Nursing homes: The good, the bad and the changing

Thinkstock | Stockbyte
Thinkstock | Stockbyte

According to a recent article by the New York Times, 70% of patients with advanced dementia will settle into a nursing home near the end of their lives. But nursing homes and the quality of care they provide have been the target of widespread criticism.

Only there’s more to the story.

The article notes that while recent reports do shine some much needed light on areas of weakness, there are elements of the nursing home care conversation that have not yet garnered the same level of public awareness—some of which are actually positive.

Now, Mary Ersek, who operates as part of an interdisciplinary team working to improve long-term facilities, is drawing those less visible elements to the forefront.

Ersek begins by tackling two major points that are commonly ignored: 

First, nursing home use is projected to increase dramatically in the coming years, despite these reports and the concerted efforts to keep people with dementia in their homes. So that means we had better move now to fix what’s wrong.

The second point is that many facilities already are trying to “get it right” and have adapted their routines, policies, staffing and physical environment to better meet the individualized needs of their residents. Some of them have succeeded.

So, what’s the secret to their success?

There are several names for the efforts to transform institutional long-term care, including relationship-centered care, person-centered care and cultural transformation. Common to all of them are the principles of palliative care: maximizing comfort and pleasure rather than cure or rehabilitation and providing care that is consistent with residents’ and families’ preferences.

But quality nursing doesn’t just utilize palliative care, it seeks to improve it. For example:

Person-centered care translates simple preferences and habits into daily routines. A critical element of this approach as applied to dementia care is training caregivers to understand the possible reasons for dementia-related behaviors that reflect distress and unmet needs.

An alternative approach is to identify possible triggers to the behavior and intervene by changing the environment or routines.

So, what’s a productive conversation?

In palliative care, we ask surrogate family decision makers to imagine what their loved ones would say “if they were able to tell us right now.” 

Would they want a feeding tube if they were no longer able to swallow?

Ersek does end the article on a more encouraging note—stressing that despite many issues, quality nursing home care does exist.

These employees make sure the TV is on at the beginning of the Phillies game because Joe likes to sing “The Star-Spangled Banner,” and they bring doughnut holes for Edith’s birthday, knowing she could eat a dozen of them (but shouldn’t). All this, for residents who think that Steve Carlton still pitches for the Phillies, or can’t name their favorite food even as they eat it. All this, for little recognition and relatively low wages. Why? Because they care. So should we.

Interested in viewing the article in it’s entirety? Check it out here, and then let us know what you think about Ersek’s many observations in the comments section below.



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3 Responses to Nursing homes: The good, the bad and the changing

  1. carolslee1949

    I as an RN on the night shift for 12 years at a long term care facility. Compared to other facilities in our area, we had a better nurse to resident ratio than most. By saying nurse, I’m referring also to CNA’s. The state dept of aging and disability performed evaluations every 1-2 years. They also came in to address any complaints lodged with them. Everyone is quick to add their “horror stories” of what happened to my mother or when my father fell out of bed, of how incompetent nursing homes are. Because the number of nursing home residents is increasing, as the aging population increases, I believe the answer is better staffing, along with commensurate pay increases. I can add my own “horror story.” It was decided that my father could not care for himself, due to dementia, but was still fairly high functioning. He was placed in a nursing home that was on his insurance plan. I lived in another state and came to help get him settled. After working in a nice facility, I was very disappointed about the place my dad was in. Several months later, I came to visit, finding that his hygiene was clearly lacking. I questioned that the staff wasn’t supervising him enough. He was being put in the shower to bathe himself or told to go brush his teeth. I was told that “they (the CNA’s) can’t watch everyone.” I was told they were terribly understaffed. I won’t go into the entire story, but before we could make arrangements to transfer dad to another facility, he suffered a stroke, and died from aspiration pneumonia from tube feeding. My point is, family members shouldn’t have to worry about their loved ones living in a nursing home. Adequate competent staffing is one of the answers.

  2. elizmcar

    I completely disagree with this article. Utilizing palliative care consultants and improving palliative care protocols is a waste of time and money. Doctors and nurses focused on primary care are more than knowledgable to provide palliative measures for any patient. I’m not even exaggerating when I say that every palliative care consult I’ve ever reviewed just recommends us to continue current treatments. They never recommend anything that we’re not already doing. By the time a patient is in the long term care setting palliative care consultants should NOT be utilized. What needs to change in order for better quality care in nursing homes is the staffing level. Nursing homes are following the minimum staffing level allowed and it’s just not enough to ensure safety.

  3. Sean Simons

    I like what Ersek says about about nursing home use being projected to increase dramatically in the next few years. I like that he says that because this is the case it is best to tackle the issue that nursing homes have with dementia patients. I think this is a good approach as a nursing home administrator. It is OK to admit that your facility isn’t perfect, as long as you are taking steps to improve.