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As I read your note, I was struck by a couple of things, and felt compelled to respond.
Before I do, I will (re)introduce myself to the list as I have been something of a "lurker". I am a general surgeon in Texas who also happens to be a newlywed. While on vacation to Holland last year (my first real vacation in 5 years), I met the person I married. He and I were married Feb 21st of this year. I went into the marriage with my eyes wide open (He is a PWP, 48/9, with quite good function on his current meds) realizing that our future will likely be trying and shortened beyond usual expectations. The love and joy we share, though, is overwhelming and helps to prepare us both for the rough times ahead.
Back to your note: I agree that Donna's granmma-in-law's situation is probably inappropriate, and home aides, etc. would be a good option for her. But a theme seemed to carry through your message that left me a bit disturbed. It was essentially that nursing homes are horrible places which should be avoided at all costs. Further, I felt that you implied that when someone places a loved one/family member in a nursing home, they are showing a lack of love and closeness by doing so.
I agree that nursing homes are often lousy, stinking places. Many are little better than places to wait (miserably) for death to bring release. Just about everyone who has visited these places will agree with that. However, there are exceptions to both the quality of nursing homes and to the appropriateness of placing someone there.
As an example: My grandmother died 6 years ago. After her death, my grandfather began having hallucinations. My parents took care of him while living only a mile away from him. He became more and more confused and weak, requiring 24 hour supervision. My mother would try to take care of him during the day, but needed help as she has had hip surgery and has mobility problems. My dad would help during the day and sleep in the house with my granddad at night. But Grandpa would get up during the night to go to the bathroom and get lost in the kitchen, urinating on the floor, falling, etc., and my dad did not always hear him. Grandpa began falling, often hurting both himself and whoever was trying to catch or steady him. There was not enough money to hire other help. No other children or grandchildren lived close enough to provide relief or assistance (all at least 7 hours drive away). Eventually, with both of them exhausted, sleep-deprived, sore, and afraid of being accused of elder abuse, they searched for and found a clean, non-smelly, fairly attentive nursing home. My granddad was visited at least daily by my parents, had more physical assistance, and improved immensely with closely monitored changes in his meds. My parents also saw rapid and remarkable improvement in their own health. All involved, including my granddad admitted that it was by far the best solution for everyone. He later was able to live alone again for a year or so before his death.
I strongly agree that whenever possible, one should try to keep a loved one at home and avoid a nursing home. But there are times when physical, financial, and/or other demands make staying at home a poor choice (even dangerous or life-threatening) for the care receiver and/or CareGiver.
I wanted to say this because so many loving families must live with guilt when staying at home is no longer a safe, viable option. I watched my mother agonize over their decision to place her father in a nursing home. She had always said, "Just let me die before you put me in one of those horrible places!!!!" So her guilt was almost unbearable at first. I also have felt guilt that I could not/did not leave my brand new practice (and my only way to pay back huge educational loans) to help them.
Thank you for your wonderful suggestions in what to look out for as one checks out nursing homes!! Finding a place where you can get the "right" answers to your questions will certainly make a transition to a nursing home much less difficult for both families and patients... :)
*snip* ... one of the things to be alert to is the strong smell of urine (or worse) or disinfectant, especially in well-travelled areas such as elevators & hallways. Such odors may indicate a significant lack of sanitary care. (And I would add that if the administration says "Sure, we use disinfectant in the hallways, it's healthful, that's why we use it and why you smell it", that too should be a signal that something is wrong... *snip* There are numerous other things too to watch out for in selecting (or monitoring) a Nursing Home before committing someone to residing there. (For example, one should spend time there to witness, unobtrusively and first-hand, how long it typically takes a staff member to bring medication, or a bedpan, to a resident who is requesting it; how many times a resident must make such a request before action finally comes; how the staff treat the residents, i.e., when the residents walk/wheelchair through public areas (hallways, lounges, dining area, etc.), do the staff typically greet them pleasantly and in a friendly manner, offer to assist, or even acknowledge the residents' existence? Are the corridors typically full of wheelchair-bound (or otherwise debilitated) residents who seem to have nowhere to go and who are not being paid attention to? If you (as investigating relative) tour (on your own) the facility and peek into open-door bedrooms, do you typically see residents strapped (usually against their will) into beds, or, better, are most of the bedrooms (in daytime) empty and most of the residents therefore "up & about" at some kind of positive activity? Look at the "leisure activity" areas -- what are they, are there many residents enjoying themselves there, are these areas pleasantly kept, are staff members supervising and doing so with a friendly & encluraging attitude?
Also, very importantly, check out the NH's *license... *snip*
Sorry for this long message, but I can't seem to resist one last note to stand up for my profession and related professions... :)
*snip*... My I suggest one more thing, learned the ultimately hard way during my Mom's hospitalization(s)?: The staffers, whether those staffers are MDs' nurses, aides, or what-have-you, are HIRELINGS; they work for pay, and *that* is primary to them; the health & well-being of their patients is, to them, purely an item on the job-description, is bureaucratically definded, and (except for the exceptionally caring staffer) it usually ranks well below their primary goal of pleasing management and making money, on their list of priorities. .. *snip*
While most people working in the medical field do so to earn a living (very few are indepently wealthy), the VAST majority are doing so because they want "to help people". I know it may sound too simple, but it is true. In particular, most nurses could have found training and work that had better pay, better hours, better smells, and less risk to their health than nursing. The pay is RARELY the primary focus. By far, the most frequent complaints that I hear from both physicians and nurses are related to paperwork, insurance, inadequate staffing, etc. which is keeping them from taking care of patients the way that they want to. We need your help in recognizing problems and taking care of patients. We are often tired and overworked, but we want the best for your loved ones. As in my situation, many of us also have loved ones who are patients or are patients ourselves. :)
With hugs and best wishes to all as I go back to lurking in the corner.
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