Warehousing Old People

Reading LawDog’s latest up date on his Nana, I was reminded of my distaste toward nursing homes. I challenge you to find an EMT anywhere, or for that matter, anyone working in an Emergency Department, who does not rank nursing home care as being only one slight step up from no care at all.

I have seen nurses busily bathing a dead lady at a nursing home, blissfully unaware that the poor lady had expired. I can think of one nursing home in particular where one can see people shuffling around with vacant stares, food caked around their mouths, with feces and urine stains on their clothing…and that’s just the nursing staff I’m talking about.

The reasons for this are many. First of all, nursing homes do not attract the best and the brightest nurses. They get the incompetent, the lazy and uninspired. Good nurses simply do not want to work in nursing homes. If a good nurse DOES go to work in a nursing home, he or she will soon be broken by a system with too many patients and not enough staff, ridiculously low pay scales and backbreaking labor, only to eventually become…a lazy, uninspired and burnt-out nurse. Only in the nursing home industry is 40:1 considered an acceptable patient to caregiver ratio.

That is not to say however, that there are no good nurses to be found in nursing homes. Occasionally you find one who genuinely cares for elderly people and finds their life’s calling in ministering to them. My mother was one. She was a talented nursing student. She could have had her pick of jobs anywhere. Yet she told us one day that the statue of Jesus outside the nursing home had told her that she should devote her career to caring for the elderly. And that was that. At the time, we all thought mom was a bit…tetched, but there was no denying she was good at what she did. The point is, she and nurses like her stand out from the rest of their colleagues. They are a rare breed indeed.

Now if you’re a nursing home nurse and you’re offended by reading this, you will find no apology here. If you don’t feel I’ve described you, then perhaps you’re one of that rare breed of which I spoke. But I’ll betcha your best pair of orthopedic stockings that the description matches the majority of your colleagues.

Don’t get me wrong – I’ll question no one’s decision to put their loved one in a nursing home. It’s a difficult and painful decision to make. It is however, worth noting that my mother swore to haunt us after her death if we ever put her in a nursing home.

If you are ever faced with the Decision No Child Ever Wants To Make concerning their parents, here are a few suggestions.

1. Nice facilities do not equate to good care. Good staff does. You will be wooed with promises of arts and crafts and an in-house movie theater and delicious meals. They mean nothing if Grandma is bed-bound with a feeding tube. In my experience, the primary difference between the fancier nursing homes and their older, more run-down competitors is that the patients fall and break their hips on carpet rather than linoleum. The best nursing home I’ve ever experienced had the oldest facilities and the poorest patients. 80% of them had Medicaid only, but the patients were treated with respect and TLC.

2. Do not be fooled by the name. “Oaklawn Manor” or “Shady Oaks” both have a rather pastoral ring, but they could hardly call it “Chateau de Staphyloccocus Aureus” or “Our Lady of The Clogged Feeding Tubes” or “Bedsore Village,” could they? Even if it does accurately reflect the care your grandparents will receive.

3. Do your research. What is the patient to caregiver ratio? How many nurses and aides are on duty at one time? How do their wages compare to the staff at other nursing homes? Show me a nursing home that employs more nurse’s aides and pays their staff substantially more than the other ones in the area, and I’ll lay odds it’s the best one around, regardless of the state of their facilities.

4. Get to know the staff, particularly the aides. Not so much the nurses, but the aides. They may have a questionable command of the English language and barely hold a GED, but I guarantee they know more about Granny than the nurses do. In a typical 3pm-11pm shift at a nursing home, the nurse makes a medication pass at 4 pm and 8 pm. By the time they set up their cart, give all the meds and do their charting, they have laid eyes on your loved one maybe a grand total of 20 minutes in an 8 hour shift. This is not the nurse’s fault – it is simply the nature of the beast. So it is little wonder that they either A) panic and send your loved one to the hospital at the slightest sign of illness, or B) miss the problem entirely until it is too late.

EMTs, take note of this next time you are tempted to talk smack about a nursing home nurse who was clueless about her patient’s condition. There’s a reason.

5. Show up often, and unexpectedly. Drop off a fruit basket for the staff if things are up to snuff. Raise Holy Hell if they are not. Pitch a fit. Threaten to sue. Threaten to turn them in to the state regulatory agency. Take your complaint to the ombudsmen. Whatever it takes. The point is, the staff should quake in fear and fall all over themselves to make you happy, and they should never know when you’ll show up. That way, they’ll neglect everyone else’s family member to lavish TLC upon yours. It ain’t fair and it ain’t right, but that’s the way it works.

6. Finally, take an active role in their care. Don’t abdicate the responsibility of caring for your loved one simply because someone else is being paid to do it. Educate yourself about their medical care. No one should EVER become dehydrated with a gastric feeding tube in place, yet I see it all the time. Bed bound patients should be turned every 2 hours to help lessen the chance of bedsores. Urinary catheters should be changed regularly, not just when your loved one is sent to the hospital with an infection. Believe me, if nursing homes ever learned to do proper catheter care and wound care, the hospital industry would collapse within a year from lack of patients.

7. People die of old age every day. They die because their bodies have worn out. They die from complications resulting from shoddy care. And they also die because they feel they’ve been forgotten and they Give Up. Don’t let this be the reason it happens to your loved one.

Now on to lighter fare…

I was flattered to notice on Tamara’s blog a new link to my scribblings. Her tagline says it all – Books, Bikes and Boomsticks. Sigh…

I think I’m in love. Now I ask you – why can’t those be the interview subjects in the Miss America pageant?

“W
ell Bob, I’d strive for world peace…through fire superiority of course. And I’d make it an essential part of my platform to add the faces of John M. Browning and Bill Ruger to Mount Rushmore. Maybe Jack O’Connor and Jeff Cooper, too. And I’d lobby for Winchester to bring back the pre-1964 Model 70…”

That would be MY Miss America right there…

Until next time…

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