Nursing Homes, Part 4

This is fourth and final (for the present) post on nursing homes. It has been an interesting process for me as I thought and remembered both the good and bad points about our Mother’s stay in a facility. Hopefully, my series of posts on this subject will be useful to you. Actually it is my hope that you are never faced with the decision of placing a family member in a nursing home.

7. Always make sure, on behalf of your family member, that his/her doctor’s orders are being carried out by the staff of the nursing home. Do not assume anything. Most of the time most staff members are very conscientious, and they will follow completely ‘doctor’s orders’. For them we are very grateful.

Then there are the others. There are not many of them, but they are present and always will be. I do not believe they are purposely neglectful, just inattentive. It is also possible that they are overwhelmed with their responsibilities and in their efforts to be sure that their residents are taken care of, tend to rush through tasks, not making sure to take care of the details. Example: When Mother’s feeding tube was put in, the doctor gave specific instructions for her bed to always be at a 45 degree angle. The reason being, if I remember correctly, so that should a problem occur with the feeding tube, she will be less likely t0 aspirate. When those orders were given, we put a sign at the head of Mothers’ bed stating that her bed be always left at a 45 degree angle, and we talked to the administration, making sure they had notified the staff about this very important instruction from the doctor. In spite of the measures taken on our part, we still, on numerous occasions came in and found her lying in a flat bed.

When the doctor changes the medication of your family member, always verify that the medication nurse has made the necessary changes on their chart. Again, don’t assume anything. You must make sure for yourself.

8. If you have concerns about your family member’s care, say something. Talking to a CNA(aide) will probably not fix the problem, because there are several CNAs taking care of your loved one on different shifts throughout the day and night. Not everyone will receive hear about your concern and therefore will continue doing what they have been doing. The best thing is to talk to the head nurse on that shift, or if necessary go to the director of nursing or the administrator. With a smile and nonthreatening tone, voice your concerns. Probably they will listen, take notes, and decide on a course of action to make sure the problem is solved and your family member’s care meets your expectations. Even then, I am sorry to say, you must check to be sure your concerns were communicated to all staff involved in caring for your loved one.

9, When you are first gathering information about a facility and deciding on placement options, ask about the ratio of CNAs to residents and if that ratio changes during the day or during then night. One of the things that concerned me, and I didn’t realize the full scope of this (in my opinion) problem at first, was that there were times during the day when at this facility, most of the CNAs were off the floor and the residents were left with almost no one to call on for help.

At meal time the CNAs took all the residents to the cafeteria to eat and stay with them to help serve the food. There were a couple of CNAs on the floor, but they were given the task of feeding residents who couldn’t get out of bed. These aides did the best they could if they saw a resident in need, but unless it was an emergency, that resident had to wait until the feedings were complete.

In addition to meal times, this nursing home had a ‘smoking break’ for residents and staff. The smokers would all go outside to the patio and puff away. It seemed that most of the CNAs smoked and they all went at the same time on this break. There were times when Mother needed assistance for something, and she had to wait until her CNA was back on the floor. In my opinion, the smoking breaks could be scheduled at a staggered time so the aides could cover for each other.

These times of short staffing on the floor became a personal problem for us during the short time that Daddy was a resident. About 3 days before his death, Rick and I decided to take a quick trip to Dallas to see our daughter and son-in-law, and also because I had a doctor’s appointment there. On our way to Dallas we decided to stop in at the nursing home and see Mother and Daddy. This was about 4 days after Daddy’s nursing home stroke. He had been semi-comatose for several days, barely responding to questions or acknowledging someone’s presence. We found Daddy fully clothed sitting in his lift chair sleeping. We talked to his CNA and she told us that she asked him if he wanted to get up that morning and he said yes. Therefore she got him up and dressed. There was no problem with her getting him up. I was thrilled to see him sitting in that chair. However, I could tell that he was getting tired and needed to go back to bed. Rick and I talked to him for awhile and he did seem a little more alert than before. About 11:00 a.m. we needed to leave. I went to the nursing station and told the charge nurse that Daddy needed to go back to bed. Daddy was beginning to be in pain, getting cramps in his She sweetly assured me that he would be transferred to bed. Something inside me told me not to leave until that was done, but I left anyway, feeling the need to ‘get to Dallas’. Because I continued to have this nagging concern, I called back about 1:30 p.m. to make sure that he was back in bed, and ‘sure nuff’ he was still in that chair. I told the nurse, the same one, that he had needed to be put to bed, reminding her that I had told her so over two hours ago. Once again, she assured me that Daddy would go right back to bed. Not completely trusting her words, I called again about 2:30 p.m. A different charge nurse answered this time and I asked again. He was still in that chair. She went immediately and put him back in bed.

Oh yes, I was mad. Yes, the administrator heard about it as well as the director of nursing. The reasons? Just after 11:00 a.m. every day, most of the staff is in the cafeteria feeding the residents. There was no one except the charge nurse available to transfer him back to bed. At 1:30 the facility was changing shifts.

In addition to being angry about my father being left in his chair for hours after he needed to be back in bed, I also felt a heavy burden for those little people who had no one to advocate for them. Were they left for hours also in chairs, beds or wheelchairs, in pain from being in one position for so long and no one available to help them? What if someone had a stroke or heart attack during meal time or a smoking break? My sisters and I voiced these concerns to our administrator, and though these concerns appeared to be well received, no changes were made while Mother was a resident in this facility.

I could make several more points on this topic of nursing homes, but for now I will write about other things. Please understand that reputable nursing homes are not inherently bad places and have bad staff members. Most of them are good facilities with staffing that is competent, caring, and compassionate.  However, as I suggested in a previous post, because the administrators and staff are human, mistakes will be made. It is up to you and me as family members to shoulder the responsibility of being aware when these errors happen and making sure they are fixed. No one else will do it on behalf of your loved one. We must ‘stand in the gap’ for them.


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