Suggestions For Easing Tensions Between Family And Nursing Home Staff

In a recent New York Times blog entitled "Easing Tensions In The Nursing Home," author Paula Span addresses the important issue of tension between family members and nursing home staff. As you can imagine, most, if not all, of the issues contributing to this tension is a family's belief their loved one is not being cared for in an appropriate manner against the staff's belief to the contrary.

According to Ms. Span, the tension between family and staff leaves the family concerned that, if they voice their concerns, their family member will suffer because unhappy staff will, in some way, retaliate against the resident for the complaints of the family. To avoid, or at least lessen, the chance for tension between family and staff, Ms. Span provides the suggestions of Karl Pillemer, a gerontologist at Cornell University, and the sociologist J. Jill Suitor of Purdue University:

  • Take complaints and requests to the right place. While aides do most of the hands-on care in nursing homes: “They’re almost never the ones who are making decisions about it. You’ve got to go high enough up the chain to make sure the person you talk to has the ability to influence what goes on.” The staff social worker is a starting point.
  • When a problem involves an aide’s duties, practice “clear and respectful communication.” “Avoid blaming the other person. As people get angry, there’s a tendency to insult the other party, and it escalates.” A demand or reproach — “How come nobody’s shaved my father?” — puts overworked staffers on the defensive. Try phrasing it this way: “I noticed my father isn’t shaved. This is very important to him. How can we make sure he’s shaved every day?” After the conversation, summarize to clarify the agreement you have reached: “I understand that you were short-staffed today. But he will be shaved every morning — is that what you’re saying?”
  • Keep visiting, and monitoring. “The amount of visiting people receive is directly related to the quality of care. Families do need to advocate for their relatives, but they need to do it in the right way.”
  • Give positive feedback as often as possible.

In a previous blog post, entitled "The Ombudsman for the Idaho Commission on Aging is on the Side of Idaho Nursing Home Residents," I addressed the role of the Idaho Ombudsman for long term care in addressing concerns regarding teh care of nursing home and assisted living facility residents. Regardless of the involvement of the Ombudsman, it is important you, as a loving and caring family member, are able to effectively communicate your concerns with the proper individual at the facility so your family member does receive the proper care. As Ms. Span and Mr. Pillemer suggest, perhaps the most important contact at any nursing home or assisted living facility is the social worker or, if none is available, the director of the facility.

I suggest not only approaching the appropriate individual with your comment or concern, but also following up with that person in writing. A written summary of your concerns, the discussion which you had with the appropriate upper-level employee and the outcome or change in care you expect are all good things to write down. This way, if the concern is not addressed, you can again voice it or contact the Ombudsman. If the concern is addressed, you will be able to follow up with a "thank you" to the staff of the facility caring for your family member or loved one.

Reliable Internet Resources For Choosing A Nursing Home

Are you choosing a nursing home for yourself or a loved one? You need to be comfortable and knowledgeable. There are numerous websites to assist you.

The United States Department of Health and Human Services' Medicare nursing home website is an excellent place to start your quest for knowledge. There, you will find a link called “Nursing Home Compare.” You can use this website to compare nursing home facilities in your area. You can also compare the quality of nursing homes you are considering. A “Nursing Home Checklist” is available if you are going to be visiting a facility.

In Idaho, you have additional choices for researching potential nursing homes. You can contact the Idaho Commission on Aging to help you in this most important decision. There you will find information about the Ombudsman program as well as a link to the Bureau of Facility Standards, where you can review results of surveys of long term care facilities in Idaho. A copy of the most recent survey results lists 84 facilities throughout Idaho. The survey includes complaints, violations discovered during inspections and a facility’s response to these things.

The "Nursing Home Checklist" is an excellent resource for when you go to various facilities to investigate which facility is the right one for you. For example, the beginning of the Checklist focuses you on whether the facility actually has the appropriate level of care you or your loved one requires. Remember, no matter how nice a facility or its staff is or appear to be, if the appropriate level of care (skilled nursing vs. custodial care) that facility is simply not the right one for you or your loved one. Choosing an inappropriate facility can lead to numerous problems, not the least of which is injury to you or your family member.

Questions To Ask When Deciding On A Nursing Home

The decision to place someone you love into a nursing home or assisted living facility is not easy. You and your loved one have decided it is “best” because they can no longer live safely on their own. You have struggled with the decision. You have spoken to everyone you know about it, but do you know the important questions to ask when making this most important decision?

In Tammy Worth's Los Angeles Times article, How to Decide Whether a Nursing Home is the Right Fit, she shares excellent questions you and your loved one should ask before deciding on a facility. Those questions are:

  • Does the care meet the needs of your family member? Does the facility have proper medical services? Can residents personalize their rooms with photographs and other items? Are staff members interacting one-on-one with residents? Is the staff smiling and welcoming?
  • Does the facility have adequate fire and safety systems? The most recent state inspection report will show if it had deficiencies related to fire drills, up-to-date manuals and policies, or expired fire extinguishers. A fire marshal report should also be posted at each facility.
  • Does it have a wanderer alert? These devices are used to make sure a disoriented resident doesn't leave the residence.
  • Does it have a pastoral care program of any kind? Such programs suggest the homes are connected to the community and that they value all dimensions of the residents' lives.
  • Does it have a volunteer program and, if so, what do those volunteers do? These programs indicate “fresh air in the place.”
  • What is the policy on chemical and physical restraints? Obviously, the fewer the better.
  • How frequently do patients get pressure ulcers? Such injuries occur when an individual stays in one position for too long and the skin in contact with the bed or other surface begins to break down. Again, the fewer the better. This is listed under a home's quality report on Medicare's Nursing Home Compare.
  • What is the medical direction model? This explains what kind of care the facility specializes in providing, i.e. subacute, Alzheimer's, for the developmentally disabled. Ideally, many of the patients at a facility would need similar kinds of care.
  • What are the weight loss numbers like? All homes will have some, but they should not be substantial. This is listed under the quality report on Nursing Home Compare.
  • Does the facility have a resident or family satisfaction survey, and if so, will they show you the results? Good facilities will be transparent?

Of course, the most important question to ask regarding any facility is whether it has the ability to meet the needs of you or your family member. If a facility does not have the experience or expertise to meet the medical and other needs of your family member, it really does not matter that it "looks nice," or "the food is good." If the facility is unable to meet a potential resident's needs, it should say so. Unfortunately, that may no always happen. That is why it is important for you to be knowledgeable and ask the right questions. Questions, like those Ms. Worth suggests are a good place to start.

The Ombudsman For The Idaho Commission On Aging Is On The Side Of Idaho Nursing Home Residents

According to a 2005 factsheet by the National Center on Elder Abuse, the incidence of abuse of the elderly is between 2% and 10% nationwide. Remarkably, the NCEA believes that, for every incident of elder abuse in America, five additional incidents are not reported. It seems like there is a story about a nursing home resident being abused in the newspaper every day.

 In Idaho, if you are a resident of a nursing home or assisted living facility and believe a loved one is being abused or neglected, you have someplace to turn. The Idaho Commission on Aging  has an “Ombudsman” program to help you.

An Ombusman is a an person appointed by the Idaho Commission on Aging to investigate complaints concerning your care in either a Nursing Home or an Assisted Living Facility. The Ombudsman will insure your health, safety, welfare and rights are protected. You can contact the Ombudsman free of charge 24 hours a day, seven days a week.

The Ombudsman is an excellent resource for residents of Idaho's nursing homes and assisted living facilities. In fact, the Ombudsman's primary job is to "advocate for resident's rights and quality care." Because the Ombusdman is familiar with the duties a nursing home or assisted living facility owes to its residents, he or she can answer a variety of questions or accept ensure the investigation of resident complaints. If you have a question about the care you or a family member is receiving in an Idaho nursing home or assisted living facility, the Ombudsman should be your first call.