Dr. Ellen K. Rudolph Blog Nursing Home Horrors? – Dr. Ellen's Blog

Nursing Home Horrors?

Posted on February 5, 2012 By

Nursing Homes scare the daylights out of most people because they lack the emotional skills necessary to deal with growing old, which is hardly what any of us consider a user-friendly activity.

Oh, we all know we are going to get old one day. We recognize that, but we also trust that it will happen somewhere in the distant future.

So if we do brave a visit to someone in a nursing home it is usually a pretty unsettling experience.

The fact is, many folks simply opt not to do it. Alzheimer’s itself is scary, but so too is the blank and expressionless face of the patient who lives in such darkness.

Mickie is a Case in Point

Mickie was in her late 80′s when I visited her.

She was a long-time resident of a small northern Minnesota town and a family friend of mine. She had been living in one of the oldest and least well-accessorized nursing homes in the region – translate that to mean the least costly – for some time. I made a special effort to visit her even though several local knowing friends advised against it, saying I wouldn’t like what I saw and, besides, she wouldn’t remember me anyway, they said.

mickie

What I found

Well, I visited Mickie anyway and I found a lonely and bewildered friend who hadn’t had a single visitor in well over a year. The Director of Volunteer Services was thrilled that I was there.

She survived her beloved spouse by dozens of years and had three grown sons, two of whom lived in the same town; the oldest had moved years ago to the Alaskan frontier and has never been back. Suffice it to say, he would be hard put to find a more remote enclave.

Only the youngest son dropped by the lobby of the nursing home occasionally to bring needed items if the nursing home happened to call him.

Mickie spent her days in tears.

Contrast Mickie’s experience to Doris’ life

Doris was another elderly friend of mine in that same little town who, at the age of 99, still lived happily in her own home and was even doing  her own grocery shopping with some transportation assistance from her elderly son who lived a few blocks away.

He drove her every few days to the local IGA grocery store and picked her up 2 hours later so she could be in charge of the grocery experience and also have an outing.

When I went to Doris’ back door I found a bold handwritten sign taped to the door that read:

“I WILL NOT GO TO A NURSING HOME!”

doris

This was a person who didn’t hear so well any more but she was competent in all other respects. She cooked her own meals and she navigated the carpeted steps to her second story bedroom just fine with a solid railing to grasp hold of.

I hadn’t been back to the area for a good many years and still she recognized me immediately!

She told me that TV and crossword puzzles were her best friends, besides her front porch where she loves to sit and watch the cars go by on busy Highway 38. She also had fed a geriatric Chipmunk on a daily basis for years; he would hop up on her lap to reach for the nuts she held for him in her outstretched hand.

From the Patient’s Point of View

There is much controversy associated with Alzheimer’s Disease; most of it having to do with recommended treatments by amyloid-suppressing drugs.

Like everything else today, dementia is viewed strictly through a medical lens by experts who vigilantly search for the ‘genetic causes of Alzheimer’s Disease‘… as if that is all there is.

The bulk of the vast literature on this disease fails to attend to the patient. It attends only to their symptoms and occasionally to psycho-social needs that are thought to be best met through a group living experience.

Scary, huh? Perhaps you can understand why someone like Doris would want to avoid that twilight zone.

The Multi-Generational Life-Cycle

Unfortunately, society has by now medicalized a normal and predictable stage of the multi-generational life-cycle.

[But growing old is not a medical phenomenon.]

It is a stage of life when higher mental functions begin deteriorating and also when the body in general begins an inevitable decline; a decline that comes slowly in some and more rapidly in others.

The symptoms are unmistakable: the skin wrinkles, the senses in turn become impaired, bones weaken, the belly protrudes, muscles atrophy, and squeamish things like digestion and elimination problems come into sharp focus.

This is not rocket science. It happens.

And while some elderly people more than others suffer cognitive impairment at this stage of life, they are still very much the same person inside as they always have been. They feel the range of human emotions, they increasingly suffer from isolation and the lack of physical touch, and they become bewildered by the losses they experience but can’t necessarily remember.

An emptiness fills in those losses like water rushes to fill a void. And, in turn, the mind retreats.

The Role of the Family

The family plays a pivotal role in the transition of an individual to old age.

A well-connected, loving family with highly interactive and involved “touchy-feely” family members is the best medicine for everyone, but especially for our elderly.

This family network serves as a safety net that keeps their minds active and their hearts nurtured. Those lucky enough to have this safety net also tend to be spared the worst of life’s physical impairments of aging. They tend to live longer, healthier lives and their cognitive functioning remains intact for a much longer period of time; for some, all the way to the end.

Those Without a Safety Net

To the contrary, those without this emotional safety net deteriorate more rapidly over time, sometimes as early as the mid-fifties.

They begin to show signs of wide-ranging physical and mental impairments as well as symptoms of escalating anxiety. Hospital admissions, falls, surgeries, and a host of other medical issues characterize their latter years to the point where institutionalization is finally deemed the most expedient solution for all concerned.

And often it is.

Broken families don’t know how to repair themselves. They lack innate healing capabilities. Many broken families often look OK on the outside but there is little of substance to them on the inside. Family members cut off and run away from each other, they neglect each other; and some become abusive towards each other.

Still others suffer from the range of impairments that inflict the body and mind and eventually they die out; sometimes whole families at a time.

Health is a State of Mind

Health is [not] just a jumble of neurological synapses.

A Caveat: many once-competent elderly persons belligerently refuse in-home care. They resent the intrusion of external (and strange) caregivers and often they will resist all attempts to provide them with assisted living services. This is particularly true when these things happen quite suddenly such as after a fall or emergency surgery.

But growing old is hardly a sudden process.

Families need to engage the involvement of elderly family members well in advance, while they are still competent both mentally and physically. They need to play an instrumental role in planning for their future care needs.

The bulk of such planning is unfortunately done at the very last minute, leaving no preparatory time whatsoever for the elderly family member to get used to the idea of assisted care. This, however, is ill-advised and it leads to a rocky road ahead for all concerned.

And, of course, it doesn’t help when family relationships are strained to begin with.

A Common But Big Mistake

It is always a mistake to remove an elderly person from an intact and caring social network.

It is far better to keep them in their own home with assisted care than it is to transport them to another state, even to another county and institutional setting that is close to where one of their grown children happen to live. Read this note from a family that has done the right thing by keeping their mother in her hometown:

“The Wills take Mom to and from church every Sunday.  My brother and his wife are 5 minutes away, and Charlaine is Mother’s primary driver for short trips and dental appointments and such. They take care of her laundry and visit every Sunday night. Their children and grandchildren also visit Mother – especially Ed’s son and daughter-in-law who have never missed a Sunday afternoon visit. I visit Mom every week and take care of things like manicures, pedicures, banking and bills, and thank-you notes to those who walk her twice daily and bring her special treats. All Mom hopes for is that her money will outlast her. She doesn’t want to come to the city to live with us because she would be away from all of her friends, her doctors, and her church.”

Nursing Home Horrors?

Too many nursing home-eligible patients are placed in facilities that their families haven’t carefully evaluated. And once admitted, many more are rarely visited by relatives or friends who can look out for their best interests.

Unresponsive staff and administrators should prompt a family to make inquiries elsewhere but they often don’t, particularly if  that multi-generational family unit is dysfunctional…or worse, broken.

The reality is that nursing home facilities cannot do it alone. Even in the very best facilities, they need participatory families. In some cases facility problems occur more from unintentional human error or unavoidable medical complications than from irresponsible conduct by understaffed nursing home personnel.

For every instance of bed sores, dehydration, weight loss or other common problems there are usually a host of familial and institutional factors at play.

It is therefore a mistake to solely blame nursing homes for the horror stories that abound. Familial neglect is part of the problem, if not often a major part of the problem.

Neglectful families will grasp at any straw to avoid seeing their own role in the problem, and they will predictably project an intense focus on the institution as their own anxieties escalate.

This projection process is an effort to gain some relief by shifting the blame away from themselves.

But Society Also Shares the Blame

The fact is, aged citizens in our society today are not particularly valued.

We no longer collectively revere our aged. In fact, we consider them a nuisance at best, and at worst a costly burden when they are not loved.

How is it that a family of 9 children, 39 grandchildren and 14 or so great-grandchildren cannot find a place in their own lives for an elderly matriarch? It happens all the time.

Trust me, the reason is not just money but also matters of the heart.

Some Things to Keep in Mind

For those who require institutional care here are some important things to keep in mind:

a. The quality of life for an elderly person is largely dependent on their interactions and relationships with others. A world barren of relationship induces depression and anxiety that, in turn, seriously degrade the person’s overall health and functioning.

Relationships heal; they give a person something to live for and they soothe and comfort. But the lack of relationship harms.

b. People often think that their relatives with Alzheimer’s have difficulty hearing when, in reality, they are taking time to process what they have heard. Often they are unable to express what they want or, if not that, they cannot interpret information the way they used to be able to do. Be patient and make eye contact with them. Allow them to finish what they are trying to say without correction or criticism. You can also help them by guessing which word they are trying to find or you can ask them to make a gesture or point to something that relates to what they are trying to say. Patience in such cases is a virtue.

c.  For a person experiencing dementia, reminiscing is very calming and it helps them to feel more secure. Talk with them about past events and places and go with the flow by enjoying some of those past moments with them. Family and other old photographs help greatly in this process. Laughter and gaiety help, too.

d. Dementia patients are able to read body language and respond to the positive attitudes of caregivers and family members. But the reverse is also true. They pick up on our insecurities and it makes them anxious in turn. When treated poorly they feel rejection, loneliness, grief and pain. They seek smiles and tender touch above all else.

e. Yes, tender touch is one of the most important communication device. A hug does wonders for any anxious person, but especially for an aging parent or friend who finds him or herself in a strange  environment. Touch more, talk less when interacting with them. Give them a massage. Hold their hand. Put a comforting shawl around their shoulders. Take them for a walk, as walking is enervating and often therapeutic. And pay attention to and comment on the beauty and novelty of your surroundings as you walk with them.

f. Even if the person with dementia does not recognize their visitors, the contact is nevertheless invaluable. Even patients with severe language deficiency fluctuate in their abilities; meaning, some days they are far more observant and attentive and expressive than others. Some of this fluctuation has to do with their level of anxiety and depression at the time, and with thoughts of abandonment. Intuitively, many such patients also know that death looms large.

g. Most elderly patients have no awareness of their memory loss. You, in your prime, may feel aggravated at their repetitive behaviors or with having to repeat what you just said for the umpteenth time, but they do not. Let the person know that you have heard them and that you can imagine what he or she might be feeling. Try to validate their feelings and also try to play a little with them! A smile goes a long way in such situations.

h. Medications used in nursing homes can overwhelm. Medications are often times used for crowd control, and sometimes they interact with other medications and induce a form of depression of their own. Beware of this and always ask about the patient’s medications and their purpose on an ongoing basis.

These are some things you can do with your confined friend or parent:

a-bring them large family photos, family momentos, books with pictures of animals, flowers or birds – even pictures of their old house and homestead – and then talk with them about these things.

b-take them for a ride to see their old house or farm, or their church.

c-if they once had a pet, bring a cuddly pet in for them to touch and love.

d-bring favorite foods or beverages if allowed; share vegetables or fruits from your garden for a special treat; as well as some of your own freshly baked bread or rolls.

e-bring a CD player with you to the visit and listen to music together; or play a CD of children or grandchildren talking and singing to them.

f-read aloud to them, or watch an old movie with them.

g-give your father a shave or your mother a new hairdo or a manicure, even a massage.

h-arrange to stay and have a meal with them on a regular basis.

i-bring a favorite perfume, powder, lotion, or even tobacco if that is something they used to enjoy, as smells evoke very powerful memories and emotions.

j-take him or her outside to smell springtime, autumn, rain, or even snow.

k-above all, remember that they are human first. They were functional members of society and your family earlier in their lives; and they probably were instrumental in your life or you wouldn’t be concerned about them.

Remember also that one day the tables will turn and [you] may be the one confined to a nursing home.

UPDATE: Both of the ladies mentioned in this commentary  have died. Mickie died within six weeks of my visit; one day she stopped accepting food and water and died shortly thereafter.

Doris lived until the ripe old age of 102 (while she was still living in her own home).

May they both rest in peace!

 

MENTAL HEALTH     ,