The idea of nursing homes may strike fear in the hearts of loved ones, caregivers, and potential nursing home residents thanks to horror stories that may appear in the media. Often, the stories evolve from lack of knowledge and lead to many misconceptions about nursing homes. Of course, not all stories are unfounded, which makes it extremely important to find the best nursing home for your loved one. Here, I detail some common misconceptions I've encountered in my 30 years as a registered trained nurse (RGN). I've also undertaken further training in the fields of vulnerable adults, abuse, health and safety, moving and handling, challenging behavior, and pain. I've completed a course in 'Training for Trainers' to teach me how to train all staff in the understanding and caring for patients with Alzheimer's.
Anxiety Before Admittance
Families have said to me that their loved ones are afraid of going into a nursing home because they fear the nursing home is just a place to die; one specific comment I often heard was:"If I'm put into a nursing home the only way I'll get out is in a box."There is a huge misconception that nursing homes are dumping grounds for the elderly, which is both a cruel and unfair statement. Many patients are only admitted for a short time, often because their medical condition has temporarily worsened and they now need 24-hour care. Other possibilities for short-term admittance include: renovations being done to the patient's house making it unsafe to stay in or their primary caregiver is on vacation or has experienced burnout. Although residents are not always admitted for life, there may come a point where it is dangerous for them to stay at home even under the watchful eye of their family or caregivers. That's when it's essential to move them into a safer environment.
In my experience, families have been concerned about proper medication administration by the staff members. They're worried their loved one will be over sedated night and day. One woman who I spoke with in the past was worried that nursing home nurses over sedated residents to make life easier and quieter for the staff. I explained to her that only the physician could prescribe her mother's medication and nurses or other qualified staff would dispense it according to the prescription and no more. I also explained if her mother became agitated the physician would be informed and would decide if any changes in medication were required. The patient would only be prescribed a sedative if it was absolutely necessary.
Families have expressed to me that they worry their loved one's daily activities will only include eating, sleeping, and using the restroom. Certain elderly residents may not be able to do much more than this depending on their age and health status, but nursing homes usually provide activity therapists who encourage mental and physical stimulation, such as flower arranging, gardening, massage therapy, painting, pet therapy, and day outings (for those physically able to handle the activity). Of course, families are welcome to take their loved one out for the day, too.
Another fear families have expressed is the loss of responsibility for their family member, they assume the nursing home will handle all decision making in regard to the health of the resident. This could not be further from the truth. In a well-run home families work together with the management and staff to ensure the best possible care for their loved one. When a family member is admitted the family details their life history, likes and dislikes, food preferences, allergies, previous occupation, and hobbies. This allows the nurse and activity therapist to complete the patient's care plan based on person-centered care. The family can then discuss how involved they wish to be with future care decisions.
Family members can visit their loved one anytime to make sure s/he is receiving appropriate care. For example, stopping in at meal times allows families toobserve the communication between residents and staff as well as an opportunity to assess meals (to make sure it's appropriate and to the resident's liking and capabilities to eat) and medication administration.. Family members can also chose clothes and personal items for their loved one and, most important, if any major decision has to be made about the care of the resident, the family must be informed and take part in care plans and discussions.
Along with family members worrying about losing responsibility for their loved one, there's the fear that residents may lose their individuality. A good nursing home will use the resident's life history along with PCC-the care plan based on individual care needs of a resident. For example, not everyone wants to get up at 9 am, maybe certain residents prefer to get up at 6 am, have their hair done weekly by a hairdresser, and add blue dye to it. The idea is to keep as close as possible to the resident's normal routine so they'll settle in better to their new surroundings. The care plan must be consistently reviewed and changed, if required, to suit the resident.
A final common misconception I've heard is that certified nursing assistants or novice nurses and foreign staff are unable to communicate effectively with residents. If language barriers or inexperience exist, the head nurse (Sr) takes it into account when creating the weekly work rota, to ensure senior staff members are working alongside foreign or young staff.
Easing the Transition
The best way to resolve any misconception is to visit nursing homes for a tour. The families can meet with the nursing home manager to discuss their loved one's lifestyle and needs and observe how the facility is managed. Use your senses to evaluate the good or bad signs in the home. Is the home decor stimulating to the eye? Is the background music relevant to the era of the residents? Does the home smell of coffee or flowers as opposed to dampness, urine, or even feces? Are there bags of used laundry sitting out all day? When visiting the home for the first time some sample questions you may wish to ask include: Does the home have yearly or intermittent inspections and what grade do they hold? Is there open visiting times? Can the resident be taken out by the family for the day? What extra activities does the home provide?
Improving the Experience
To make sure nursing homes are doing right by their residents, families can always visit unannounced. This visit should confirm what management has told them is being carried out, and should be adequately conducted. . It's not always an easy decision to admit a loved one into a nursing home, so to help ease the transition, families can seek counselling or therapy or even speak with the families of other residents to learn their coping mechanisms. Families may also want to consider finding ways to fill up their day to avoid loneliness, especially if they were the primary caregiver(s) for their loved one in the nursing home.Nursing homes are not meant to be scary places; nursing home residents can lead enriching, valuable lives when family and staff work together. As nurses, it's our job to help quell anxiety and provide the best care possible, which will ultimately eradicate the common misconceptions of nursing homes.
Ann Marie Gallogly is a retired nurse with over 30 years' experience in the dementia/alzheimer's care sector based in Northern Ireland. She's written a book that covers this topic in depth: "Alzheimer's - Dementia: Find the Best Nursing Home with Sister Ann."