Authors

  1. Hayen, Don MD
  2. Gafford, Jenni

Article Content

I am a 74-year-old retired physician. It is almost 3 years now since my daughter, who at the time was working in a nursing home, and my wife went to talk to my doctor regarding my changing behavior. After lengthy testing, he told me I had Alzheimer's disease.

 

As I considered the consequences of this devastating news, I found myself reflecting on my many experiences seeing patients in nursing homes. As a dermatologist, I would often be called in to examine a rash or bed-sore caused by sitting or lying too long in one position. Even though I instructed the staff on correcting this problem, I felt little was done about it.

 

Back in the 1970s and 1980s, a nursing home could easily replace a Hollywood movie set of a mental hospital. They were usually shabby and dirty, with smelly wards behind ubiquitous locked doors. Except when staff chased after wandering residents to guide them back to their chair, there was little interaction. Residents sat staring into space, ignoring blaring TVs. If they talked to each other, the comments were disjointed and pointless. They could not process what they heard or, if they did, they could not make an appropriate response.

 

When not doing chores, the staff gathered at nurses' station to visit. When they did interact with residents, it was brief and patronizing. Too often, it was a brusque demand to change behavior.

 

Frequently I would overhear staff members discussing personal issues about residents directly in front of them. It was as if the resident's feelings or privacy did not matter. In my view, because staff assumed that residents had regressed to a child-like state, staff believed residents could not process anything they heard.

 

A NEW PARADIGM

Unfortunately, the kind of facility I just described continues to exist today. Still the scene has changed because investors have found success in providing upscale facilities for the insured and well-to-do. These facilities are beautiful to the point of opulence.

 

One major issue remains, regardless of the upgraded decor and landscaping. If you could be a fly on the wall of many nursing care facilities, you would discover a distinct absence of one vital component. No matter the quality of physical care, the comfortable surroundings, the recreational diversions or the security, the thing missing is a close, loving, caring human presence. The results: What is left of a resident's brain wastes away [horizontal ellipsis] and their soul along with it.

 

My daughter treasured the moments she could sit and visit with her residents, listening to their stories as they repeated them over and over. She liked reading to them or playing a simple game. But doing so got her into trouble. These activities were not in her job description. Yet, as often as possible, she did it anyway and she was always amazed to find that, although dementia residents had lost much to the ravages of Alzheimer's disease, they had not lost their personality, manners, or sense of humor. And, they still remembered much of their childhood, which they loved to share.

 

THE PERFECT NURSING HOME

So, when the time comes for me to enter a dementia unit, what would be my ideal environment? Well, other than cleanliness and comfort, the physical amenities are of little concern. Security is important as is healthy food and professional nursing care. Recreational activities, outdoor facilities, field trips, and the like would add a measure of variety to life. To achieve this, one must recognize that what makes a house, a home, are the people. The "facility" does not care for the residents; the people serving as staff care for the residents.

 

Because my daughter has frontline experience in working in a dementia unit, and a father with Alzheimer's disease, she has a passionate interest in this subject. Together we would like to offer our example of an ideal nursing home for residents with dementia.

 

The nurses' aide is our focal point for change, the person assigned to meet the resident's needs. These employees interact most with residents, yet they are paid least on the staff. The following is a set of points to consider when trying to enhance the relationship between residents and aides.

 

The responsibility for direct resident care should be divided into 2 jobs.

 

1. An aide to do the heavy lifting. Someone who can deal with bed, baths, cleanup, feeding, and other physical needs. These employees would be overseen by the rest of the nursing staff and instructed regularly in appropriate care and communication.

 

2. A new kind of employee called a "Compassionate Companion" (my daughter's term) would provide the other half of hands-on resident care. This would be someone to deal with the communication and caring concerns of each resident. They would involve the residents, have time to read, play games, and visit in a small group or a one-on-one basis. They would get to know the residents and their families and communicate regularly with them.

 

 

* Present pay level for aides overlooks the vital role they play in resident care. They should be paid a reasonable salary with benefits and given opportunities for an advancing pay scale.

 

* To deal with a sensitive subject as delicately as I can, presently these low-paying jobs attract many people whose first language is not English. Often their cultural backgrounds make them particularly respectful to elderly folk so they could be ideal nurses' aides, but language often gets in the way. When a resident with Alzheimer's disease can only speak a few, sometimes inappropriate words, aides who are limited in their understanding of English cannot understand what is needed.

 

* At present, these poorly paid positions are not being filled. My daughter observed that staff was always short that left those on duty responsible for more residents than they could reasonably handle. The administration, knowing it was happening but unwilling to raise salaries, ordered her never to tell a family member that "we are understaffed."

 

* There is no way to create compassion in an individual who does not possess it. Careful selection in the hiring process is vital to find those with a natural caring spirit. Beyond the usual methods of advertising, one suggestion is to team with a local community college or high school looking for students interested in social work who might want to intern for such positions. A recent article in our local paper tells of a program started by a teen who recruits others to fill the needs of senior citizens. There are "compassionate companions" out there. Facilities just need to be persistent in their efforts.

 

* A quiet environment is vital. Loud talking, radios, and TVs should be tempered. Background music should be selected that will soothe the residents rather than entertain the staff.

 

 

A FINAL THOUGHT

When I enter a nursing home, I want the aides who tend to my care to be paid a living wage. I want them to be secure and happy in their work. I want them to look forward to seeing me, even if I do not remember them from yesterday. I want them to respect my dignity and treat me kindly and compassionately.

 

I have instructed my family that, when they are looking for a nursing home for me, they should ask how much they pay their nurse aides. Do they provide benefits? Do they have serious turnover problems? I know that a good aide, happy in his or her job, is going to make my life as happy as it can be.

 

Do not bother about the looks of the buildings, the gardens, who the owner is, or the administrator, the medical director, the senior nurse, or even the ward nurse. They are all too busy to deal with my day-to-day problems. Instead, check on the person who gives me a bath and listens to me and laughs at my war stories, no matter how often they have heard them.