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• Bed sores and pain • Inappropriate medication • Use of chemical or physical restraints If you sense there is a problem with any of these, you must intervene. It is perfectly appropriate and absolutely within your rights to speak with the facility dietician, to request a dental check-up, to con sult with a nurse or physician about any physical prob lems you may discover, and to challenge anything that you feel is inappropriate or inadequate. Listen to what your elderly relative is telling you. If he or she com plains about pain, make certain that the nursing staff is responsive to such complaints. Request a list all medi cations being administered, know their purpose, and be prepared to challenge if you disagree. The use of physical or chemical restraints should be carefully assessed because, in many cases, such restraints can do more harm than good. They are associated with pressure sores, increased agitation, increased risk of pneumonia, and weak muscles and that stem from a loss of mobility. If they are being used, arrange for a meeting with the doctor and nurs ing staff to discuss whether they are truly needed. Are they being used to protect the resident or are they be ing used for the convenience of the staff? If you feel that they present a problem, arrange for a re- evaluation. To become a better advocate, get to know the names of the key staff members in the facility; the Administrator, Director of Nursing, dietician, physical therapist, charge nurse and recreation director. Famil iarize yourself with the staff that is directly responsible for your elder’s care, and establish a working relation ship with them. Don’t be afraid to ask questions about your elder’s care, and arrange to meet with staff mem bers to voice any concerns. Be mindful that the resi dent and the family have the right to be informed about every aspect of the care received in the nursing home. Despite your efforts and vigilance, problems will arise. For instance, a resident's Care Plan may call for five days of physical and occupational therapy. One day, the family caregiver is informed that the resident can only receive physical therapy three days a week, be cause he “is not cooperating” or is unable to follow directions. This happens frequently and requires the immediate intervention of the caregiver. It is a signal to you that the medical, emotional, or nutritional status of your elderly relative needs to be re-assessed so that the staff can determine the underlying reasons for the change in the resident’s ability to participate in the care plan. Sometimes, the problem can be traced to a change in medication or improper nutrition. At other times, it can signal an undetected physical problem or some other factor that should not be ignored. If you disagree with any aspect of care, be mindful that every resident has the right to optimal care. As the resident’s representative, you have the right to request another care planning meeting. Be spe cific about the problem and focus on ways of solving it. To make certain that the "baby is not thrown out with the bathwater" specify which parts of the original plan are to be retained. Keep records of when the problem occurred and make note of whom you spoke to about the prob lem. Above all, when advocating, remain aware of the rights of your relative to self-determination and the right to participate in the care plan. It is important to include your relative in the decision-making process. If you support you’re his or her right to dignity and re spect, the staff will do the same. Remember that caregivers, family, and friends play an important role in improving the quality of life in a nursing home. There are many things that can be done to help in the adjustment process. Help your rela tives maintain an interest in the world around them by providing stimulation such as music and books. Help them to write letters. Make certain they have access to a telephone, a television, a radio. Encourage them to participate in activities that are offered at the facility. Make certain that such activities are appropriate to their abilities and interests. If possible, take them out to church, for a walk, or to visit a friend. Create a homelike atmosphere by bringing personal belongings, clothing, and photographs. Visits from family members and friends are essential in maintaining morale and well-being. Fre quent visits will help your elder feel less abandoned. Visits during meals are an excellent opportunity to bond and carry the benefit of allowing you to monitor food quality and food intake. During your visit, carefully observe the inter action between staff and residents. Is staff courteous and pleasant to residents? Does staff seem caring? Are they responsive to residents’ needs? The most impor tant thing to remember is that your participation and interest can have a major impact on what occurs when you are not there. If nursing home staff recognize that the family is involved in the care of the resident, they will be more responsive to that resident's needs and will be more likely to address those needs more care fully and more diligently. The next article in this series will address “Patients ’ Rights and Handling Complaints. ” 13
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