May 23, 2006

Adam and Eve - Part 2

Sometimes I write because I feel an impression, and I try to follow my inner voice. The ripple effect may never be known.

In my last article I promised to teach you what questions to ask and who to ask when evaluating for a nursing home placement.

Nursing homes are not just for old people. Diseases and accidents happen to anyone, and families are often unexpectedly forced to quickly find a nursing home.

Sometimes there’s just no one left but "dad", and the house is falling down. Heating bills are too high. There’s no transportation for food and meds. Loneliness and depression is often an issue causing the doctor to suggest a change. Or, the younger family members are raising children and working full time.

I see it all everyday.

Nursing homes are usually divided into two categories: Skilled and Long Term Care. Skilled is usually reserved for therapy and recovery after surgery or illness. Most of the time, residency in the skilled unit is no more than 1-3 months. After that, the cost is very prohibited. About $300 a DAY!

Long Term Care is just as expensive, but Medicare usually picks up most of the cost. (If I’m right about that.) The social worker can provide expert advice and information on the cost. I do know it’s all very expensive and very few so-called Long Term Care Insurances actually cover the cost! Don’t get misled by them.

So, let’s pretend that I have my debilitating stroke and I’m completely paralyzed on the right side and can’t speak for myself.

Planning for my discharge from the hospital will began from the moment I’m admitted to the hospital. Decisions about my future placement will begin immediately, so make sure Jim is informed on those plans and has a chance to provide input.

The hospital social worker may provide Jim with names of nursing homes. He should toss this into the nearest trash receptacle and open the yellow pages of the phone book and start making phone calls.

He’s going to be busy visiting facilities close to home. He will first walk the halls without talking to anyone. (As I do before I apply for a job.) He will use his five senses to their fullest.

Listening: What are the staff talking about to each other. What are the nurses gabbing about at the nurses’ station? Do they sound like teamwork? Are they complaining and if so, who or what are they complaining about? Each other? The administration? The residents? (Heaven forbid!)

At a former job, most every nurse disliked and did not trust the director of nursing. She wasn’t fair, honest or even knowledgeable about her staff and residents. But, she put on a real good front and most of the visitors who toured the place were very impressed. If visitors had actually spent time listening, they would have learned much!

Jim will listen carefully for beeping sounds of the “call-lights” that every patient has. State Regulators often cite nursing homes for making patients wait more than three minutes for a call light to be answered. The fast-beeping noises are the bathroom emergency light and should be answered within 30 seconds. I’ve seen and heard them go on for an hour at a time. I will not work in a nursing home where this is allowed to happen, so please don’t make me live in one.

Odors: My Jim has the worse nose ever. It has to be really, really bad for him to notice an odor. I’d suggest he take Sheba, but the objective would not be the same… There is always an odor problem in nursing homes. (Unless you bought one of those Alpine Units from Floyd Phillips.)
It simply cannot be helped with so many people wearing diapers and using urinals and bedpans. There are bedsores, tube feedings, catheters and urine bags. If any of these are not cleaned well, there will be an odor.

Will Jim see housekeeping mopping under the beds and behind the toilets? How often is this done? (You may be shocked. Once I placed a kleenex box under a bed and it stayed there for months!) Look at the condition of the wheelchairs. (I almost hate to tell you this secret.) In most nursing homes, the wheelchairs are suppose to be on a nighttime shower schedule, but rarely does it happen. Most of us nursing home employees have conditioned ourselves not to look at the footrests and armrests of the wheelchairs.

Food odors and mealtimes tell so much I could write a book on what to watch for in the dining room. Is there a suction machine in the dining room for when I choke on my piece of bread because the kitchen thought bread was on a pureed diet? Are nurses passing pills in the dining room? (They shouldn't.) Is there a nurse monitoring the meal until the last resident leaves? (They should.) Is another resident taking food off my tray? Is the aide feeding me and another resident at the same time? Did they give me a pretty bib to wear, or just let the (pureed) food dribble on my dress. (Am I dressed for the dining room?)

Be there at mealtime and see if the meal sparks your taste buds. Can you smell the coffee? Or, is coffee limited for visitors and staff? Frozen meals provide little “home cooked” fragrance at mealtime. Homemade deserts are refreshing and a sign of better dietary services. Are confused residents given very hot food (or being fed steaming hot food?!)

If you can, notice the expiration dates on milk cartons and ice cream. Some nursing homes use outdated food to save money. By the way, what brand of ice cream, applesauce and milk do they use? Would I be willing to have this fed to me?

I hate to say this, but how do the staff look and smell? Have they worked double shifts and not had a shower for two days? Did they wear protective gowns when they cleaned up that last big accident? Do the women residents have make-up and perfume on. Don't stare, but have the men been shaved? (Every day!)

As you walk the length of one hall, how many staff people did you see? Not just aides, but at least one nurse – maybe two. (Do they nod or speak to you?) You should see the social worker hurrying by, physical therapists walking behind patients, a busy, smiling activity director and her activity aides playing games, a cook with a thermometer in his front pocket and kitchen personnel delivering snacks to the halls. You may see the admissions director showing a tour.

How often does the doctor making rounds (Be alert to evasiveness.) Actually, they usually rely on the nurses to keep them posted. I haven't seen doctors make rounds for many years!. Is there an 'eye doctor' on staff? Who will replace my glasses when they get lost in the sheets? Is there a podiatrist who actually comes in to cut toenails. I'm a diabetic and only a poditrist should cut my toenails. What about dental service? Some nursing homes have a dentist who comes in and checks those dentures and partials. (You should ask these questions later. I'll explain in another article.)

By the way, will I have my own denture cup for my little partial plate? Jim will need to make sure it gets removed and cleaned every night. Make sure they don't put my dentures in my roommate's mouth!

Later, you will need to know. Who is the administrator and how long have they been there? Frequent changes in administrators or the director of nurses indicate internal problems. Who is the assistant director of nursing (or is there one?) Later you should see the director of housekeeping and laundry. Who is the maintenance man? Is he dressed for ‘work” or as one who reads the newspaper in a back office?

At the nursing home where I work now, I made that silent walk through and vowed not to apply to work there. I saw some things that indicated sloppiness and lack of professionalism. These are just little things that mean a lot to me. When I did my tour, not one nurse asked if they could help me. I purposely walked into an area near a back entrance that had storage supplies and looked unused, but still no one asked who I was. I saw nurses eating at the nurses’ station (a sign of being too busy to take a break), and med carts messy with litter and disorganization.

But Jim was excited to have me working close to home (5 minutes), and when I (reluctently) applied, the director of nurses blew me away with her professionalism and courtesy. I gave her a hard time with many questions I knew she really didn't have time for. I pressed her to explain her system of organization and communication. (As I left her office, I heard her let out a deep sigh of relief) I figured I'd never hear from her again. But, I did feel like I would be appreciated – and this has proven to be true.

Next time I’ll write about more questions to ask and who to ask them to.

What's this about Adam and Eve? That's coming too!

Take Care on the Journey,


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