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The Nursing Home Resident's Adjustment: What a Family Member Can Do

Having a family member in a nursing home can be a daunting experience. Placing a relative can actually make a family member more stressed than the actual resident themselves. Family members not only are attempting to accommodate the emotional needs of the resident and their response to the nursing home, but they are also attempting to cope with their own response as well. The following is a list of ideas that a family member can utilize to enhance the adjustment of the resident in the nursing home. Once a resident shows signs of becoming more comfortable in the nursing home environment, a family member's level of comfort can soon follow. Before you consider implementing any of these suggestions, you first need to read your rights as caregivers. No family can truly optimize the adjustment of their loved one in a nursing home until they first ensure they are caring for themselves.

KNOW ALL THREE SHIFTS

There are three shifts caring for your resident in the nursing home and a family must get to know each one of them. The day shift is usually from 7 a.m. to 3:00 p.m.; then there is the 3:00 to 11:00 p.m. shift and the overnight shift, which lasts from 11:00 p.m. to 7:00 a.m. It is important to become familiar with some of the staff from all three shifts.

The staff in a nursing home treats residents differently if they know more about them as people and the lives they led before they actually came into the building. Most sites have a nursing supervisor who is key to the unit and the workings of all three nursing shifts. This supervisor primarily works on the day shift, and it is important to get to know him or her well. This nurse communicates the resident's needs to the staff of all three shifts responsible for the care of the resident. If you call or visit, looking for information when this supervisor is absent or gone for the day, it is possible that the information that you give is not being given to the right person.

The supervisor on the unit usually oversees the care planning process. Although the supervisor may communicate the resident's needs to the care team, do not assume they provide each shift an overview of the resident's social history. Provide this information whenever possible.

Helping members of each shift get to know who your loved one is, can be valuable to ensuring they receive the highest quality of care.

MEMORY BOARDS

Memory boards have become very popular on Dementia or Alzheimer's Units in nursing homes. They can range from simple to very elaborate. The board itself is a standard, mid-sized bulletin board, which can be easily purchased and installed in the resident's room. Memory boards incorporate information about a resident's past and future. They are an expression of the resident's life and may include past and present photos of the resident and family, or familiar locations that are key to the resident. It is important that each photograph is labeled clearly, and that items are taped on rather than push-pinned. The focus of the board, and perhaps more valuable than the photographs, is the actual written information about the resident. This information is not provided just for the resident's benefit, but for the staff as well. Good information can benefit the staff while caring for the resident.

This information can include:

Past accomplishments
Things that the resident is most proud of
Place of birth
Children's/grandchildren's names
A favorite vacation destination
Something the resident might find funny
A favorite things/favorite TV programs

Although valuable to the Alzheimer's resident, memory boards can be of great benefit for the more alert, oriented resident as well. Be creative.

CLOTHING FOR ALL SEASONS

Clothing can the largest source of frustration for family members. First, realize that upon admission a nursing home does provide a clothing list to fill out. During a resident's stay it is crucial that any clothing replaced by you is updated on this form.

Since facilities wash hundreds of articles of clothing each day, it is inevitable for some clothing to get lost. This is why labeling of clothes is so important. Purchasing nametags for clothes and having the clothes clearly marked can make a big difference. If nametags are unavailable, then use a laundry marker and write the resident's name on the inside of the item.

Residents feel better in their own clothes, regardless of their medical condition. Meet with the department of social work or even the director of the laundry department and ask what type and quantity of clothes would suit the resident's needs the best. Also keep in mind that when the seasons change, so does the need for different kinds of clothing. Take the summer clothes home and replace them with winter clothes, and vice versa.

Family members also believe that clothes in a nursing home are intended to last forever and this could not be further from the truth. The heavy detergents in the laundry department wear clothes down actually quicker, and hence replacing clothes is crucial when needed.

VALUABLES

There is nothing more heart wrenching than when a resident loses something valuable to them. Many have long held wedding rings, bring cash or even hearing aids and all of these things can easily be missing at some point during their stay.

Since medical problems contribute to weight loss, recognize how it is very easy for rings to slide off a resident's finger. Replace them with less valuable rings before admission and before placement occurs to prevent the hardship of this loss.

Residents carry pocketbooks and wallets all through their lives but unfortunately, they are easy targets for loss in a nursing home. Nursing home residents can continue to have their pocketbooks and wallets on them in the nursing home but a family member must ensure that nothing valuable is inside of them. Having a small amount of cash is absolutely advisable if the resident is used to having cash on them, but allow the staff members to know when the cash is being provided to the resident and keep the amount of cash extremely low. Most facilities have small lock boxes in the resident's rooms, but only encourage their use if your resident can fully understand how to work the lock box with a key or combination lock.

Unfortunately, most hearing aids end up wrapped up in tissues and are accidentally thrown away. If a resident has a valuable hearing aid, the family should meet immediately with the nursing supervisor. Together they should create a protocol on how to keep the hearing aid well protected at all times. Reviewing how to protect this valuable with the nurse can help in preventing its loss and expensive replacement.

HOME FURNISHINGS

Each nursing home is required to make the facility as "home-like" as possible. Although family members have little input into the actual physical plant outside of the room, they can have input on the physical environment inside the room. For the long-term resident of a nursing home, it is often permissible to bring in a favorite piece of furniture from home. Having something clearly identifiable to the resident can offer a great deal to them when they are coming to a nursing home. Families are encouraged to meet with the maintenance director, as most will not only help a family member bring the furniture into the building, but also help in putting up photographs or even shelving on the walls so the resident can have increased space. Bring in the favorite picture, put up brick-a-brack on the shelves or post a favorite wall hanging, as this can really help the resident feel more at home. Realize that the nursing home has to follow certain Department of Public Health Regulations and fire codes, but they can usually accommodate a family to help make the room more comfortable.

Bedding is also something a family can assist in. Most nursing homes will allow the resident to bring in a favorite comforter, quilt or pillows. Since the bedroom is where the resident will spend most of his or her time, make the bed the actual centerpiece of the room. If the resident's mattress is not comfortable, discuss a change of mattresses with the maintenance department. Often, simply turning the mattress over can bring a great difference. Feel free in any capacity to decorate the resident's room in order to make it feel more like the home they left behind.

ESTABLISH A VISITING SCHEDULE

Most residents grow anxious when a family member leaves the building. Having the resident aware of when the future visit will occur is extremely helpful. Some families actually place a full calendar in the resident's room and simply circle the day and the time of their next visit. This is very beneficial to staff because they can actually use the next date to reassure the resident when they are actually asking when their family is coming in. For residents, consistency is actually more important at times than the length of your actual visit.

SHARE YOUR MEMORIES

An article which helps family members have more productive visits in the nursing home can be found here. Residents want to talk about their lives if someone will listen to them. Family members struggle with what to talk about when they visit, and this can be related to how uneasy they feel in the nursing home environment themselves. Getting the resident to simply review their lives is a great distraction from their current concerns and adds to their peace of mind. Even if you bring up the same story at each visit, if the resident is talking, keep it up. Bring family photo albums in and bring them in regularly. Do not avoid bringing in new photos of events for the resident to look at and share with them. Some family members even utilize their VCR to bring in past or more current family events and share them with the resident. What many residents strive for is the simple act of feeling that they are involved in some meaningful way with their families outside of the building.

FOOD

All nursing homes have dietary departments as well as dieticians mandated to go over your loved one's nutritional needs. In the nursing home environment, family members can often feel little can be done to improve the resident's food likes and dislikes, and this is untrue. Ask to meet with the food or kitchen supervisor to make changes in the resident's food, as many residents themselves do not take this initiative. Ask if the resident can keep their own food seasonings in the room and review how food from home can be brought in and stored safely, close to the resident's room.

Food can often ease the stress involved when a family member visits a loved one in a nursing home. Food is utilized socially throughout the resident's history and this should not stop just because of placement. Get a full sense of what you can do within the facility with regards to food. Most nursing homes encourage outside meals or snacks that can be brought in. Visit while food is being eaten and most visits can go much smoother. Also realize that facilities can usually accommodate a guest tray so that family members can share a meal together with their loved one.

MEETINGS

Nursing homes are prone to providing many opportunities for family members to visit. Unfortunately, many of these meetings occur when the family members are working. Care plan meetings occur every three months and most sites have a conference call capability if the family member cannot attend them. These meetings are usually 20 minutes long. Attend them! They give the family time to describe and discuss the care being provided with the care staff of the facility. The meeting is an opportunity to meet the department heads in the building responsible for each of the disciplines that serve the resident. Staff at the nursing home simply do a better job when they know who you are. Give them the opportunity to meet and talk to you during the care plan meeting and at any time when you visit. If you need to meet with the staff in addition to the care plan meetings, then go to the social worker and make the request. Most facilities will easily accommodate the need for an additional meeting to go over your loved one's care.

HELP WITH FRIENDSHIP BUILDING

Adjustment is prime when a resident can make relationships with others; without it, depression can follow. Do not assume your resident knows how to make friends or is used to having a roommate. Nothing is more frustrating to a resident than attempting to have a conversation with a fellow peer who cannot hear them or is confused. The social worker and activities director can personally assist you as a family to identify other key residents who share your loved one's past interests or ability in terms of communication. Making relationships and meaningful ones is key to a resident's long-term adjustment in the nursing home.

ADDITIONAL HELP

If after a period of time (usually within six months) you find that your loved one in the nursing home is not responding well, even despite all of your efforts and the efforts of the staff, additional intervention may be needed. Most of the nursing homes have a psychiatric team which includes licensed, professional counselors. Sometimes medications are even needed and can be considered if there is a potential benefit. Other situations might actually require a therapist to come in weekly to help the resident talk out fears and concerns. Regardless, most social workers can help make the referral for this type of help, and family members should be encouraged to do so if they feel the help is needed.

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Contact Inter-Generations at intergens@cox.net