Please help me respond to this disturbing article

  1. While I certainly believe that alot of nursing homes don't do as good as a job as they should, their are certain things about this article that I would like to educate the public on:

    1) the nursing shortage and staffing ratios mandated by the state prevent us from giving one on one care-we are really busy and tired and I encourage family members to come in and help feed, etc. We couldn't do it without them!

    2) family members' presence and questions DO help - they know the resident better than we do and also, if they speak up in this crazy healthcare system, they can ensure the resident gets better care.

    3) many families insist that Mother sit up in the wheelchair all day, and wonder why is she tired, sitting in the hall in her wheelchair, slumped over sleeping? Because you insist that she not be able to be laid down after lunch and she is 96, she is tired and I didn't want to disturb her. Also, I invite you to come sit in a wheelchair all day and see how darn interesting you think living in a nursing home is- all kinds of lovely sights and smells. And sounds, like "I want to go home and I want my mother" and "How do I get out of here?" Activities can only do so much to cut into the boredom and depression that come from getting very old and losing everything you ever held dear- like income, mobility, social contacts and roles, life roles like the grandmother, the boss, the sister, the bread winner.

    4) the respirdol or ativan we gave your father in the am is due to his hitting the aids repeatedly, or your mother yelling at the top of her lungs such things as "Don't rape me!". I feel so much sadness for her and have tried EVERY intervention from touch and therapeutic conversation, but she has done this every night for the last 2 months and the Psychiatrist prescribed the medication: we will carefully monitor it for side effects, and yes, sometimes before we get the dosage just right, the resident is zonked and I call the MD right away to let him know and get the dosage reduced or the medication changed.

    5) We are careful not to use medication as a restraint, and the state monitors things like this very closely. We want your loved one to be happy and safe.

    Here is the article- please give me suggestions to respond in such a way as to help our elderly population and take away the negative connation that we all medicate our elderly to make less care.

    http://www.post-gazette.com/neigh_wa...020watank4.asp



    Home > Local News > Neighborhoods


    Think Tank: Nursing suspicions
    Panelists believe patients are put in an overmedicated stupor so they're docile

    Sunday, October 20, 2002



    While good nursing homes bridge the move from hospital to home, bad ones are criticized for doing little more than warehousing the elderly. Visit a nursing home as patients in wheelchairs nod off around the nursing station and you get the picture.

    Elmo George of South Franklin, Sam Cushey of Peters, Bill Brna and Maya Patch, both of Carroll, Bernie Hobach of Washington and Verteree Johnson of Clarksville discuss whether senior citizens are overmedicated.

    Patch believes they are. She coined a term for the drug-induced state she's seen in some nursing home patients -- zombie-ized. She believes patients have been drugged into a zombie state to make them more manageable.

    Her suspicions about overmedication were raised when her mother-in-law, Dora Patch, was admitted to the hospital with congestive heart failure. She was prescribed medication in addition to what she already had been taking, Patch said. After being released, her mother-in-law was readmitted and taken off all her medication -- about 14 pills at the time. The scenario made Patch question why all the medication was necessary in the first place.

    The response she got from health-care professionals was "'We want to keep her comfortable.' Could they all be that sick that they have to be zombie-ized?" Patch asked.

    Patch does not oppose drugs when necessary for illness such as high blood pressure or diabetes but questioned medication that makes patients lie in bed and sleep all day.

    "That's what they call you're being warehoused," said Hobach, who cited a report in the Journal of the American Medical Association that of people older than 65, nearly 25 percent a year are overmedicated.

    If a patient is not mentally sharp enough to inquire about what doctors and nurses are doing, George said, he has to have family members or an advocate to speak on his behalf. It requires constant surveillance of what the medication is, the dosage and the frequency, why it's being taken and how it interacts with other drugs.

    George, too, finds patients are frequently overmedicated. When attending to the care of his wife and later his sister, George said, he made sure he knew when the doctor was going to be in the hospital so he could ask questions.

    Brna suspects overmedication has a lot to do with American culture.

    "We've become a drug culture in this country -- prescription drugs or whatever. Somebody goes to a doctor -- I don't care who it is -- they do not feel that they get any good out of the visit unless the doctor prescribes a pill," he said.

    Often the doctor will not tell the patient why he's prescribing the pill or discuss its side effects, Brna said. He also faults doctors for paying too little attention to medications the patient already is taking.

    Johnson, too, believes patients are overmedicated. She noticed it when she placed her son, Carlton, in a nursing home for a brief time.

    "I could tell he was overmedicated because all he did was sleep," said Johnson, who noticed the same lethargy in a neighbor when she visited him in a nursing home.

    Like the other seniors, she said, "I think they do use medication to keep [patients] quiet. Most of those people who are in facilities, that's a way of controlling them. They are almost like zombies, slowed down so much so they couldn't think straight."

    Cushey said he, too, had been to quite a few nursing homes. He's seen patients sitting in the hall and hanging over chairs, leaving no doubt in his mind there are too few personnel to care for patients. Their solution is to put people near the nurses' station, where the person at the desk can watch them.

    But when you make a human being a zombie, you're wrong, Patch said. While she did not want to demean everything about hospital care, she did say of health-care professionals: "When you feel you've gotten that way or you're not compassionate enough to do whatever you have to do or you're so hardened, you should get out of that profession."

    Since the experience with her mother-in-law, Patch said, she's become leery of taking drugs just because a doctor advises it.

    "That's because you have your mental faculties," George said, referring to those seniors ill-equipped to stand up to the medical establishment.

    "I agree with you," Patch said.

    George believes seniors, for their own good, should take notes and recall what was discussed when visiting their doctors.

    Patch said that for people of her generation, going to the doctor was thought of as if you went to God.

    "I hope that people that are younger than us will start to ask more questions and realize that this could be them. Would you like to just be put asleep in a bed because 'I don't have time for you' or whatever the reason is?" she asked.

    Lynda Guydon Taylor can be reached at ltaylor@post-gazette.com or 724-746-8813.




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  2. 30 Comments

  3. by   sjoe
    The link does not work.

    But, besides that, what is the problem? The comments are true about many nursing homes, psych facilities, correctional facilities, etc. If they are not true about yours, good, but too much denial or arguing simply makes people think you are covering something up. I'd let things be and spend your time improving your facility instead. No matter what you do in ANY field, some people won't like it. You can't spend your time reacting to their comments or you'll accomplish exactly nothing.

    For what it's worth.
    Last edit by sjoe on Oct 30, '02
  4. by   Stargazer
    sjoe, I don't think the tone of Carrie's response was defensive or argumentative. Her intent as stated was to help educate the public about both the appearance and realities of LTC. I certainly don't see why she couldn't respond to that article with the info she's posted. I'm a nurse, and I've given care in a LTC facility, and I still thought what she had to say was both educational and interesting. In fact, this
    Activities can only do so much to cut into the boredom and depression that come from getting very old and losing everything you ever held dear- like income, mobility, social contacts and roles, life roles like the grandmother, the boss, the sister, the bread winner.
    was very affecting.

    Carrie, I think your post as written is compassionate and eloquent. Clean it up a little, add an opening and closing, a salutation and signature, and send it off to the editor.
  5. by   cargal
    Thanks sjoe, for pointing out that the link is bad. This article was taken directly from the from news on the home page of allnurse.com. That I work in Pgh where the article was written and that I work very hard in LTC and see both the bad sides and the good sides impelled me to formulate a reply. I also feel that most of the article is true, but for the wrong reasons.
    Thanks for your responses, and stargazer for your support.

    Blessings,
  6. by   ktwlpn
    Originally posted by sjoe
    The link does not work.

    But, besides that, what is the problem? The comments are true about many nursing homes, psych facilities, correctional facilities, etc. If they are not true about yours, good, but too much denial or arguing simply makes people think you are covering something up. I'd let things be and spend your time improving your facility instead. No matter what you do in ANY field, some people won't like it. You can't spend your time reacting to their comments or you'll accomplish exactly nothing.

    For what it's worth.
    I happen to disagree-and feel that many misconceptions the public have about nursing homes come from ignorance....It's not denial or being argumentative when one attempts to explain how tightly the industry is regulated in Pa-and other factors that could be affecting the behavior of the residents...Same goes for acute care-the public needs to know what a nurses responsibilties really are....Its education the public-not arguing....
  7. by   deespoohbear
    Maybe those people who are complaining about nursing homes and hospitals overmedicating the patients ought to work in one for about 6 weeks to get a real feel for those kind of facilities. I am not for overmedicating people, but when my safety or others around me is compromised because someone is taking a swing or whatever, you can pretty much bet I am going to get them calmed down. I didn't go into this profession do have my lights punched out. I come to work in one piece, and I intend on leaving work in one piece at the end of my shift. Wonder how much time these people who are complaining actually spent with their families? Probably the kind that waltz in for 10 minutes every month and tell the nursing staff everything they are doing wrong, complain to the administrator and/or DON and leave. Granted there are some rotten nusing homes out there, but there are also some great ones too. The media needs to publish stories about these facilities too.....
  8. by   NICU_Nurse
    Have these people not considered that sleeping more often is one of the first red flags of depression???? I mean, the drug issue aside for a moment, these people are, as we know, sometimes shipped to these facilities against their will. Many families do not or are unable to visit very often, if at all. Why do these people jump right on the drug administration without considering first that it may simply be lonliness or boredom?
  9. by   Sleepyeyes
    The people making these judgments are not professionals and have no idea about why the folks are in the nursing homes in the first place. When did they observe? How long? How many? Were they allowed patient-specific information? Or are these just the opinions of a couple of casual observers?

    Do these people know how to differentiate between common problems of the elderly, such as:

    Overmedication or illness? Lethargy or CVA residual? Confusion or UTI? Combativeness or pain? Fatigue or pneumonia?

    Diagnosing the elderly is not an exact science, but the point is: if they were not ill in the first place, if they could take care of themselves in the first place, if there was no need for any medication in the first place, then the residents would probably not be in the nursing home to begin with.
  10. by   sanakruz
    Cargal- I found that article to be inflammatory at best. The problems seen in nursing homes are multifaceted. To cut to the chase: The staffing is inadequate. 1)If the issue is an ethical one of whether or not we should be chemically and physically restraining our frail elders- The answer is staff on a 1:1 ratio for these individuals in question. 2) If the issue is a medical one (med errors, missed S/S, unanswered call bells), Increase the floor staff- Cna Lvn Rn housekeepers! The staffing regs are antiquated- in place well before managed care sent truly sick people to nursing homes (Not just little old ladies with pace makers playing bingo...) The only nursing shortage there really is is the one created by the profit driven corporation that runs the facilities. Now sjoe you tell me how to fight corporate America cuz I'm running out of answers- 9 times out of 10 i find my back against the wall- I'd love to "do something" to make it better
  11. by   sjoe
    psychnurse--It appears to me that our entire healthcare system is going to get steadily worse over time, regardless of what any nurses do, individually or collectively. Much like during a tornado, you've just got to find a way to take care of yourself and those few people you choose, and have a way, to help. That may be doing something outside the nursing field. There is a time for everything, and the time for turning things around is WAY in the future in this country.

    With that said: Lacking strong national direction, strict rationing of remedial health care (based on a prediction of economic return to society--which is, after all, paying the bills in one way or another), major funding for and emphasis on prevention (in short, a complete restructuring of health care), there can be nothing close to a solution. Germany's system seems to be about the best in the world at this time, costing less than half what ours costs and providing health care for every citizen.

    So long as Americans maintain the fantasy that somehow Americans should never be inconvenienced by the predictable outcomes of their everyday behaviors (diet, exercise, drinking, automobile use, air and water pollution, crime, etc.), and if they are inconvenienced, somebody ELSE should both fix it (right now!) and pay for it, there will be no improvement. So long as Americans fantasize that they and their loved ones somehow should never die, and that death is always such a tragedy that we should spend about 1/3 of our healthcare budget on the final few weeks of people's lives, there will be no improvement.

    It is mostly this head-in-the-sand attitude, fear of death and illness, and attempting to avoid any and all responsibility for one's own activities that have created our present dysfunctional system. Until and unless that changes, any fixes can be only a matter of enabling and applying temporary band-aids.

    IMHO

    [Disclaimer: I do not work for, nor own stock in, nor have any commercial interest in Johnson & Johnson].
    Last edit by sjoe on Oct 31, '02
  12. by   Stargazer
    Heh. Can't argue with anything in your last post, sjoe. Well stated.
  13. by   BBnurse34
    While she did not want to demean everything about hospital care, she did say of health-care professionals: "When you feel you've gotten that way or you're not compassionate enough to do whatever you have to do or you're so hardened, you should get out of that profession."
    Who does this woman think she is?
    Someone should invite her to care for 30 long term care patients, especially since she was not able to care for the one family member that she placed there.
  14. by   ktwlpn
    [QUOTE]Originally posted by cargal
    [B]While I certainly believe that alot of nursing homes don't do as good as a job as they should, their are certain things about this article that I would like to educate the public on:

    1) the nursing shortage and staffing ratios mandated by the state prevent us from giving one on one care-we are really busy and tired and I encourage family members to come in and help feed, etc. We couldn't do it without them!

    2) family members' presence and questions DO help - they know the resident better than we do and also, if they speak up in this crazy healthcare system, they can ensure the resident gets better care.

    3) many families insist that Mother sit up in the wheelchair all day, and wonder why is she tired, sitting in the hall in her wheelchair, slumped over sleeping? Because you insist that she not be able to be laid down after lunch and she is 96, she is tired and I didn't want to disturb her. Also, I invite you to come sit in a wheelchair all day and see how darn interesting you think living in a nursing home is- all kinds of lovely sights and smells. And sounds, like "I want to go home and I want my mother" and "How do I get out of here?" Activities can only do so much to cut into the boredom and depression that come from getting very old and losing everything you ever held dear- like income, mobility, social contacts and roles, life roles like the grandmother, the boss, the sister, the bread winner.

    4) the respirdol or ativan we gave your father in the am is due to his hitting the aids repeatedly, or your mother yelling at the top of her lungs such things as "Don't rape me!". I feel so much sadness for her and have tried EVERY intervention from touch and therapeutic conversation, but she has done this every night for the last 2 months and the Psychiatrist prescribed the medication: we will carefully monitor it for side effects, and yes, sometimes before we get the dosage just right, the resident is zonked and I call the MD right away to let him know and get the dosage reduced or the medication changed.

    5) We are careful not to use medication as a restraint, and the state monitors things like this very closely. We want your loved one to be happy and safe.

    Here is the article- please give me suggestions to respond in such a way as to help our elderly population and take away the negative connation that we all medicate our elderly to make less care.

    http://www.post-gazette.com/neigh_wa...020watank4.asp



    Home > Local News > Neighborhoods


    Think Tank: Nursing suspicions
    Panelists believe patients are put in an overmedicated stupor so they're docile

    Sunday, October 20, 2002



    While good nursing homes bridge the move from hospital to home, bad ones are criticized for doing little more than warehousing the elderly. Visit a nursing home as patients in wheelchairs nod off around the nursing station and you get the picture.

    Elmo George of South Franklin, Sam Cushey of Peters, Bill Brna and Maya Patch, both of Carroll, Bernie Hobach of Washington and Verteree Johnson of Clarksville discuss whether senior citizens are overmedicated.

    Patch believes they are. She coined a term for the drug-induced state she's seen in some nursing home patients -- zombie-ized. She believes patients have been drugged into a zombie state to make them more manageable.

    Her suspicions about overmedication were raised when her mother-in-law, Dora Patch, was admitted to the hospital with congestive heart failure. She was prescribed medication in addition to what she already had been taking, Patch said. After being released, her mother-in-law was readmitted and taken off all her medication -- about 14 pills at the time. The scenario made Patch question why all the medication was necessary in the first place.

    The response she got from health-care professionals was "'We want to keep her comfortable.' Could they all be that sick that they have to be zombie-ized?" Patch asked.

    Patch does not oppose drugs when necessary for illness such as high blood pressure or diabetes but questioned medication that makes patients lie in bed and sleep all day.

    "That's what they call you're being warehoused," said Hobach, who cited a report in the Journal of the American Medical Association that of people older than 65, nearly 25 percent a year are overmedicated.

    If a patient is not mentally sharp enough to inquire about what doctors and nurses are doing, George said, he has to have family members or an advocate to speak on his behalf. It requires constant surveillance of what the medication is, the dosage and the frequency, why it's being taken and how it interacts with other drugs.

    George, too, finds patients are frequently overmedicated. When attending to the care of his wife and later his sister, George said, he made sure he knew when the doctor was going to be in the hospital so he could ask questions.

    Brna suspects overmedication has a lot to do with American culture.

    "We've become a drug culture in this country -- prescription drugs or whatever. Somebody goes to a doctor -- I don't care who it is -- they do not feel that they get any good out of the visit unless the doctor prescribes a pill," he said.

    Often the doctor will not tell the patient why he's prescribing the pill or discuss its side effects, Brna said. He also faults doctors for paying too little attention to medications the patient already is taking.

    Johnson, too, believes patients are overmedicated. She noticed it when she placed her son, Carlton, in a nursing home for a brief time.

    "I could tell he was overmedicated because all he did was sleep," said Johnson, who noticed the same lethargy in a neighbor when she visited him in a nursing home.

    Like the other seniors, she said, "I think they do use medication to keep [patients] quiet. Most of those people who are in facilities, that's a way of controlling them. They are almost like zombies, slowed down so much so they couldn't think straight."

    Cushey said he, too, had been to quite a few nursing homes. He's seen patients sitting in the hall and hanging over chairs, leaving no doubt in his mind there are too few personnel to care for patients. Their solution is to put people near the nurses' station, where the person at the desk can watch them.

    But when you make a human being a zombie, you're wrong, Patch said. While she did not want to demean everything about hospital care, she did say of health-care professionals: "When you feel you've gotten that way or you're not compassionate enough to do whatever you have to do or you're so hardened, you should get out of that profession."

    Since the experience with her mother-in-law, Patch said, she's become leery of taking drugs just because a doctor advises it.

    "That's because you have your mental faculties," George said, referring to those seniors ill-equipped to stand up to the medical establishment.

    "I agree with you," Patch said.

    George believes seniors, for their own good, should take notes and recall what was discussed when visiting their doctors.

    Patch said that for people of her generation, going to the doctor was thought of as if you went to God.

    "I hope that people that are younger than us will start to ask more questions and realize that this could be them. Would you like to just be put asleep in a bed because 'I don't have time for you' or whatever the reason is?" she asked.

    Lynda Guydon Taylor can be reached at ltaylor@post-gazette.com or 724-746-8813.QUOTE] >I e-mailed the author several days ago-she promptly answered back.Was very open to receiving information contradicting that article.Seems she has written another article that I was unable to find in the archives in which she quotes her RN expert=a nursing instructor-not one whom has recently or is currently actually working in acute or long term care.She was very appreciative of information. I take offense to so many quotes in that article-First-the fact that thses people are so eager to give someone else responsibility for their care "They" prescribe meds and don't tell us what they are" So-it is the patients or significant others responsibility to gather that info if it is not offered freely. As for residents seated around the nurses station-it is for their own safety.I have 44 residents on my unit-and no-not enough staff to give them all 1 to 1 care....As far as health care professionals becoming "hardened"-I will NOT set myself up to be emotionally destroyed at work...I have suffered loss in my personal life aplenty-I don't need to bear the burden of all of my patients.I can give compassionate care without bawling and snotting at every bedside(I wait until I get in my car) The article did offer some good advice-primarily to seniors advising them to keep a written record-I have told my pts for years to do so.including a list of all of their meds...... -

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