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Life in a Nursing Home: Your Role in Quality Control by Irene Repczuk-D’Alessio For most elderly people, admission to a nurs ing home or skilled nursing facility signals the final phase of life. It represents a loss of independence, a loss of self-determination, a loss of home, and a loss of individuality. Strong feelings of abandonment and hopelessness often hamper the adjustment to a nursing home setting. Feelings of depression can often impede the recovery process and can lead to further health problems. The adjustment for the caregiver can be just as difficult. Some may feel a sense of relief at having the burden of care lifted from them, but this sense or relief is often tinted by feelings of guilt and concern that the elderly person will not be properly cared for. Such feelings and concerns are normal, but there are ways to alleviate them. Whether your elder is admitted to a nursing home as a short-term resident or for long term care, the involvement of a family mem ber in his or her care is crucial in ensuring that quality care is provided. Most elderly are admitted to a skilled nursing facility directly from the hospital following a major illness that requires extensive physical therapy. Family caregivers who are already faced with dealing with the complexities of their elders' medical problems often find it difficult to design a systematic plan to ensure that their loved ones are well cared for in this new setting. But it is crucial to have such a plan. Un derstanding the nursing home process and the rights of the elderly and their families is the first step to em powerment. Knowledge can help you become an effec tive advocate for quality care. According to the Federal Nursing Home Re form Act of 1987, all residents in nursing homes have the right to good care. This law, which is part of the Social Security Act, states that a nursing home must “provide services and activities to attain or maintain the highest practicable, physical, mental and psycho logical well-being for residents in accordance with a written plan of care.” Each nursing home resident must receive a careful and thorough assessment within fourteen days after admission (7 days for Medicare residents.) Staff must assess and plan care that will support each resi dent’s life-long patterns, current interests, strengths and needs, based on information that is received from medical records, staff, and most importantly, from family members. The input of family in the assessment is critical in the development of an appropriate Plan of Care. Therefore, caregivers should communicate with staff and inform them of the needs of their elders. The assessment should take into account the following key areas: • ability to perform activities of daily living • communication abilities • nutritional status and medications • potential for improvement After the assessment is completed, the infor mation is analyzed and used to develop a Care Plan to address the specific needs and concerns of the resident. An interdisciplinary team—nurse, physical therapist, dietary staff, and social worker, completes the Initial Care Plan* based on the input of the resident and her family. A Care Planning Conference is held within seven days to discuss the resident’s care. During this conference, all medical and non-medical issues, in cluding meals, activities, therapies, personal schedule, nursing care, and emotional needs are addressed and agreed upon. It is imperative for the caregiver to attend the Care Planning Conference. Unfortunately, because of scheduling issues, the meeting is often held without a family member being present. If you cannot attend, it is wise to send a representative who is aware of your concerns and can speak on your behalf. The care planning conference is one way in which the family can exercise some measure of control in the care that their elder will receive. It will help to educate staff of their elder’s medical, emotional and social needs and will provide input about the type of care that is requested and expected of the nursing home. All resident and family member concerns should be acknowledged by staff and should be ad dressed in the Care Plan. A good Care Plan Confer ence should not be rushed and should take at least one hour. It is important to come to the meeting with a list of specific questions and concerns. It is also advisable to obtain a written copy of the care plan to determine whether all of these questions and concerns have been appropriately addressed. Although the nursing home staff is obligated to carry out the care of each resident according to the individualized care plan, the family must remain vigi lant and monitor the care. One of the main concerns is the shortage of nursing staff who provide direct patient care. Therefore, as caregivers, we must be aware of any changes in our elder’s condition. We must be able to intervene if problems develop. A partial list of things to watch for follows: • Loss of appetite and dehydration • Poor dental health 12 “НАШ Е Ж ИТТЯ”, ЧЕРВЕНЬ 2003 Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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