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Visiting a Nursing Home - part one
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Visiting a Nursing Home - part one

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There are a few things to consider when visiting a severely debilitated friend or relative in a nursing home.

(1) Make hand to shoulder or hand to wrist contact throughout the visit. Don't just stand near the end of the bed.
(2) If you are thinking of things to bring, several soft fresh fruits - peaches, strawberries, bannanas (not hard) and not too many.
(3) Think about bring as a gift an inexpensive chess set, checkers set or backgammon. There is a game room where the seniors can get these, but it often has limited hours, andf the number of sets are limited.
(4) One of the re-current problems is that the seniors do not eat their food, and it is taken away after a short time. One of the reasons is that the kitchen help have to wash the dishes before the next meal. Having a supply of disposable containers to put food in to be enjoyed during the next hour after the meal is helpful. Do not bring washable plastic containers. They cannot be cleaned properly and will gum up the sink in the room. Obtain the small four-inch-by-four inch transparent salad containers (order on the net) and some plastic spoons and forks. And some hot-service cups for soups. The main entree, if not finished, can be placed in one of these containers and left on the tray over the patient. Then the staff can take asway the dishes for cleaning and sanitation. Do not put the food in a drawer. If it is not on the tray it should be thrown out.
(5) Try to find a small battery-operated radio. Most homes have television, but not a radio. Many homes will ,object to a plug-in 115 volt radio that is kept on the bed.  You need a continuously tuned radio, preferably AM-FM with a rotating knob for tuning. The digital radios cannot be operated by the frail and stroke disabled. I am not a happy camper with the ear-plugs, which become lost rapidly. If the volume is kept low the radio can be placed on a pillow next to the ear. Talk-shows and easy-listening music are good ways to full up the empty hours. And, of course bring extra batteries.
(6) Usually there are two to a room in nursing homes. Often one patient can walk while the other (your patient) is bedridden. If your mom or dad is very debilitated and the other person is not ask them to assist when you are not there. One of the biggest problems is hydration. The patient does not drink enough. You can ask them to continually offer small cups of juice or water to your bedridden loved one throuighout the day. The CNA's do not pay enough attention to this.
(7) If there are two pair of eyeglasses make sure the ones for reading have different frames or are marked with tape. Usually nursing homes will provide eyeglasses for near and far, but will mount them in identical frames.
(8) Think about obtaining large-print newspapers or reading material.
(9) Talk to the CNA's and compliment them. In the summer bring them a dozen cans of ice-cold soda to the nursing station. Or a box of jelly donuts.  In winter order a large pizza for the staff. Monetary tips are inappropriate.
(10) Bring some fresh-squeezed juice or your choise and some small plastic cups to share.
(11) If you have to take a break while the staff cleans your loved one go down the hall and talk to the other patients. You will find many have not had visitors for months. Always ask the CNA if you can give them food or drink. Many have swallowing problems.
(12) If there is an outdoor area where you can take your patient, ask the CNA for permission to do so whenever you visit in good weather. Avoid sunburn.
(13) Try to spend a reasonable amount of time sitting next to the patient and holding their hand or wrist.
(14)  Ask the patient what he/she would like you to bring for a treat next time. (i.e - fresh strawberries)
(15) If you say you are going to visit on a certain day do not miss the day.
(16) Tell the patient what the weather is outside, the time, the day and the year (if they are very debilitated). Mention a single big event of the day to taslk abouit that is not too controversial (sports, for example).
(17) Find out the names of the CNA's and nurses that work the stations. And the physician, psychiatrist, physical therapist and nursing home administrator.  Do this quietly. Many re reluctant to provide this information.
(18) If the patient is very debilitated perform some simple range-of-motion exercises with their hands and arms. There is never enough of this done.
(19) avoid complaining to the staff unless absolutely necessary.
(20) Do not ask the staff about the patient's medications or attempt to read the nurses notes. This always causes an issue. Although you may have a right to this it places the low level staff in a difficult position because they have been ordered to maintain patient privacy. If necessary make a specific appointment with the nursing home physician with your health care proxy to discuss these issues.
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Other things to bring:

(21) A box of 64 Crayola crayons and a stiff spiral-bound drawing book with three to five-ply bristol board (stiff). Not too big a book. Available at art stores. Writing paper size or slightly larger. It has to fit in the drawer next to the nursing room bed. In addition (or alternatively) a bound book (at least letter writing size) with blank paper and a colorful cover. These are available at art stores and some bookstores. Some stick-on stuff from Staples (butterflies, animals, etc.) available for children for them to put on the cover. Let them select and put them on.
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(22) Bring a quality cosmetic bar or hand soap and a plastic dish to keep ther bar between use. Glycerine, olive oil..etc. The nursing homes usually use a soap dispenser these days.
(23) Purchase a quality cushion for the patient's wheelchair and write the patient's name on it with magic marker. Most nursing homes only provide a thin cushion upon which to soften the seat.
(24) Obtain a colorful velco snap-on bag for the patient's wheelchair to transport accessories. Write their name on it in magic marker.
(25) If you go to an art supply store purchase a box of HB pencils or number 2. HB are better for drawing and shading. Plus a soft eraser. Get an art sharpener, which differs from a regular sharpener in that it only shaves the wood off and the artist sharpens the point with a piece of sandpaper or a little booklet with tiny sandpaper strips. As an alternative you can use sandpaper boards used to file fingernails. Get an inexpensive plastic box to hold art supplies. A selection of colored pens from a store such as staples are also nice. Everything should fit in the small box, which can go in the drawer next to the bed.
(26) A box of pastel envelopes with colorful commemorative stamps from the post office. Let the patient stick them on. The post office has a wonderful selection of colored stamps if you ask. Plus a pad of lined stationary from an art store.
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I just wanted to thank you for alllllllll the effort you put into sharing your expertise/experience with those of us in the 'realm of care-giving', to whatever extent that might be. I will be reading up on this site, extensively, as I'm at a crossroads with my step-father. I am looking for the appropriate place to post my experience with in home care-giving, as well as the toll that it's taken on me and my mother.

Reading a list like this is just a very helpful reminder. I've learned most of this by just dealing with him first hand.

Thanks again
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I would recommend joining the American Geriatric Association, that has a membership fee, but lots of material available to the caregiver/supervisor. One of the biggest problems if the "chain-of-command". People only work well for one master and the universal practice of the commercial services is to have the aides report to a nurse, or worse yet to a nurse who reports to a "care coordinator". The "care coordinator" nonsense is new, and they will soon have to be licensed! A sinecure for social workers. And in New York, it will be the care coordinator who will be responsible for selecting and hiring the aides. There are many senior centers who have once-a-day home-delivered meals at a very modest rate (In New York $1.50 a day) that include a five-minute daily visit. A lot depends upon the type of disability of the elder person. My experience has been with the stroke-disabled super-elderly, those with difficulty swallowing, as well as those with pegs, which, contrary to popular belief are not necessarily painful nor do they mean a person cannot eat some meals (soft and special;ly prepared) normally.
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An aide will become something like a "member of the family" and this always results in a somewhat delicate supervisory relationship. Especially when the aides do not consider you a "doctor". As an example, many elderly people will suffer ocassional blackouts on the toilet when constipated. This is solved with good attention to keeping the bowels soft, but it sometimes happens. It means that a well-padded carpet must surround the portable toilet and an aide must remain with the patient throughout the process. If the patient faints the drill is to lie them down immediately, with the feet elevated six-to-ten inches and to make sure they have a good airway. And hold their hand and provide reassurance. This is one of the reasons one of my "rules of the road" was "use the toilet BEFORE breakfast and ensure they are well-hydrated. In any event, if you know what happened this is not necessarily a 911 call. Dragging a 100 year old woman to the hospital when this happens is not appropriate. Recovery will take place naturally. The drill is to avoid straining.. But the care services, to cover their legal buts will always call 911 if the patient faints, and if you are not there, there will be an unnecessary ambulance trip, an inappropriate intravenous line (paramedic protocol), and a waste of time, money, and a frightening episode for the little one.
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My latest discovery was how much nursing home residents enjoy large magnifying glasses!  I found six-inch ones on sale for ninety-nine cents and brought a dozen in to one of the nursing homes I visit. INSTANT HIT!
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