These Nursing Homes Care About Their Elderly Charges

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Respect for our seniors?Who "thought" of that?Oprah? Is that in some way trendy?Why the hell has that not been the way for some time?

Ben of IN 4:10PM January 14, 2010

is to end up like the guy in Tim McGraw's song who got a terminal illness and said "I went sky-diving, I went Rocky Mountain climbing, I went two-point-seven seconds on a bull named Fu Man Chu, and I loved deeper, and I spoke sweeter, and I gave forgiveness I'd been denyin'----someday I hope you get the chance to live like you were dyin'." (Then, presumably, he died.)
Nursing home was never mentioned, and with a little luck for many, never will be seen at all.

Muser of NM 4:08PM January 14, 2010

The culture change movement in nursing homes has many strengths, as this describes. However, it was disappointing to see that not a single representative of a nursing home consumer group was quoted and that there is virtually no discussion of some of the many pitfalls of so-called culture change nursing homes.
I know a number of providers who are really trying to make a difference for their residents through culture change. However, I estimate that the majority of so-called culture change facilities are not really doing anything that is meaningful. Putting a gazebo next to the parking lot or bringing a pet in may be nice, but they are not culture change.
MOST IMPORTANTLY, it is critical that the public is made aware that the ability to decide when to get up and what to eat - including things that might be "bad" for you like ice cream or salty foods - and the right to have a homelike environment and dignity and choice is federally mandated for EVERY SINGLE NURSING HOME RESIDENT IN THE UNITED STATES. This has been the law since the passage of the Nursing Home Reform Law over 20 year ago.
The reason why so few nursing homes actually provide this level of care and quality of life is because the law is not adequately enforced.
Why? Because nursing homes are highly profitable businesses with very powerful lobbyists in the states and in Washington. Though we pay them to care for our most vulnerable and frail loved ones, there is almost no accountability when they fail to meet legal standards. [What a great job that must be!]
The state of affairs for the vast majority of nursing home residents is, frankly, appalling. But the commentators who blame too much government interference or regulation could not be more wrong. If government standards were properly enforced, "culture change" would be the norm, not the exception. But that wont happen until state and federal policy makers hear from their constituents that nursing home residents are important, and that there should be accountability for meeting standards when the public is paying the provider industry billions of dollars to provide a vital service; when they literally hold our loved ones lives in their hands.

Richard Mollot of NY 3:52PM January 14, 2010

I want to respond to the comments by Ray Downen and by Sara of MI and their experiences with about regulations. All nursing homes are heavily regulated. But the regulations are FOR the quality of life of the resident. Regarding Sarah's experiences: If a family member is being told that the State regulates what kind and quantity of food must be served, regardless of what the resident wants, they are not being told the truth. Resident choice is a priority in the regulations.
Ray's comments: "The staff members are told what contact is allowed with each patient, how they can interact, and what they're allowed to do at the patient's request." If these things are happening, they are in DIRECT VIOLATION of State and Federal regulations. As for psychotropic drugs being discontinued, I do not know the particular circumstances, but would encourage Ray to Google "Overmedication in nursing homes" or "Overmedication in older adults" for a real education about the abuse of elders because of inappropriate and often "off label" use of antipsychotic drugs.
Culture Change, as Joanne Rader notes in the very frist comment here,is a profound, transformational change that rests on new, healthy, and solid understandings of aging, of growth and development at every stage of life, and of the dignity of the individual at every stage of life.
One of the first 'proverbs' of long-term care I learned when I began working with older adults was this: "If if doesn't seem right to you, it probably isn't." Don't simply take "it's the regulations" response without pursuing it.
To that end, the entire set of federal regulations is available on the internet at: http://www.law.cornell.edu/uscode/42/1396r.html

Imelda Maurer, cdp of CA 3:44PM January 14, 2010

I have worked in nursing homes for many years as a nurse and teacher. The culture change movement towards more personal, individualized care is happening but we need people to understand that it can be different. Yes, regulations have limited choices. But providers too easily fall back on that as an excuse not to change. The regulators are supporting this change in a number of ways. But mostly we need consumers and families to believe that it can be different and ask for it and advocate for it. It is being done differently within the current regulations. Check out the Pioneer Network website www.PioneerNetwork.net for more examples of who things are changing.
As our overall population ages, we need to create a new way of thinking about and experiencing aging. Find out more. Be a part of the change. Ate least 37 states now have culture change coalitions working on this. You will find the contact information on the Pioneer Network website

Joanne Rader of OR 5:41PM January 13, 2010

I know the nursing home my grandma is in is heavily regulated by the state. My grandma can request things but because the state "rules" are so strict, she feels bad for others that can not speak for themselves. For instance, my grandma likes when people call her honey but the state will not allow it. I know one lady that was on a certain antipsychotic for years, but the state stepped in and said that it is no longer appropriate for her to take that one. She has never been the same since the state forced a change in her medication. The state is good in a limited way but they regulate way too many things.

Sara of MI 9:51PM January 11, 2010

I'm a frequent guest in one nursing home. I know for a fact that the government regulations limit what can be done for each patient. The kitchen is told how much of what kind of food must be served, regardless of what the patient wants and in what quantity. The staff members are told what contact is allowed with each patient, how they can interact, and what they're allowed to do at the patient's request. Only patients who are able to walk alone are allowed to do so, with no regard to the desire for independence of the patient. Many kind and friendly things that could be done for a patient are not allowed due to regulations from outside the home. Uncle Sam knows best, the staff are told. If they want to continue working, they obey what the regulations require.

Ray Downen of MO 4:48PM January 11, 2010

Wow! How rare and unusual!
Shouldn't that be the norm, and shouldn't the authorities and regulators make sure it is, or are we living in a jungle each fending for himself?

Bruce of CO 2:37PM January 11, 2010