With Love and Gratitude

A blessing a day keeps the doc away

Baby Boomers: Start Turning Nursing Homes Upside Down

Today's nursing homes are designed for fish not people.

If the generation that grew up with the Beatles, the Grateful Dead, and Woodstock is to live out the last chapter of their lives in nursing homes, then there will have to be some changes made. Whenever I walk into a nursing home, I feel as if I am in a giant fish tank of people. But the fish have it better, they have the freedom to swim about and get some exercise.

It's time to start now to turn nursing homes upside down.  We all know someone we love in such a facility -- a family member, a neighbor.  Their quality of life within the fishbowl of open doors and little privacy is improved with every visit from "the outside."  But from a selfish perspective, baby boomers should start today to assess nursing homes, lobby for better care, and demand responsive physicians as well as integrated recreation with qualified counselors and activities that stimulate the mind and body.  With health care’s entrenched models of convenience for providers, it may take a full 10 - 20 years before we begin to see nursing homes that any of us would like to consider home.

Dr. S. Jay Olshansky, University of Chicago

Getting a handle on the nursing-home situation is critical for baby boomers as was underscored at the recent Gerontological Society of America’s 65th annual scientific meeting.

A member of the MacArthur Foundation Research Network on an Aging Society, S. Jay Olshansky, Ph.D. pointed out: “As this generation of those ages 55 to 64 move into retirement within the next 10 to 15 years, they are going to experience levels of morbidity, disability and frailty that are higher than the generations that preceded them into retirement” because they will live longer.  Museum of Science and Industry | S. Jay Olshansky podcast.

Nursing home inspect: New way to make comparisons

Nursing homes are often associated with one’s final move. Once there, you stay. But families who are actively involved with the nursing homes where someone they love resides are evaluating care and even changing nursing homes when they identify deficiencies or are dissatisfied with placements made during hasty hospital-discharge planning.

Whether to determine an initial placement or identify a new home for change, making comparisons has been challenging because of how information is presented on state and national web sites.

However, recently a tool was devised that appears on the website of ProPublica, a nonprofit investigative journalism organization in New York. Called Nursing Home Inspect the tool lets users easily examine trends at the facilities, according to reporter Charles Ornstein, one of those who spearheaded the project.   

Ornstein said: “U.S. Centers for Medicare and Medicaid Services (CMS) made the decision to put inspection reports online, but there was no means to quickly compare homes. With our tool people can search through and obtain information that they need. This tool makes available more than 58,000 nursing home inspection reports from the past three years encompassing over 262,500 deficiencies.”

Is it too traumatic to change nursing homes?

One concern about making a nursing-home change is the perception of transfer trauma. Robert L. Kane, M.D., professor and chairman in the Long-term Care and Aging Department of the University of Minnesota, said that there has been a belief that nursing-home transfers are beleaguered with setbacks.

He explained: “What we know about care in general is that change introduces an opportunity for bad things to happen. You counter this by preparation and engaging the resident in the decision as much as possible.

“Caregivers should recognize the importance of arranging for the information transfer of medical history, medication and behavioral records. The caregiver is the only person who really knows what is going on and the more you can compile the better the chances for success at a new home.”

While caregivers may fret with worry, Dr. Kane, author of “The Good Caregiver: A One-of-a-Kind A One-of-a-Kind Compassionate Resource for Anyone Caring for an Aging Loved One” added: “We do know that humans are incredibly adaptable. However, if a person is happy in a situation that is not good, how do you weigh the benefits against the disruption? And keep in mind that you as ‘the weigher’ are already biased.”

Become proactive today or there will be no change tomorrow

Finding an appropriate nursing home is a challenge. However the facilities we see today will be there unchanged tomorrow unless boomers demand new models of care. The only way that is going to happen is to get on nursing home boards, volunteer to assist with activities, bring a choral group to engage residents, visit relatives and friends and stay for lunch and dinner. Make a note of everything you dislike in a particular home and address it with the staff.  Watch to see signs of depression.  Few facilities have a psychiatrist on staff. And of course, check to see about a physician.

Is there a doctor in the house?

If there is a physician on staff, he or she may not often be willing to talk to family members. Perhaps this can change.  Writing in the Annals of Internal Medicine, Paul R. Katz, M.D., made a compelling argument for a new model of nursing home physician. 

“We contend that rather than accepting a diminished presence of physicians in nursing homes and finding alternative care models, it is time to fully consider, appropriately fund, and test the nursing home specialist model. If nearly half of the baby boomers spend some time in a nursing home, the question 'Is there a doctor in the house?' will take on new urgency and meaning.”  Nursing Home Physician Specialists - Annals of Internal Medicine

Dr. Katz, University of Rochester, and his team were long-term care poster presenters at the GSA: "Medical Models in Veterans Health Administration Community Living Centers."

Written through the MetLife Foundation Journalist in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America. Copyright 2013 Rita Watson, MPH.

 Have you read these articles?

Rita Watson is an Associate Fellow at Yale's Ezra Stiles College and a columnist for The Providence Journal.

more...

Subscribe to With Love and Gratitude

Current Issue

Dreams of Glory

Daydreaming: How the best ideas emerge from the ether.