ALF issues, please help

pielęgniarka, RN · Apr 7, 2009

Sure the residents have the right to refuse cares. But they have to be advised of and acknowledge the consequences. The majority of residents are in assisted living facilities to get "assistance" with their ADL's. You have to encourage and help everyone to get up and complete those ADL's. Its that way everywhere and sometimes its hard. Decreased mobility leads to pneumonia and constipation other serious health ailments in the elderly which in turn would cause uneccessary suffering.

If a resident is depressed and withdrawing, please notify the RN or head nurse right away so they can contact the doctor and family and make changes to the plan of care. The nurse might also include the chaplin or social worker in working with the withdrawn resident.

~Sara

tiggerforhim · Apr 7, 2009

Well, it's nice to think of the patient's rights, but the previous poster is right. If the residents were allowed to lie in bed all day, not eat, and only use their wheelchair, in no time they would have pneumonia, constipation, more falls (from no exercise and muscles weakening), bedsores, skin tears, and death. I'm not trying to be stark, but these complications are all preventable by mobility and nutrition. They need to get up and move around. Lord knows, it's not an easy job you have, especially with people who might actively resist you, but it's part of your job description to do that and what your head CNA tells you to do (unless it will be injurious to the patients, of course).

nurturer · Apr 8, 2009

Perhaps hospice is calling my name. I'd much rather help people die comfortabley and with dignity than to badger tired old folks into doing things they don't want to. Some of these people just don't have the "fight" in them. My guess is they never did. Why, then at the age of 90, when they are placed in an ALF, should they start working on thier fitness and nutrition? So the people around them don't have watch them die?

There are other folks that refuse to let me help them. They are bound and determined to do EVERYTHING themselves, even if it takes 10 minutes for them to get from their wheelchair to thier bed, I try to stand back and allow them the time to do this. This is unrealistic of course....but I do try like heck to allow people the dignity to do as they choose. I believe that preserving thier right to choose naturally compels the elderly to "live." When we take thier choices away... personal choices such as diet and exercise, we take away all they have.

I think that if they use a wheelchair, they are much less likely to suffer from falls than those who are made to walk beyond what thier aging bodies will allow. There comes a time to rest and to allow death to happen....from pnuemonia, from a fall, from whatever. Why prolong the inevitable? Assisted LIVING includes helping with the challenge of facing the end of life. Insisting that people walk when they don't want to, or to eat when they don't want to puts the focus of living on the physical and does not consider the PEOPLE within those aging tired bodies.

If it were in my hands I would say assisted living means sitting with them, taking the time to listening to all their stories, going to get them an apple juice in the middle of the night because that's what they want. Wheeling them out into the sunshine and helping them to smell the flowers....holding thier hands, bathing them with love and attention. This is the way I want to go out of this world....not having some irritable overworked nurse or CNA rushing me onto the toilet and making me eat that nasty eggplant parmesean because I ordered it, and making me walk a very painful walk to another boring social where I can't hear or understand anything anyone is saying.

I hope to God I never end up in an ALF, where my last years, months, days and minutes are determined by people who have no idea about what living means to ME.

I've got a lot to learn as a CNA and eventually a nurse, I suppose. However, I hope that what I value about life and people doesn't change. I hope I don't someday come think that a clean bottom and full tummy trumps the value of the precious souls inside those aged bodies.

What I love most about my job is saying goodnight to my residents. It feels very much like what it felt like to tuck my own kids in at the end of the day. All the hard work...all the running around, all the stress...all the frustration is so worth the satisfaction of knowing my "people" are safe, nurtured and cared for. :redbeathe And just like with my kids....I feel like if I don't advocate for them...who will?

Havin' A Party!, ASN, RN · Apr 12, 2009

Nurturer -- I'm with ya on this one.

My general approach is to encourage participation in activities and eating, as previous posters have indicated.

But over time, status changes are likely, and natural. As aging / disease processes progress, at some point "forcing / coercing" residents to undertake activities / tasks they truly don't want partake in becomes tantamount to a form of "torture."

Truly sensitive professionals, having learned the nature of the folks being cared for, will know when it's appropriate to lighten up, realize that a new phase of treatment / care has been reached, and then modify the plan.

Good luck!