CARING FOR THE VULNERABLE…..(PART TWO)

Thank you to all who made comments and called me after part one of ‘Caring for the Vulnerable’ where I talked about having patient-based care and single rooms for all who live in care facilities.

If politicians are serious about making a positive difference to the care of the elderly and those with complex health needs, new thinking must be implemented.

A one hour planned visit does not give anyone the true picture of a facility. In order to make economically wise decisions while keeping patient needs first, talk to family who visit regularly, residents and staff.

My parents were part of a survey, yet they didn’t want to say anything negative that would upset the staff that they were dependent on. I suspect some staff felt the same way when asked for opinions.

Those of us who visited often, and spent years in and out of facilities have much to offer. We have watched staff interact, seen residents arrive and later fade as their health needs become more complex. We see the caring staff who take time to visit, the cleaning staff who sing while they work and the laundry people who sew buttons on, using their own time. I watched the handyman cheer so many people as he went about his work, calling residents by name and asking questions they could answer.

For the most part the staff I saw were professional, worked hard and cared about their residents. There were just too few and there were too many patients for them to be successful. I could sense frustration when they couldn’t reach all residents in a timely manner.

I think that the buildings need to be utilized differently.

When I visited my parents, I always thought how wonderful it would be if high school students, who were in alternative programs/classes used the eating areas for classes. They would arrive after breakfast, have a break for lunch and sit with the seniors as they all ate together. After lunch they could resume classes.

It would give residents something to look forward too and it would afford students an opportunity to connect with the residents. It would promote conversation at the tables.

I could see some residents just coming and watching the students or sitting in on the classes. In Alberta there is required program in high school called Career and Life Management (CALM) that would work well.

If once a week classes were held in a care faculty all kinds of enrichment would occur.

My parents had so many wonderful stories to tell of growing up. They rode horses to school, trapped weasals on the way to school, that were later used for the Queen’s coronation and had memories of going to and later teaching in a one room school. The first job, on cold winter days was to light the fire and gather snow to rub on children who arrived with frost bite.

What rich experiences students, who perhaps missed out on grandparents, could have when these readily available resources were so accessible. The rewards would be two-way.

When I have visited in assisted living and long term care facilities there are always some common rooms not being used. How about hosting adult classes there? Classes such as Writing Memories, Arm Chair Travel, Crib Club, Yoga, Balance Classes, Knitting or Craft Groups. What a treat for the residents to be able to sit in or participate with their outside community.

Residents are often bored and feel useless. I could see making rag rugs or adding to discussions a great opportunity for all. People sitting around doing a craft together would encourage talk, something many seniors in institutionalized care crave.

Most residents have a regular church service, why not offer groups a place to hold regular meetings? When members arrived they could stop by rooms to invite the residents. My dad and uncles would have loved to hear about the new farm machinery available and what it was capable of. Others would enjoy watching demonstrations of word craving or watching an artist paint a picture.

When I think of the atrium at my parents spot, if artists were to come in and set up their canvases I could see residents watching, possibly interacting and simply enjoying something different.

How about a local band or school band coming in monthly to practise and present a concert? Or a small group such as the jazz band or string quartet setting up in small areas to practise and offer more intimate concerts.

Book discussion groups, politicians, gardeners, a genealogy group, local museum group or those interested in royalty are often looking for space to hold meetings. Offer up a room for an hour or two at the local care facility.

If more people were coming in and out I believe the residents would be more stimulated and willing to participate. Also ‘the public’ would begin to see what goes on in these facilities and perhaps discover ways to help out or lobby for more care.

While some people can’t hear and others can’t see the fact that there is more going on around them in the public areas would be excellent. I remember one fellow would be looking out the window in the hall when I arrived. I asked him what he was seeing and he told me he was watching a farmer seed. Everyone else was in their rooms. He wanted and needed some conversation and stimulation.

It’s not just seniors in these facilities. One fellow I got to know was probably in his early fifties and he watched movies from morning to night, all alone in his room. If I engaged him in a discussion he was knowledgable and enthused. What a rich resource that was not being utilized.

Another young person who had some kind of advanced muscular disease always looked so lonely as there was no one her age to chat with. While frail, she needed something to look forward to. I only ever saw her at meals, sitting at a table with non-verbal residents. No wonder she spent all her time in her room.

When the recreation director had an exercise class with all the residents sitting in a circle throwing a ball to each other I can understand the reluctance of residents to attend. Why not have community yoga classes where instructors can adapt movements for residents who attend and other residents are able to watch the outside people participate. I bet over time conversations after classes would be rich for all.

Preschool and kindergarten programs could be offered and residents would love to watch the children and teachers interact. Many residents would enjoy having children read to them or residents would happily read or simply chat with the children.

Why not have raised flower and vegetable beds in atriums so some of the more agile residents could plant gardens or help to keep them weed free. Young children could help out too. These kinds of adaptations would give the residents a feeling of being needed and worth.

Because my parents were in a small town care facility, the staff mostly stayed the same. This should be a requirement of all institutions. When staff are hired they are offered full-time or part-time positions and only work at one location. Staff also need to work with the same residents so all begin to understand each others idiosyncrasies.

For residents to never know who is going to show up to bathe or administer medications is upsetting and confusing. As they need more care, the staff understands them and is able to offer much more compassionate care.

My mom’ personality changed over the four years she was in her long-term care facility and what comfort for her to have familiar caregivers. It was comforting for me to know that the caregivers knew what she was like before her disease took away some of her former personality traits.

At my parents’ long-term care facility there were registered nurses (RNs) who were their case workers and had many residents under their care. They worked Monday to Friday during the day. Who believes that these residents’ needs are only a day job with no week ends?

There was a also a part-time nurse practitioner. This person was not visible on the wards, unless there was an issue. Do the ‘experts’ who staff these places think residents need to have prescriptions filled, medications changed or adapted or bed sores checked, infections diagnosed only a couple of days a week?

When my mother got an urinary infection it seemed to usually occur on Fridays….if a urine sample was collected we didn’t hear the results until Monday….by this time she was often confused and uncomfortable. She was taken to the hospital a couple of times when all she needed was to start on an antibiotic. Why?

If there was a nurse practitioner on-site, 7 days a week and Registered Nurses on 7 days a week many ambulance trips to emergency departments at the hospital would be saved.

It was a common occurrence to have an ambulance idling at the front door of the care facility as I drove up. Keeping residents in familiar surroundings with staff who understand their unique needs just makes sense. Emergency room staff, not knowing the history etc. were not in the best position to treat these vulnerable human beings.

Trips to the hospital are costly, confusing and frightening for the vulnerable. Let’s treat these people in a more humane way.

The lack of staff has been highlighted during the COVID pandemic. Seniors buzzing for assistance to get to the bathroom are often waiting over 45 minutes, residents are lined up in halls to be wheeled to a meal and then later falling asleep at the meal tables because no one was around to take them back to their rooms. The staff, I observed, were not sitting around, they simply could not attend to the number of patients they were responsible for. Let’s acknowledge that care facilities need an update on staffing levels.

With modern medicine, seniors and those with complex health needs are living longer. The requirements of 20 years ago are not the same as today.

Staffing levels need to reflect this new reality as does that fact that we need qualified health professionals in place 24/7. The wages must reflect this level of care we insist on. Training must be rigorous and on-going.

The money saved, if hospital wards where seniors are in holding pattern until a room in a care facility comes open,would be better spent on care facilities that meet the needs that are now evident and as we baby boomers age will become more critical.

In Part Three I will look at why Home-Care does not work in it’s present stage unless you have family members or friends willing to augment the limited care as mandated by the government regulations.