People move into nursing home environments for a variety of reasons. They require more care than is available in their community or present living environment but, also oftentimes because they are isolated and alone in their own home.
What is striking about the nursing home environment is that despite being surrounded by people, from young to the most advanced in years over 100, people are isolated and lonely. The traditional nursing home environment is not conceived as a place of community, gathering, togetherness or connectedness. All of which are essential for thriving physically, emotionally and psychologically.
Most of us can conjure up images of a nursing home environment. Many of us have seen them first-hand:
We have or have had a family member or loved one in a nursing home, we visited or are working/worked in a nursing home, we were in a nursing home. We envision people lining the hallways in wheelchairs with vacuous stares; people languishing in their rooms staring aimlessly into space, calling for help, calling for attention; people propped in front of televisions as if they are children set in front of the TV as a means of occupying them. Much of the time people show little interest in the programming, many times it’s not suited to their interests. Of course, a stint on a short-term rehabilitation unit may find a different experience from a long-term care unit.
There are occasional activities as they are called: bingo, monthly birthday parties, sing-a-longs, maybe a baking activity. However, for the most part what I have seen in the traditional nursing home environment is that these are few and far between the daily monotony to break up passing of time. That is not to say that in many homes there is not a dynamic recreational or engagement leader that understands the importance of purposeful enjoyable activities that ignite the spirit and engage the mind.
While some traditional nursing environments are making efforts and have been successful at embracing culture change and creating a sense of community and belonging for residents, others use the word community and person-centered care like a “buzz word”, checking off the required box to fulfill some latest CMS guideline about providing optimal care environments.
For the residents residing in the latter environment, they continue to languish in loneliness and isolation. With little interaction or feelings of connection with others. I intentionally use the word ‘residing’ for this is not living, this is existing. The great waiting ground between life and the ultimate end-of-life destination. It surely doesn’t have to be, and shouldn’t be, that way.
One of the most important lessons from COVID was bringing to light the effects of isolation, loneliness, and overall disconnectedness. It affected all of us.
Life changing solutions came out of it. Zoom exploded in popularity and nursing home residents finally enjoyed face time visits with some degree of regularity, a practice I was trying to get going for a few years without any success.
But the frenzy surrounding COVID has all but faded from the landscape. Facetime visits have also all but faded from the nursing home landscape, at least the ones that I have seen. Not to say they don’t happen at all, but it doesn’t seem to have been incorporated as a standard practice.
Where does that leave residents? Back where they started. Isolated and lonely despite being surrounded by people. Waiting like a puppy for someone to notice them as they walk by. It’s heart wrenching and tragic.
How or why does this continue?
As for helplessness, for expedience purposes, tasks are oftentimes completed by others. People are served food on trays with little containers needed to be opened by others. This is not how we eat in our homes.
Food is cut for them. Half the time no one even asks if the person would like someone to open something or cut their food for them. The other half of the time it’s done automatically or not at all.
My experience in some buildings is that food is ordered already chopped because staff is not willing, available or has the time to assist a person with the cutting of the food into bite sized pieces. This is a dignity issue. It’s essentially like dumbing it down for the purpose of expedience.
In many instances, residents eat in their rooms, in hallways, or at tables with little conversation or interaction.
Last but not least: Despair. Not only for the people residing in the nursing home but for the people who work there at every level.
I came face to face with this the other day which is what prompted me to write about it as the subject of today’s blog.
For the past 6 months I’ve been working in a nursing home helping to develop a clinical speech program.
The issues related to food were egregious, with only limited improvement in the six months that I was there.
My exit was precipitated by 2 factors: The driving distance from my hone and a professional colleague whose skill level left me uncomfortable.
Upon my exit, the facility made a decision, I’ve seen made repeatedly and is probably at the root cause of poor quality of care, dignity and respect in nursing homes as much as lack of sufficient staffing.
Rather than have no one to provide service, they brought back the person who they knew had questionable skills to do the job. Rather have someone doing a terrible job than having no one to do the job is the prevailing point of view. This is part of the downfall of the entire nursing home industry. Bad or toxic behavior, and substandard work are infestations that are corrosive in a work environment. It creates poor morale and affects work performance; if they can do it, why am I killing myself?
This is where I came face to face with despair.
I was headed up in the vicinity of that nursing home for an appointment. Though I did not have to go to there on the drive in that direction I had a sinking feeling in my stomach and in my heart. It was the feeling of despair, of utter hopelessness to enter a situation where though I was told I have made a difference in people’s awareness and willingness to speak up about what they see as causing potential harm, especially where food and eating are concerned, little to nothing had changed in the 6 months I was there. Situations that likely were not going to change. In recognizing how I felt, I realized this is how most of the workers in traditional nursing homes must feel.
Many of them want to do a good job. They are people who do the best they can with what they have. They care for others with a caring heart.
But the nursing home destroys their morale, their empathy, their drive. They go to work in despair. They perform their jobs with despair in their heart and the residents live in despair.
It’s not their fault. It is the fault of a system that was created while conceptually rooted with the fundamental premise that older people who are ill, frail and infirm need an environment where they can receive care, the purveyors of these environments have not entered the business for the purpose of caring for people. For the most part it is a business mindset. While this piece is not intended to support or dispute the nursing home industry as a business, fundamental to the business is taking care of people. All of the people in the environment. Workers and residents.
Until there is a mindset shift and change in the structure of the nursing home environment, loneliness, isolation and despair will continue for both workers and residents alike.
Phyllis conceived and is host of the Podcast SeniorsSTRAIGHTTalk on the Voice America Empowerment Channel and can be found on all popular podcast platforms.
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