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Miss Co Says

{A series of blogs from a Social Worker perspective pertaining to nursing home placement}

September 20, 2021

MEDICARE IS BEST INSURANCE TO HAVE

It seems logical to go with the insurance that offers little to no monthly premium which is great while at home. If you or someone you know ever needs to go into a skilled nursing facility the best insurance to have is Traditional Medicare.

Miss Co Says...

September 21, 2021

ADVANCE DIRECTIVES ARE NECESSARY

I know it's not the easiest conversation to have but having a Living Will, Healthcare Power of Attorney and/or General Power of Attorney really helps to decrease family squabbles. A loved one being sick or on their death bed is not the time to be fussing over their money, belongings and medical wishes. 

Miss Co Says...

September 22, 2021

IT'S REHAB NOT PRISON

Don't delay going into a nursing facility for short term rehab because  you fear that you will have to stay forever. A nursing facility by law can't keep anyone from returning home. You have a right to ask to be discharged.

Miss Co Says...

October 5, 2021

CAREGIVER BURNOUT IS REAL

Nursing home placement is not for everyone just like staying at home is not the best for everyone. Some families choose to take on the burden of caring for a loved one at home for as long as they can even when it becomes mentally, emotionally, financially and physically overwhelming. I say burden not because it's a bad thing to care for a loved one but it can be a hard thing, especially when there is little to no support from other family members. Nursing homes help to relieve the burden. Nursing homes are not perfect but they are equipped with qualified staff that can provide the needed 24/7 supervision and care. Placing "mama" or "daddy" in a nursing home does not mean you don't love them, it just means you love them enough to get help in caring for them.

Miss Co Says...

October 6, 2021

ALL NURSING HOMES ARE NOT BAD

Most people seem to think that "all nursing homes are bad" but that is not the case. True, there are some nursing homes that don't meet the standards of proper nursing home care but that is not the case for all nursing homes. As previously referenced in another blog, nursing homes are not perfect, meaning the staff will make mistakes but you must know that the majority of the staff do actually care for the residents. Unfortunately, one bad apple do sometimes spoil a bunch. Consider this for a moment, just because a staff member is not jumping through hoops for a very demanding, overbearing family member doesn't mean they don't care or that they would mistreat that person's loved one. In spite of the negative perception that most have of nursing homes, the staff sometimes care more than family members do about the well-being of the residents.

Miss Co Says...

October 21, 2021

GUILTY BY ADMISSIONS

A lot of people feel guilty about placing their loved one into a nursing facility. The guilt mostly comes from feelings of not being able or not wanting to care for them in a home setting. It's a tough decision, true, and some people really would care for their loved one in a home setting if they could but that is not the case for all but to each his own. Regardless of the reason for a guilty conscience please don't make the nursing home staff do what you wouldn't do at home. Yes nursing home staff have a job to do, they are to provide quality care but don't get beside yourself by making a bunch of trivial requests because you're feeling guilty about leaving "mama" or "daddy" in a facility. Most requests made by some family members is not something they would do or were doing while their loved one was at home. You want the staff to go over and beyond but were you? And even if you were the one going over and beyond when they were home, guess what, they aren't home anymore. They are in a facility which means it's not just about them. The staff cannot cater to them as you would because they have other residents to tend to; it would be nice if nursing facilities could provide each resident with their own CNA but of course that is not the case.

Miss Co Says...

November 2, 2021

PAY ATTENTION

If staff don't do anything else in a nursing home, they must pay attention. Pay attention to the residents at all times. Pay attention to a change in their condition, behavior, eating habits, weight etc. Those with cognitive impairment and are ambulatory need more attention. Truth is no matter how much attention and supervision staff provide for a resident, unfortunately things will still happen. The key thing is trying to prevent incidents from happening before they happen but knowing what to do if or when it happens and following protocol promptly to ensure that the matter is quickly addressed, resolved and never happens again if at all possible. There are some incidents that should never happen in a nursing home setting.  Observation means paying attention, documentation means paying attention and making note of what is seen and preparation is paying attention to the best way to handle an incident, come up with a plan and following through with the plan if or when the incident happens. In addition, get other staff involved that provide direct care on a daily basis, involve the family, doctors, nurse practitioners, mental health professionals whoever is needed to ensure that a proper plan is in place for each resident. Lastly, if a plan of care or plan of action doesn't work for a certain resident or a certain incident, then change the plan to reflect that individual resident or incident. That's why it's a good thing to always pay attention.

Miss Co Says...

November 3, 2021

BE NICE TO THE NEW KID ON THE HALL

Working in a nursing facility is a different world, literally. It is a very diverse setting with so many different facets to learn. So when new employees start they should be made to feel welcomed for joining the team but that is not the case for the most part. There may be some nursing home staff that are friendly, helpful and understanding but most of them are not. They are not friendly, not helpful, not kind, not anything but mean and hateful. New employees are trying to learn the ropes so to speak, trying to learn how things are done, trying to learn residents, trying to learn their way around the facility, trying to learn the rules and guidelines, trying to learn staff personalities and preferences and the list goes on. Stop being so mean to the new kid regardless of what role they are hired into at the facility; a simple hello and a smile goes a long way and I know for a fact that speaking hasn't ever hurt anybody. Speaking and smiling takes less energy than being mean and rude all day. Everybody has a job to do, everybody has bills to pay, everybody has problems, everybody tired and ready to go home but guess what everybody has a shift to complete. It will make the day go by a whole lot smoother and  probably cause everyone to sleep better at night. My point is, old staff should be more friendly toward new staff especially since old staff is always complaining about not having enough help, imagine that. Stop running the help off.

Miss Co Says...

November 4, 2021

THE RESIDENT IS NOT ALWAYS RIGHT

It's sad to say but the most loving, sweetest and kindest resident will tell a lie. In most cases they don't realize that what they are saying is not true because in their mind it happened just the way they are telling it. The truth of the matter is the resident misunderstood what was said and/or misperceived what was done. Of course you can't tell a resident that they are lying but you can try to help them understand what was done or said. Sometimes what a resident says is just what happened and sometimes the resident is deliberately telling a lie. Regardless of what the resident says, whether it's true or not, an investigation should be conducted to make sure nothing that shouldn't be happening is happening. It doesn't matter how far-fetched their story is, the facility should still look into it. In most cases the findings will be that the resident's story was not true or it didn't happen exactly the way that they said. When it comes to the state surveyors coming in, if a resident was to tell them this same far-fetched story that you knew about, you best have some documentation showing the facility looked into the matter. Please don't bank on the resident not remembering because that will be the one time they do and the facility could face unnecessary consequences. No the resident is not always right but always treat them like they are right.

Miss Co Says...

November 9, 2021

HOLIDAYS ARE SPECIAL

Residents in nursing facilities for the most part look forward to the holiday season because they anticipate that they'll get to see family they don't see throughout the year or haven't seen in a while. I know some people have their lives, their schedules, their this and their that and they can't visit their loved one as much as they'd like but holidays should be a must. All schedules should be cleared for Thanksgiving day and if not the actual day some time around that day as well as Christmas day. Some residents really get sad and depressed around the holiday season because not only do family not come visit with them throughout the year they know no one is coming during the holidays. The facility of course picks up the slack by hosting holiday events and having the activities department to decorate the facility for the holiday occasion. This seems to put a smile on the residents faces but it's nothing like seeing family. It does not take much effort to show someone that you care and that you have not forgotten about them. Help spread some holiday cheer by going to see your loved one or someone in a nursing home this year or any year. I can assure you they will be happy and overwhelmed with joy by the mere fact that you showed up which is an indicator to them that someone cares. That kind of stuff makes them feel special and loved because all they want is affection and attention, even if it is from a complete stranger.

Miss Co Says...

December 1, 2021

DON'T OVER-DECORATE 

The old saying “there is no place like home” holds true. So when a resident goes into a nursing home of course you want to make it feel like home. The home feeling helps them to adjust to the new setting and environment but don’t overdo it. Granted residents have designated areas and space for decorations, the space is small. You can’t fit their whole house/apartment inside half of a room and even if they have a room to themselves it won’t be as big as their home. A few pictures sure. Their favorite pillow of course. A small recliner absolutely. Needed yet small and simple things. Keyword is “need”. Too much stuff (whether room décor or clothes) in a room is breading grounds for roaches, ants and even mice, yikes! That’s why there are state guidelines in place regarding the setup of rooms and facilities have to follow them to ensure all residents have equal space as well as to prevent unnecessary fire hazards and rodents. Totes are helpful but too many totes can be a problem, especially if they are too big to fit in the closet. It’s a safety hazard to staff for totes, boxes, unnecessary furniture to be on the floor especially around the area of the bed. If the resident was to have a medical emergency those items could prevent staff from providing prompt care because they would have to move items out of the way or they could fall over items trying to get to resident in a rushed manner. In a medical emergency every minute counts. Make the room feel like home, yes, but remember it’s not home anymore, they are in a setting where there is less space and more sharing.

Miss Co Says...

December 16, 2021

THEM REMEMBERING IS IRRELEVANT

This blog is more of a personal one. Though I’m no longer the Social Worker in the facility, I recently had the opportunity to visit my former facility to see some of the residents. Out of all the ones that I got a chance to see, only one actually remembered my name, a few others remembered my face and the rest had no clue who I was. Them not remembering me did not matter because I remembered them. I greeted each one with a big smile, I called them by their name and they in return smiled at me, not because they “knew” who I was but because they recognized kindness, they saw gentleness and they felt loved. It felt good to see them, to be among them and to see them still doing well for the most part. It’s true that your loved one that’s in a facility may not remember you as their son, daughter, brother, sister, aunt, uncle, niece, nephew, husband, wife, neighbor or friend but they will remember how you make them feel. Those of us that don’t suffer from mind diseases that increases memory loss still at times forget things, people and places but can always remember the “feeling” attached to an act of kindness. Please still go, don’t talk yourself out of going because you won’t be remembered, go because you remember. You remember the moments, times and events you’ve shared in life with the person that you see, even if they don’t “see" you. That’s what matters. When I went to the facility, soon as I walked through the doors, I remembered… It did my heart good and put a smile on my face to know I had an opportunity to be of service to those who couldn’t do anything for me, yet did everything for me. They gave me very fond memories that I’ll remember for a lifetime! Some of the best moments of my life! Alzheimer’s may take away the memories but it can’t take away the moments!

Miss Co Says...

December 21, 2021

LIFE CAN CHANGE IN A BLINK OF AN EYE

Please don’t every get beside yourself and think just because you’re young, healthy and strong that you’d never have to go into a nursing home. I’m sure all the young, once upon a time healthy and strong people that are currently in nursing homes would advise you otherwise. It’s not just the elderly and disabled needing nursing home placement. You could be living your best life one moment and needing rehab/long term care the next. Life really can change in a blink of an eye. Always count your blessings. Don’t look down upon those in nursing homes or judge the family that had to place them there. Most people would care for their loved ones in the home setting if they could but they just don't have the means to provide needed care or their finances are limited with little to no resources. No one expects it and they literally feel blindsided when they find out that the loved one they thought was going to be able to return home after an hospitalization or rehab is now in need of long-term care. The reality is they aren’t coming back home, it won't be life as usual. A new life begins as the old one ends. Truth of the matter is I don’t think anyone lives their life with the expectation of …Yep I’m preparing to go into the nursing home one day and even if some do, they see it as something far off like after 70 but for some it’s before 25. Most people don’t even like hearing the word “nursing home” let alone having to be admitted in one for the rest of their life. We all know that two things are for certain and that is taxes and death but we never know what path life may takes us before we take our last breath. As the old wise saying goes, it’s not always the leaning tree that falls. In other words it’s not always the unhealthy and fragile that needs help, sometimes it’s the healthy and vibrant that all of a sudden needs help. Speaking of that leaning tree, in some cases Hospice may be called in but just because Hospice has been called in doesn’t mean it’s the end. Some Hospice patients make a full recovery and continue to live a quality and productive life and then there’s those that are living a quality and productive life that all of sudden slip away. Don’t put anyone in the grave before their time but at the same time don’t take time for granted. It’s not always the worse-case scenario but don’t ever think that it can’t happen to you because in a blink of an eye it could be you.  

Miss Co Says...

January 11, 2022

IT'S JUST ANOTHER DAY

After being in a nursing home for an extended period of time, the residents literally lose track of the days, months and years. It’s the same routine day in and day out and the same schedule of events for the most part. So when it’s the end of the work week and Saturday begins or it’s the start of a new year or it’s a federal holiday, and staff is getting excited about their weekend plans or about celebrating the new year or about being off during the middle of the week, to the residents it’s just another day. Another day they are able to enjoy and hopefully get to see family; another day to gather in the hallway with friends;  another day to enjoy their favorite meal; another day to sit and watch their favorite TV show; another day to admire the bouquet of flowers that was sent to them; another day to play BINGO;  another day to share their wisdom and life stories with staff. All these exciting things going on and people are able to make plans, reap the benefits of or take advantage of and the residents are unaware of what's going on outside of the facility and to be honest they really don't care, they are just thankful for another day. I suppose it's a blessing in disguise that they really don't keep up with "outside" happenings because it would probably make them feel bad. Aside from being confined to the walls and halls of a nursing facility and not being able to go as they please, the residents really are living a care free life where they can enjoy the simple, non-exciting happenings in a days time. Some people only get excited if something grand is taking place or something new is on the horizon or perhaps their lives are so busy that they literally don't have time to stop and smell the roses, the residents, however, find enjoyment in just seeing another day. The way I see it if you're above ground, that's something to be excited about...you're alive and you are able to enjoy "outside" happenings. I have heard it before countless times and I'm sure you have to this saying "There's always someone else worse off than you" well this saying holds true. It's the little things for me, so find enjoyment in everyday the good Lord allows you to see and show more gratitude for the life you're able to live. It really could be worse.

Miss Co Says...

January 20, 2022

THINGS MUST CHANGE

Staffing is already an issue during "normal" operating hours but when there's outside influences such as inclement weather that further effect staffing issues, it makes matters even worse on the residents. Not having the needed staff to cover each hall/shift really deprives residents of receiving the best quality of care. The term "short staffed" doesn't exist to most facilities because to them even with the bare minimum required to be on schedule they are "fully" staffed. The bare minimum is not enough. I know it's not possible for each resident to have their own CNA but things must change. It's not fair to the residents, it's not fair to the staff and it's not fair to the family members. I understand that the LPNs, RNs, CNAs and PCAs signed up for this kind of work and all that it entails, the good, bad and ugly but it seems that it's not enough effort put into reassuring that a facility has an adequate amount of staff to cover all the residents and give quality care. Not to mention that those that do the hardest work, get the least amount of pay. Let's be honest if there's only one CNA doing the workload of 2 or 3 CNAs do you really expect that one CNA to thoroughly address ALL the needs of the residents? Regardless of the expectation, they are only going to do the bare minimum. See it's okay to have the bare minimum staff but it's not okay for staff to do the bare minimum and that's just not right. For one they physically aren't capable of handling all the residents and secondly it's mentally taxing and frustrating. Then, as soon as family comes in to see their "loved one" unattended, in need and staff not moving fast enough then they want to call in the higher powers. It's time that the decision makers concerning long-term care really start to look into providing more resources to the facilities so they can provide better care to these residents. Everyone has a part to play not just the staff, but all involved. Having bad staff is one thing, meaning the staff is not doing their jobs but having bad management is a horse of another color, meaning management is not ensuring that staff have all they need to provide quality and timely care. When working in a facility, you should have the "take one for the team" mentality. Sometimes facility management have to be willing to lend a helping hand literally and then upper management in the corporate setting should stop biting the many hands that feed them.  I'm definitely not pointing fingers but I am most certainly pointing out that things must change. 

Miss Co Says...

February 22, 2022

STAY CONNECTED

If you have ever worked in a nursing facility and truly had a heart for the job and the residents, even after leaving, you should always feel connected to the residents as well as the facility. It does my heart good, every time I visit the facility I used to work in as a Social Worker. It's a joy to my soul to see the residents I use to work with still doing well and I also get the opportunity to see new faces. I must admit it is a damper to my spirit to find out that some of my most beloved residents have passed away but at the same time, I'm glad they aren't suffering anymore. I probably won't ever work in a nursing facility again, not because I didn't love it but because I'm on a new path but I will always have a heart for the residents in that facility. I guess that's why I do what I do now. My time and experience working in a nursing facility laid the foundation for so many other areas in my life and I appreciate it all. I didn't realize going in the magnitude and impact that it would have on my destiny. Many times I wanted to run out the door and not look back but my heart would not let me, my desire to help those residents would not let me, my connection to my Lord and Savior would not let me. I had a purpose in being there and I could not leave until my purpose was fulfilled. I had to finish my time there in spite of the many challenges I faced day in and day out and when the assignment was complete, a new door of opportunity came my way and the stage for greatness had been set. I still feel so connected to the residents and facility, probably because God had a greater plan in mind and he used the experiences there to prepare me for His plan for my life and I believe something far greater than I could have ever imagined is going to come out of me being there seven years. Seven represents completion. God definitely completed some things in me. I am always going to be a Social Worker at heart because it was and still is ministry for me. The best is yet to come. 

Miss Co Says...

March 28, 2022

DON'T LEAVE THEM LIKE THAT

It really makes a difference when you visit a loved one that’s in a facility. The staff have their duties and responsibilities, however, at times the staff in some cases is overwhelmed and they may miss something but then in other cases they are just being lazy. The more you visit and see what’s going on regarding the type care your loved one is receiving the more the staff will do. The family must set the “expectation” in order to give staff something to work toward, as long as the expectation is realistic and within the means of the facility. Please don’t be the family member that makes a scene because of something not being done, just talk with staff and make it known that you expect it. If they don’t do it, then sure take the necessary steps to attempt to get the matter resolved but remember you can draw more flies with honey than you can vinegar. Please don’t be the one that goes to visit and see your loved one not looking their best and leave them looking like that. That is your family, regardless of the relation or relationship and if it was you laying in that bed, not being able to do for yourself wouldn’t you want someone to do it for you? If it’s something you can do, please do it. It doesn’t take much effort to walk up the hall to the nurses station and make a simple request or if it’s in your means to do it, you do it. If their hair is unkempt, comb it. If they happen to bring in a food tray while you’re there and they need assistance with eating, help them and speaking of food, if you know they have a favorite meal or they mention wanting something other than the nursing home food, get it for them. If they are able to take themselves to the rest room with assistance and need to go, take them. Please don’t leave them like that when there is something that you can do. Yes the staff is being paid and the facility is responsible for their care but that is your family. They was your family before they was a resident in that facility and though they may not always be a resident, they will always be your family. Such times as these is what family is for; so don't focus on what you can’t do, focus on what you can do. You may not be able to provide 24/7 care and supervision or even visit every day but when you do get a chance to visit, make it worthwhile because the simple things you can do really does matter and makes a difference. It helps with boosting their morale and gives them a more positive outlook about being in a nursing facility. It also lets them know they are loved and still cared for in spite of being there and they have not been forgotten.

Miss Co Says...

May 12, 2022

EVERYBODY NEED HELP

At some point in everybody's life, help is needed. Just because you're not in a nursing home doesn't mean you won't ever need help. I think if we have this mentality, we will be able to have more compassion and show more empathy on those in constant need of help. If you think of that one time when you needed someone to help you financially to help pay a bill, or maybe you were without a vehicle and needed a ride to work, perhaps you were hurt on the job or had surgery which caused you to have limited mobility and you needed someone to clean your house or even help you take a bath. The difference is your circumstance was more than likely temporary, those in a nursing home not so much, it's not a circumstance, it's their reality …everyday. So my advice to you is, never think you don't need anyone just because you're up today, life is up today, money is up today, things are looking up today because at any second all can come crumbling down. Today may be good, today may be up but only the good Lord knows what tomorrow holds. Be more patient, be more kind and help out when you can, how you can, those in need of help whether their in a facility or not, family or not, friend or not, if you can help them, then help them. The harsh truth could be this, the ones that you could help but refuse to help will be the ones that actually help you, ouch, how do you face them when you're vulnerable, down and out and have to look up at the face of the person you turned away in their time of need or it could be instead of helping you they decide to give you the same treatment you gave them, either way its not a good feeling. It's like taking that castor oil, mama or grandma made you take, it don't taste good going down but it makes you better.  

Miss Co Says...

October 17, 2022

IT'S NOT US AGAINST THEM...IT'S WE

Nursing home staff and the family members of the residents are a team! The staff has their duties and responsibilities but so does the family. Did you know that by law a facility can’t make a resident do anything against their will? In other words if the resident says “No” to eating, bathing, therapy then that’s exactly what it is…NO. Now in such cases the staff should get creative in their approach and try it again later. Nonetheless if a resident keeps flat out refusing then the family should be notified then the family can come to the facility and “strongly encourage” their loved one to eat, bathe and/or do therapy. Sometimes it’s not that staff is neglecting to provide care but the resident is refusing care. So contrary to popular belief, it’s not all on the staff just because they are in a facility. It’s on the staff to offer needed care and provide it as long as the resident allows it, otherwise it’s up to the family members to ensure that resident receives proper care!! Family members are not free and clear of their duties and responsibilities to their loved ones once they are placed in a facility. Yes the nursing home is being paid and yes the nursing home has trained and certified staff and yes that is their job, all this is true but they can't do their job if they are told, No. In or out of a facility that is still your loved one and overall you are responsible for making sure they receive proper care.

Miss Co Says...

January 1, 2023

SKILLED NURSING FACILITY VS ASSISTED LIVING FACILITY

People often wander what is the difference between a Skilled Nursing Facility (SNF) and an Assisted Living Facility (ALF) and how to determine which facility is best for someone needing placement. Simply put a SNF is best for someone who is either wheelchair or bed bound; walks independently but has a dementia diagnosis or some other neurological disorder that requires them to have 24/7 supervision from a nurse. An ALF is best for someone who may be wheelchair bound or walks independently with little to no effect of dementia and doesn't need 24/7 supervision from a nurse. In those cases where rehab is needed, a SNF provides rehab care and after rehab if they need long term placement but don't fit the SNF criteria then the recommendation would be for an ALF. The Primary Care Physician (PCP) helps to determine which facility is best based upon level of care needed. 

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