of quality of care can be answered when visiting during lulls between the time they get up from their rest and lunch or dinner.
Note About Dementia Care: There are also some facilities that are capable of providing dementia care, but some that are ill-equipped for providing adequate supervision and safety. For this reason, many long-term care facilities have plans in how they go about referring and transferring residents needing dementia care to facilities more capable of meeting their needs. I would ask about this, even if dementia is not relevant at the time.
To best determine the level of care that is needed, I recommend joining the resident in creating a multidisciplinary team. Included on such a team, should be a social worker, the resident’s physician, any other medical professionals providing care and other members of the resident’s close-knit community who will allow for the planning of optimal quality of life for that individual like a pastor, a close friend who will visit regularly, etc.
Talking with the social worker at the long-term care facility will help you gain an understanding of the types of services provided at the facility. According to NASW “a social worker has, at minimum, a bachelor’s degree from an accredited school or program of social work; has two years of post graduate experience in long-term care or related programs; and meets equivalent state requirements for social work practice, or, in jurisdictions not having such legal regulation, holds certification or credentialing from the National Association of Social Workers. In no instance shall a social worker have less than a baccalaureate degree from an accredited school or program of social work.”(NASW 2010). These individuals can also help you build a map of the resident’s support network, including contact information and can help the resident become engaged in services provided by the facility.
In addition to identifying a knowledgeable social worker at a long-term facility, I also recommend that you and the resident ask about the following services…
Does the facility have an exercise facility with state-of-the art equipment and an accredited exercise therapist who is readily available to instruct residents in how to use the equipment given their specific physical limitations? Is there a movement therapy class provided on a daily basis? What are the supervision and safety procedures regarding the gym facility and all gym apparatus?
Many residents of long-term care facilities have been recommended by their doctors for physical therapy. Physical therapists in these types of facilities often train and directly supervise restorative aids that provide the mobility therapy residents need to gain optimal independence. “When rehabilitation releases a resident with continuing therapy needs to nursing, that resident should be cared for by the best restorative-trained nursing staff, usually the RNAs… Therapy should be involved in resident assessment, determination of restorative need (including orthotics), training nursing staff, identifying feeding program candidates, etc.” (Bonn, 1997).
Asking pertinent questions about the number of physical therapists who are on-sight, what types of training restorative aids receive and level of supervision these aids are provided can be key in deciding if the therapeutic needs of the resident are going to be met. To get an even better understanding of the quality of restorative therapy provided, you may want to visit during the weekend. Again, just an opinion, but a true test of a consistent therapy program can be seen when most office staff are out of the office until Monday! I also recommend reading (or at least skimming!) the Department of Health and Human Services, Office of Inspector General August 1999 report titled “Physical and Occupational Therapy in Nursing Homes. A Medical Necessity at http://oig.hhs.gov/oei/reports.
In North America, food is a very important part of our everyday life. Why should that change based on the level of care we require? When asking about different services provided within a given facility, I would ask if the facility has a registered dietitian. I would also ask how the dietician goes about menu planning when given specific dietary guidelines by a resident’s medical team. Further, I would ask how this crucial information is communicated to the staff serving meals to every resident in every level of care provided within the facility. I also recommend visiting www.seniorindian.com for current elderly dietary information.
This is a subject very near and dear to my heart and I’ll tell you why. When I was earning my Nursing Assistant certification, my classmates and I were assigned a given number of residents within an assisted living and skilled nursing facility. What struck me as wrong then still bothers me now. For the entire time we were there, the only avenue of entertainment for the residents at that facility was either watching television or sitting in the halls. I was relieved to find that not all facilities are the same. I have had the pleasure to work at wonderful facilities since then that support engaging horticulture programs, intergenerational programs, music programs and, my personal favorite, “Eden Alternative”. To learn about the “Ten Key Principles of Eden Alternative” and about this wonderful program, I recommend visiting www.edenalt.org.
There are a million and one things to consider when looking at long-term care facilities. If you are facing making tough decisions regarding the ongoing care of a loved one, these are just a few ideas to help you along the way. Allow the driving force of your decision-making be the question of how best to provide the most optimal quality of life given the specific needs of the individual.
<http://www.BNET.com>. Bonn, K.L., April, 1997, Path: FindArticles/Health/Nursing Homes/April, 1997.
<http://www.socialworkers.org>. National Association of Social Workers, 2010, Path: Standards for Social Work Services in Long-Term Care Facilities.
<http://www.voamn.org>. Path: Assisted Living Programs.
http://www.helpguide.org. Path: Elder/nursing homes/skilled nursing/facilities.