STOP NURSING HOME ABUSE AND NEGLECT BEFORE IT STARTS
By Debra D. SavageiUniverse, Inc.
Copyright © 2011 Debra D. Savage
All right reserved.ISBN: 978-1-4502-8120-1Contents
Introduction............................................................................................................xi1. Making the Decision to Place a Loved One in a Nursing Facility.......................................................12. How to Deal with Your Emotions after Making the Decision of Nursing Home Placement...................................73. All Nursing Homes Are Not Equal......................................................................................134. How to Decide Which Nursing Home Is Best for Your Loved One..........................................................215. What Type of Relationship Should Family Members Maintain with Staff Members?.........................................276. What Is the Role of the Ombudsman?...................................................................................337. Advance Directive, Living Will & Other End-of-Life Documents (Does Your Family Member Have One?).....................398. What Are Patient Rights, and Why Are They Important?.................................................................459. When Should Your Loved One Become a Palliative Care, Hospice, or DNR Candidate?......................................4910. How to Identify the Telltale Signs of Abuse or Neglect..............................................................5711. Overview of Abuse and Neglect.......................................................................................6312. What to Do When Abuse or Neglect Is Suspected, and Who to Contact...................................................73Epilogue................................................................................................................85About the Author........................................................................................................91
Chapter One
Making the Decision to Place a Loved One in a Nursing Facility
"Trust in the Lord with all thine heart; and lean not to thine own understanding" (Proverbs 3:5).
I am not sure which is more challenging, being the decision maker or the one whom the decision is being made for. I had the unpleasant assignment of being the decision maker for placing my mother in a nursing home(s). It was after a massive stroke in May of 2008 that I had to entertain the thought of nursing home placement. I remember one other relative in my family that had ever been placed in a nursing home. It was my grandmother's sister, who was a widow and had no children to care for her or to look after her affairs.
In most instances where long-term care is needed, most families do not consider a nursing facility as the first or second options. Most families opt to keep their family members at home as they attempt to care for them. Others hire outside agencies to come in and perform home-health tasks, nonmedical services, and respite care, hence freeing the caregivers to take care of other matters.
For more information on caregiver resources, go to my Web site at www.DebraSavageOnline.org to purchase your copy of Caregivers and the Baby-Boomer Generation. It is a powerful and informative autobiography of my own experiences of more than 24 years as a caregiver, both private and professional. You would be surprised to know that in a lot of ethnic communities, placing a loved one in a nursing home would be an insult to the integrity and honor of that family member. Too many people have the wrong concept of why an individual needs to be placed in a long-term care facility or nursing home.
There are as many reasons to place a person in a nursing facility as there are to keep them in the privacy and comfort of their own home. Here are some: Sometimes there are not enough family members available to help facilitate the care, the decision maker or power of attorney (POA) is an only child, perhaps all of the family members must work or live out of town. There are other reasons as well, including the caregiver having a family of their own, the health condition of the "would-be caregiver," and not having the resources to accommodate the soaring cost of round-the-clock care. Whatever the reason(s) that necessitate the family member being placed in a nursing home, there are some things that family members can do to make the transition easier.
The last thing that decision makers need to do is to allow themselves to feel guilty about what quite possibly was, or is, the only option available based on the surrounding circumstances. One has to remember that every ideal decision we make in life will not always line up with what has to take place realistically. Save the guilt, the emotions, and the drama. It takes a village to do a lot more than just raise a child. It takes others to render long-term care to a chronically ill individual, and unfortunately, sometimes the extra manpower is not always available.
Be encouraged and know that God is in control, even when we feel helpless and out of control. If you, along with me and so many other spouses, children, families, etc., have had the unfortunate decision laid upon you, thank God that His guidance and direction are available without measure to help make informed decisions on behalf of others.
No one looks forward to the day of placing an aging parent, family member, or loved one into a nursing home. For whatever reason, this figment of the imagination now becomes a pressing issue. There are times when a family member is hospitalized and takes a turn for the worse and will need long-term rehabilitation in a skilled care facility.
Then, other times, the decision has been pondered over an extended number of weeks and months due to a decline in mental status, frequent falls, or a chronic illness. There are no "how-to manuals" on what to expect, how to cope mentally or emotionally, or whether the decision is right or wrong. Unfortunately, we must trust our gut instincts.
There may be times when you as the decision maker may feel as if you have somehow let your loved one down, forsaken them, even abandoned them. Again, as time goes on and your loved one becomes more involved and settled in, those feelings will subside. Another thing that you may have to dismiss are the voices in the crowd that will come from outsiders looking in. These are the distant relatives, friends, or other extended individuals who have made no effort in helping to aid you in this very difficult process. Naysayers and others who are not a part of your support network should never allow you to feel bad about your informed decisions.
People are really interesting. They will say one thing in your face and another behind your back. It is so unfair in any given situation to utter the words, "If I were you," or "If it were me, I would have done thus and so." At no point in our human existence will we get a chance to be another person. We cannot live vicariously through each other. Only Jesus came to do that! People make decisions based on knowledge, circumstances, and previous experiences.
Oftentimes, individuals reflect back to a similar analogy. If there are no prior events to rely on or guide you in the course of your decision, then you have to rely on God to guide you, or new data on the subject matter, or again, think of what is best for everyone involved, considering the patient first and foremost.
As with other important matters such as living wills, advance directives, and life insurance, families should also have a definitive plan for their aging parents. So if the day should ever come when they are faced with chronic or a catastrophic illness, a plan can be implemented which will cut down on the emotional trauma that acute decisions cause.
I am a firm believer of planning ahead. I have learned through my experiences as a POA (power of attorney) and patient advocate in health care that if provision or protective means are in place, it cuts straight to the chase. Now, I certainly don't mean to sound as if everything is so cut-and-dry. However, careful planning does help to make difficult situations less stressful in most instances. If nothing else, it takes the pressure off of the really tedious details, and more often than not, the strain of financial depravity.
Finally, making the decision to place a loved one in a nursing home may be one of the most difficult, if not critical, decisions you may have to make. Let me encourage you through this book and give you vital information, real testimonies, and resources for making the best choice and ensure that your loved ones and family members are cared for, respected, and protected while entrusted in the care of paid professionals and medical staff members. The decision may not be easy, but as you read on, you will receive updated, cutting-edge information that you can utilize yourself and pass on to others who may one day be in the same or similar situations. Remember: Knowledge is power, and it is no good if we keep it to ourselves and not share it with others! In the words of George Eliot, "What do we live for if it is not to make life less difficult for each other?"
Chapter Two
How to Deal with Your Emotions after Making the Decision of Nursing Home Placement
"For if our heart condemn us, God is greater than our heart, and knoweth all things" (I John 3:20).
I once heard someone say, "A mind is a terrible thing to waste." I concur! The mind is a very complex puzzle. The complexity of the brain makes it an uneasy puzzle to solve. Blend in the factor of the mind and we have a mystery inside a mystery. Scholars all over the world have attempted to describe the mind's functioning from the detailed, microscopic perspective, as well as the big-picture perspective, such as the discussion of personality traits. The question of whether the brain explains the mind still exists, as well posed by neurosurgeon Wilder Penfield: Does the brain think, "by the simple performance of its neuronal mechanisms, or by supplying energy to the mind? Or both?"
Consciousness both encompasses and transcends its physical workings; that is, the conclusion drawn by the brain. Surgeon Roger Sperry says, "In the human head there are forces within forces, as in no other cubic half foot of the universe that we know." J. A. Hobson believes that when we finally have a full understanding of the brain and the mind, the molecular and the molar views will eventually converge, and, with the shock of realization, become one entity (reference: www. library.thinkquest.org).
What does all of this mean in layman's terms? There are many faucets to the human mind. It is the seat of our emotions (not to be confused with the soul); it is where we rationalize, process information, make decisions, feel pain & hurt (not physically but mentally), think, rethink, and visualize. Our minds are a lot like computers and cameras. We can store information and recall it (usually at will).
In terms of a camera, it takes mental pictures of the images we see in our minds that have to be developed through the lenses of our eyes. It is also a place where we can allow negativity and feelings of guilt to set up a battlefield in which our mind becomes the prime target.
The decision to place your mother or father, husband or wife, or aging family member in a nursing facility is not one that is cut-and-dry, but one that usually comes with hesitation and reservation. I think that any decision we make should always be accompanied by prayer and delay. What I mean by "delay" is, it is not good to make important decisions hastily. When deciding ultimately upon nursing home placement, much research and background information about the facility is vital. I will deal with that more in Chapter 4.
When you have exhausted all aspects of the research process, gathered detailed facts, and have talked to others who have been down this road, the decision for placement should not cause you to have a nervous breakdown. If your emotions are out of control, then perhaps there are some unresolved underlying issues that need to be dealt with, even a need to speak with a counselor. I am in no way discounting the fact that it may have an effect upon one emotionally, but it should not become a chronic problem that lingers indefinitely.
I know that in my own personal situation with my mother and nursing home placement, I felt awful. The day she was discharged from the hospital and transferred to the first nursing facility, I made sure I was there to meet her. Upon admission, we were greeted by the staff and received a very warm welcome. I had brought plenty of plants, family pictures, flowers, wall decorum, a telephone, and anything else that I thought would give her a feeling of home. It is very important to make sure that the environment is not too "institutional and hospital-like." It should be as warm and inviting as possible. The other thing is to make sure that your loved one or family member has regular visitors. They can be church members, coworkers (if retired), family, and close friends.
In the beginning of the placement, it is imperative that you reassure your loved one that you will be there for them, that you keep your promises to them, make sure you call them daily, and sometimes several times a day. If they feel like they have been "dumped or put away," they will usually in a short period of time deteriorate and their health will decline. Some individuals when placed in nursing homes go into severe depression. They stop eating, become detached from others, withdraw from activities, and sometimes die.
Another thing that I recommend is that when visiting your loved ones, don't rush in and rush out. "Perpetual optimism is a force multiplier," said Colin Powell. Take the time to talk to them, listen to them, observe the staff, survey the environment (more details to come in Chapter 11). Sometimes things, good or bad, are going on in the facility and the patient is trying to tell you, but family members don't always catch their clues or are in too big of a hurry to get back to their own lives.
Realize that if you are having struggles with your emotions, usually this will subside after a little while. The more comfortable and adjusted your loved one becomes, the more adjusted you will too. I am describing "comfortable" and "adjusted" in terms of getting settled in. "Adjusted" in no way should be interpreted as relaxed and unassuming.
You can never become so relaxed that you ignore possible warning signs of abuse or neglect. I might also add not only the abuse or neglect of your loved one, but others who may not have as many concerned family members or who have no family at all. I feel that we are our brothers' keepers, and as Confucius once stated, "To know what is right and not do it is the worst cowardice." It is right to report when someone is being violated, mistreated, or in danger of any kind.
The work is not over just because you have selected a facility, gotten your family member moved in, and decorated his or her room. Now the real work begins. If you are fortunate enough and your schedule will allow you to visit daily, keep a journal, ask your family member questions like: "How was your day?" "What did you eat today?" "What was the activity plan today?" or "When and how often does the doctor come around?" Let your family member know that you are deeply concerned.
When your family member tells you something that is out of the norm, ask the staff questions so that they know you are paying close attention to the needs and concerns of your loved one. You don't have to act like a detective or make the staff feel uncomfortable, but at least they know that your loved one is keeping you informed (more details on this in Chapter 11).
Also, there should never ever be any form of retaliation against your family member because he or she told you something in regards to their care or lack of care. There is a way to deal with retaliation, and I will address that in Chapter 12.
I heard a famous songwriter say, "When you have done your best telling the world that the Savior has come, God will reward you and say, 'Well done!'" What does that mean in the context of this chapter? When you have sought the Lord earnestly in what to do, coupled with input from your support network, updated information about the facility, and not acted irrationally or hastily, then I believe God will smile upon your efforts and say to you, "Well done." That does not mean that the journey is over, but that which was most important and involved your wise resolution was handled with competency, wisdom, love & patience.
"The greatest mistake you can make in life is continually to be fearing you will make one," according to Elbert Hubbard. As Charles Stanley often says as his broadcast ends, "Obey God and leave all the consequences up to Him!"
Chapter Three
All Nursing Homes Are Not Equal
"Do not go where the path may lead; instead, go where there is no path and leave a trail," Waldo Emerson.
It is interesting to know that most people still take people, places, and things at face value based on the outer appearance. Interestingly enough, I sometimes do the same thing. I remember a dear ninety-five-year-old patient (friend) of mine who had to be placed in a nursing facility. At the same time of her admission, my mother was in a nursing facility as well. My friend's nursing home was a really beautiful place with Persian rugs, chair rail-trimmed walls, a picturesque appearance, columns in the foyer, expensive furniture, a beauty salon & day spa, and designer artwork on the walls.
My friend came from a very wealthy family, and her sons spared no expense to make sure that she was in an atmosphere of luxury and comfort. On the other hand, my mother was about 3 miles south of this very prestigious and ritzy hotel-styled nursing facility, and as soon as you walked in the doors where she (my mother) was at, you might smell a hint of urine or feces. The decorum was bland and outdated, the carpet was nowhere close to being considered plush, the furniture needed replacing, and the entire building needed a face-lift. However, both facilities had one thing in common. They both had staff members with the same mind-set and attitude.
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Excerpted from STOP NURSING HOME ABUSE AND NEGLECT BEFORE IT STARTSby Debra D. Savage Copyright © 2011 by Debra D. Savage. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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