The February 2014 issue (supplement) of The Gerontologist is devoted to the topic of “nursing homes” and their culture. I particular, the issue focuses on the transformation of nursing home culture – or at least the attempt to do so.
I put the phrase “nursing homes” in quotes because to me t is pretty darn close to an oxymoron. Yes, it is a facility in which on-going nursing occurs, because that is what the patients who reside there require. Some of these facilities (which we refer to as long-term care facilities or skilled nursing facilities [SNFs]) are excellent at what they do for their patients / residents. Are they “homes”, however? Not the ones we frequently visit in our role at Support For Home, providing elder care and Geriatric Care Management.
As The Gerontologist issue points out,
Efforts to shift to a broader focus on overall quality of life an well-being face several serious challenges. First, most nursing home residents have a combination of complex medical conditions and frailty … Further, 60% require human assistance with three or more activities of daily living … [and the facilities are not – cannot afford to be – staffed to provide that 1:1 care]
The issue is not that bad people work at skilled nursing facilities (sorry, but I cannot use the phrase nursing homes any more). Most of the SNFs we work with are as well staffed as they can be, with dedicated, talented people. They are never going to be able, however, to provide the 1-on-1 care that will turn a facility into a home.
The laws governing care for the elderly and disabled continue to focus on providing care in the “least restrictive” environment possible. For some patients, that is going to be a SNF, regardless of whether it has the slightest resemblance to a home. For others, a combination of caregiving at home, combined with Home Health, are a better solution.
Until our healthcare system provides the budget that enables a SNF to act, look and smell like a home, let’s recognize the critical value they have and respect the folks who do their very best in that environment. Make them better and more resident-centric, absolutely. But let’s not pretend they can be something they are not.
With many thanks to the folks who work in SNFs, and best wishes. Bert