Nursing home phenomenon/ What's this?

Juliet310 · Oct 28, 2014

p.s. This is a sensitive topic so I hope it was worded in a way that does not feel offensive to others, I apologize if any part of message comes across that way. And secondly, I might have projected some

of my own ideas in the post because I am still in the phase of gathering information, and things evolve and change as new ideas bounce around. And lastly, I am just really trying to figure it out and learn more about topic. : )

LadyFree28, BSN, LPN, RN · Oct 28, 2014

Have you heard of Advance Directives, Power of Attorney, futile care?

Have you heard of palliative care?

These issues come into play in terms of rights of self-determination, as well as notifying loved ones of end-of-life issues.

As far as funding, it depends on insurance, private pay, etc-meaning that the public is not necessarily paying, although that can be open for debate.

The nursing home business is lucrative to many companies; it is also a highly regulated one in this country, the largest staff are nurses, RNs and LPN/LVNs, and CNAs that provide direct care.

There are many discussions here on AN that address end of life issues; you can also use the search function to find some of those discussions.

**NICU Guy, BSN, RN** · Oct 28, 2014

Your questions are well articulated and have the hint of a homework assignment veiled as student curiosity.

Juliet310 · Oct 28, 2014

Thank you, Yes I am aware of those legal terms. I think my question is more about what events in time and political forces are behind this current trend. It seems like to find the answers I am looking for I need to do alot of research!

LadyFree28, BSN, LPN, RN · Oct 29, 2014

Thank you, Yes I am aware of those legal terms. I think my question is more about what events in time and political forces are behind this current trend. It seems like to find the answers I am looking for I need to do alot of research!

The "events in time" is due to one of the largest generations is starting to age, political forces may be due to economic laws changing resulting in economic downturn, and overall health in the nation being less than stellar...the perfect storm.

Yes you need to do research in all capabilities to have an informed insight into what the cause is; however, it's not "one" thing, and it may or may not be political, although to me, politics is a percentage in terms of what the general public is doing in terms of health and viability; but then there is illness and how one recovers from it that plays a part as well.

amoLucia · Oct 29, 2014

Your questions are well articulated and have the hint of a homework assignment veiled as student curiosity.

Yep. I was thinking homework too.

To OP --- just curious - do you (or your parents) have Advanced Directives done? From this response, you may be able to answer some of your own questions as to why or why not.

And the paragraph from LadyFree28 "events in time" pretty much answers your post also.

ktwlpn, LPN · Oct 30, 2014

It's NOT a current trend.I do see a fewer number of end stage elderly residents with artificial feedings. It's a big change from 25 years ago. Also our culture moved away from housing the extended a generation ago. Our parents and our children are cared for by others because we believe we need a dual income to survive.We "feminists" also believe we can have it all-a career,a home and a family ...I think we have all suffered because of it.

I'm too tired to get into our society's denial of death, lack of advance life care planning and futile care because "I can't let momma starve" etc, etc. I hope you complete an advance directive and encourage your family to follow suit.

Juliet310 · Oct 30, 2014

Thanks for all of the responses. The only thing I can clearly understand is that I don't understand and I will try to find out more. It

just seems unethical. I suspect, and I could be wrong because I have not done the research - is that things just snowballed and now

we have the current situation because of all the past events you all have mentioned and the general puplic is the one to suffer because we don't make the laws we just abide. I feel the sick, elderly, disabled, and poor are the ones to suffer because they lack

the resources to make informed decisions. To answer your questions, yes I had this discussion with my father who recently had an urgent surgery, an aortic valve replacement. I told him the conditions about the nursing home, and asked him if he wanted DNR status, and if he had a living will and advance directives. My father is a practicing Catholic and he believes that he is not DNR but

additionally has said that he would never want to live like that. I am not sure what the Catholic church says exactly either, but I know their belief with regards to physician assisted suicide. All of the legal , medical , and religious details are complicated and are not easily interpreted by the public, that I think is unethical. I asked my brother , who is an attorney and my father who is a scientist with 2 PHD's and neither of them knew all the details, we had a probate lawyer do the living will. I guess my hopes would

be that somehow this info can be made readily available because effects so many lives.

Juliet310 · Oct 30, 2014

I know I am tired too, I just pray that I have enough energy in the day to get good grades, pass the

test, and help humanity with my career. I was hoping to work with seniors, but the conditions in this

LTC/ SNF is deplorable. I can't understand my purpose there except to learn , I feel like the patient's

life is gone. : ((((((((((( I wondered if I work there if my job would have purpose or am I just getting

a good pay check and keeping people safe and alive. I think I enjoyed working with the developmentally disabled much more. I could work as a care planner instead and help teach relationship skills and teach them how to live independently safely, and protect them from people who try to harm them. Even as a caregiver I witnessed sd ituations which I felt exploited them.

For example, a person living in independent group setting managed by a company that will hire staff for 24 hour care and a day program that provides them recreational opportunities. I was a sleep shift night sitter for my client, and the other staff (in the same house with a private room) was the "awake" staff for the other resident who usually is awake all night getting into trouble. I would not really be able to sleep because the other resident would take random baths in the middle of the night and I had to stop it, (his caregiver was sleeping) I found him asleep when his bath was too long, and I got him out of the back door from digging in the trash cans because his fridge was locked by his parents. The caregiver was irresponsible yes, but he was a full time student and the company did not offer to pay the awake staff any more than me. I reported all of it, and the person who was hired to fix all of their ******** was fired because his rate " was not worth it" and they couldn't humble themselves from listening. THat company had all of their clients pulled from regional center because this negligence of course ended up harming the clients and they ended in hospitals. I am so grateful that regional center did that, but sad for the people in their care who suffered because of their corporate greed. As soon as the new manager was fired I quit because they did not care to change their ways. I am so glad that company is no longer in business.

bluegeegoo2, LPN · Oct 31, 2014

In my experience, a fair amount of people (residents and their Responsible Party's alike) tend toward quantity of life vs quality. I've had countless family members proudly proclaim that "Mom" is 97 years old. (Or whatever advanced age.) They seem to fail to see that "Mom" has a very poor quality of life. I've even had a resident that was 104 years old and a full code because "I didn't bring my mother here to die." ?!! I've also been told to "do everything that you can" to keep their loved one alive. For more than a few of the residents that I've cared for that can speak for themselves, they don't want to be coded. However, "my daughter/son/spouse wants me to be a full code, so I guess that's what we'll do." In other words, it seems to be the family more often than not who wants any and all measures taken to preserve the life of their loved one at the cost of their quality of life in some cases, even if the choice is in opposition of what the resident wants for their self. I see a lot of guilt in those decisions as well. They want to feel that they made sure they did everything for their loved one and when death ensues, they will carry no guilt that they "should have" or "could have" done this or that.

I don't see these decisions as a lack of education. I personally see it (based on many, many statements from family) to do whatever it takes for them to be as guilt free as possible. Guilt transcends all backgrounds regardless of age, race, religion, financial status. Please keep in mind these are my own observations for the last few years in LTC.

Juliet310 · Oct 31, 2014

Yes that must be another reason. I was just discussing this with a neighbor of mine and we talked about people being so uncomfortable with death. And I don't think these family members are really

doing "all they can", it's the nurses that are! It seems the families are being unethical by pressuring

them to not allow them to live that way. It would be more ethical to for families to learn about option

and discuss them with loved ones before they are unable to understand and allow them to 100 % make their decision. I notice as our loved ones get older they become much more vulnerable and

if the children are not ethical they get bossed around. So maybe education would still help here? I think these family members do not see themselves as being unethical.