Tuesday, September 16, 2008
Include the patient when selecting a nursing home
Dr. Michael Camardi
Recent columns
About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.
Dear Dr. Camardi: This is very hard for us, but the time has come for me and my family to find a nursing home for my mother.
Mom has been living between me and my two other sisters for three- to four-month stretches of time for a few years now since dad passed on, and it's been taking a toll on us and her, moving around all the time.
She's got some things wrong with her, and it seems like new things go wrong all the time, and we're worn out taking her to doctors.
What are we going to do? How do you tell if a nursing home is any good?
-- Lynchburg
This is one of the most frequent questions I get asked and it weighs on people's minds like a millstone.
The fact is, going to a nursing home as a permanent residence can frequently become an extremely traumatic experience for both the patient and the family.
When I see the patient for the first time in the nursing home setting they often speak, and I quote, of "being thrown aside" or "they just think I am bunch of garbage" and "I'm not worth their trouble anymore" and the like. And reactions often fall along somewhat gender-specific lines in that men tend to act out agitated aggressive-depressive tendencies while women become passive, uninvolved and detached with their environment and caregivers.
I honestly think that it is sometimes worse for the families who shoulder deep feelings of guilt and then proceed to act upon them in their behavior that results in troubled interactions with the nursing home staff.
The worst mistake people make is when they exclude the loved in the decision-making process. Even if very resistant at first, by bringing the patient into the process early on, it gives the patient time to get used to the idea and a sense of dignity and control.
While there are no easy answers, the critical first step for families is to understand that they are empowered by following the steps I outline here:
1. Geography. Try to find a home within a 20-minute driving distance (no longer than a half-hour) so as to make the journey easily as there will be frequent trips to visit, bring various items, attend meetings with the staff, etc. When there's an emergency, time is important.
2. Use your phone sense. Call prospective homes and gauge how well the staff handles your questions and arranges an appointment for you to take a tour of the facility. You can tell a lot about the stress level of the site by the way a phone inquiry is handled.
3. Go the state health department Web site for a copy of the last three state surveys. Seeing the last one is not enough. What you want to see is if the site has a tradition of excellence in caring for the elderly.
4. Use your instinct. Recall how your senses were alerted when you went to look at a prospective house for sale? Think of what you looked for: Was it clean or dusty? Was it bright and cheerful or dull and depressing? Did it smell fresh or was there an odor? Apply those same standards when looking for a place to live for your loved one.
5. Make a list of the specific issues that pertain to your loved one and pose those questions. These can run the gamut from dietary concerns to newspaper delivery to types of TV/radio sets to pictures on the wall. Does the facility make every effort to make the nursing home your loved one's home or do they put barriers in the way?
6. When you get to the site, how are you received? Do you get eye-to-eye contact? Are you given an information package detailing the key features of the facility? Do they offer refreshments while you're on tour? In short, are they happy to do their best so as to have you entrust them with your loved one?
7. Look closely at the other residents. Don't see many? There may be a reason. Do the patients who seem most impaired look clean and well-kept? Those are the most challenging ones for the staff and can be a good insight into the level and quality of nursing care. Look down the halls and see how long it takes for a call bell to be answered.
8. Look at the staff. Are they busy and engaged with the residents? Are there relationships there or is everyone just going through the motions?
9. Come back on the evening shift unannounced. This is very, very important on many levels, and if the impression you received during your tour is confirmed during your evening visit, then you have a serious candidate.
10. Talk to people about your findings and seek affirmation. Friends who have placed loved ones in nursing homes, social workers who place patients in nursing homes and doctors who care for patients in nursing homes. These are the people at the tip of the spear.
11. Make the decision about the final placement together. Leave nobody out even if they are not directly involved. Don't be second-guessed. This is the time to bring up the issue of appointing someone as having power of attorney. It is a great responsibility and the one who is chosen must have good judgment, sound reasoning and have known the patient very well over the years.
One final word
Take it easy on yourself. You have thought through this very difficult decision and have decided that it is the best path to take for all concerned. Now, move forward and make it the best it can be.
There are many happy people who I care for in nursing homes, and those people are the ones who have made the nursing home their home. They have established strong appreciative relationships with the staff, and they feel welcomed. And believe me when I advise you not to bring life's accumulated baggage along for this emotional roller coaster.
Lastly, from my 30-some years of experience, I say to you, don't underestimate your loved one: They're stronger than you suspect and they probably already know what's best!
Mom has been living between me and my two other sisters for three- to four-month stretches of time for a few years now since dad passed on, and it's been taking a toll on us and her, moving around all the time.
She's got some things wrong with her, and it seems like new things go wrong all the time, and we're worn out taking her to doctors.
What are we going to do? How do you tell if a nursing home is any good?
-- Lynchburg
This is one of the most frequent questions I get asked and it weighs on people's minds like a millstone.
The fact is, going to a nursing home as a permanent residence can frequently become an extremely traumatic experience for both the patient and the family.
When I see the patient for the first time in the nursing home setting they often speak, and I quote, of "being thrown aside" or "they just think I am bunch of garbage" and "I'm not worth their trouble anymore" and the like. And reactions often fall along somewhat gender-specific lines in that men tend to act out agitated aggressive-depressive tendencies while women become passive, uninvolved and detached with their environment and caregivers.
I honestly think that it is sometimes worse for the families who shoulder deep feelings of guilt and then proceed to act upon them in their behavior that results in troubled interactions with the nursing home staff.
The worst mistake people make is when they exclude the loved in the decision-making process. Even if very resistant at first, by bringing the patient into the process early on, it gives the patient time to get used to the idea and a sense of dignity and control.
While there are no easy answers, the critical first step for families is to understand that they are empowered by following the steps I outline here:
1. Geography. Try to find a home within a 20-minute driving distance (no longer than a half-hour) so as to make the journey easily as there will be frequent trips to visit, bring various items, attend meetings with the staff, etc. When there's an emergency, time is important.
2. Use your phone sense. Call prospective homes and gauge how well the staff handles your questions and arranges an appointment for you to take a tour of the facility. You can tell a lot about the stress level of the site by the way a phone inquiry is handled.
3. Go the state health department Web site for a copy of the last three state surveys. Seeing the last one is not enough. What you want to see is if the site has a tradition of excellence in caring for the elderly.
4. Use your instinct. Recall how your senses were alerted when you went to look at a prospective house for sale? Think of what you looked for: Was it clean or dusty? Was it bright and cheerful or dull and depressing? Did it smell fresh or was there an odor? Apply those same standards when looking for a place to live for your loved one.
5. Make a list of the specific issues that pertain to your loved one and pose those questions. These can run the gamut from dietary concerns to newspaper delivery to types of TV/radio sets to pictures on the wall. Does the facility make every effort to make the nursing home your loved one's home or do they put barriers in the way?
6. When you get to the site, how are you received? Do you get eye-to-eye contact? Are you given an information package detailing the key features of the facility? Do they offer refreshments while you're on tour? In short, are they happy to do their best so as to have you entrust them with your loved one?
7. Look closely at the other residents. Don't see many? There may be a reason. Do the patients who seem most impaired look clean and well-kept? Those are the most challenging ones for the staff and can be a good insight into the level and quality of nursing care. Look down the halls and see how long it takes for a call bell to be answered.
8. Look at the staff. Are they busy and engaged with the residents? Are there relationships there or is everyone just going through the motions?
9. Come back on the evening shift unannounced. This is very, very important on many levels, and if the impression you received during your tour is confirmed during your evening visit, then you have a serious candidate.
10. Talk to people about your findings and seek affirmation. Friends who have placed loved ones in nursing homes, social workers who place patients in nursing homes and doctors who care for patients in nursing homes. These are the people at the tip of the spear.
11. Make the decision about the final placement together. Leave nobody out even if they are not directly involved. Don't be second-guessed. This is the time to bring up the issue of appointing someone as having power of attorney. It is a great responsibility and the one who is chosen must have good judgment, sound reasoning and have known the patient very well over the years.
One final word
Take it easy on yourself. You have thought through this very difficult decision and have decided that it is the best path to take for all concerned. Now, move forward and make it the best it can be.
There are many happy people who I care for in nursing homes, and those people are the ones who have made the nursing home their home. They have established strong appreciative relationships with the staff, and they feel welcomed. And believe me when I advise you not to bring life's accumulated baggage along for this emotional roller coaster.
Lastly, from my 30-some years of experience, I say to you, don't underestimate your loved one: They're stronger than you suspect and they probably already know what's best!
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