I see a lot of fiercely independent seniors who haven't planned well for the next phase of life. In the rural areas, they are used to living on their own, sometimes on properties that are deteriorating due to their owners creeping infirmities, or lifelong patterns of sloppiness.
Some have had hoarding tendencies that have gotten out of hand. EMS will give colorful reports on that.
What a good way to help these stubborn folk, who need to be guided into assisted living, or toward accepting family help? Sometimes adult children are spread out, or alienated from their parents.
Sometimes it not that they failed to prepare for the future but rather putting food on the table, cloths on your families back and a roof over their head took priority. It’s easy to say prepare for the future when you make sufficient money to do so but not everyone gets to have jobs making larger amounts of money. All you can do from a nursing standpoint is educated the patient and try to encourage them to at least accept home health type services. But it the end it is their Choice. I have not seen very many well run nursing homes and the ones that are usually cost 12,000 to 15,000 a month (yep that’s the amount they charge) plus other expenses such as foley kits or wound care and medications Medicare pays very little if any and they usually won’t accept Medicaid anymore (at least not here). And sometimes even those facilities are not that well ran.
I would have a lawyer look at any contract/paperwork because I had an Great Aunt get involved in a place much like you describe but when it came time to her needing the care it was minuscule at best, not at all like she was told/led to believe. After 20+ years who can be sure what you are going to get. I hope your place is different and wish you well.
.... All you can do from a nursing standpoint is educated the patient and try to encourage them to at least accept home health type services. But it the end it is their Choice .....
On 8/14/2020 at 5:32 PM, CharleeFoxtrot said:
Those services are expensive as well, with a minimum 4 hours/day commitment.
Where do you get 4 hours/day min???????
Services ARE out there, but ...
Medicare is sooo limited and it focuses on SKILLED care (nsg, PT/OT). Skilled visits are quickie in & out - the CNA visits are time-limited as well and usually task-limiting. Mostly domestic-type services are what's desired, but that's not Medicare.
Medicaid will cover more of the domestic/housekeeping services, but that's also usually limited. And then the pt/client must be Medicaid eligible. We're talking money!
Any other extra/additional desired services over & above are then out-of-pocket, private-pay. Talk about expensive!
I guess it all boils down to what someone is willing to pay for. Pts and families are often so opposed to pay for such needed services. Even when it is clearly indicated to maintain a better quality of life. But there's the choices to be made.
The title of this post should really have been 'old pts clinging to independent living". Successful or unsuccessful is purely subjective - to whose standards should the pt's lifestyle be judged? And then who should pay?
I took the comment "home health type services" to mean Visiting Angels type, which do require a 4 hr minimum/d they have either CNA or companion care (no medical, ADLs etc). We have this type of companion care for my elderly relative. They drive to store/appts, cook, clean etc.
Around here it is a 4 hour minimum for private duty/private paid agency in home help. They won't come out for just an hour to say get someone up and dressed.
Gotcha! The commercial care-provider organizations are muy expensive.
A consumer of those services needs to be cognizant of tasks within a time window to make the best use of the limited time block. Like TIME MANAGEMENT in the home, only with a price tag on it and you're paying!
I see a lot of fiercely independent seniors who haven't planned well for the next phase of life. In the rural areas, they are used to living on their own, sometimes on properties that are deteriorating due to their owners creeping infirmities, or lifelong patterns of sloppiness.
Some have had hoarding tendencies that have gotten out of hand. EMS will give colorful reports on that.
What a good way to help these stubborn folk, who need to be guided into assisted living, or toward accepting family help? Sometimes adult children are spread out, or alienated from their parents.
As a nurse manager in a short-term rehab facility, I work with residents and their families on a daily basis to ensure that they have safe discharge arrangements made prior to leaving our facility. Many of our residents are able to return to their homes if they have increased services, while other have care needs that are so extensive that returning home is not recommended. Typically, I meet with social work, therapy and family (if available) to help explain the risks and benefits of each option. Many residents are receptive to increased services and/or new living arrangements if they understand why the recommendations are being made and how they can benefit their health and wellbeing. However, others are more reluctant--not necessarily because they "did not prepare for the next phase of life," but because they have a home and family they have come to know and love over a period of many years. Some might be scared of moving to a new place, while others are just seeking the comfort of a familiar environment. In these types of situations, in addition to explaining the risks of returning home, we try to project a positive outlook on their possible new living arrangements. For some residents, this is effective. However, others would rather accept the risks of returning home. If the resident is cognizant and/or has family to advocate for that choice, there is not much we can do except document that risks were explained to the resident and family and they are willing to accept those risks. If there is no family and if the resident has cognitive concerns, social worker may take it from there and work with services that can meet the safety needs of vulnerable adults. However, in most cases, residents do have the right to choose where they would like to live at the end of their life. As long as they have been educated about their options, we need to respect their wishes.
I have encouraged my mother to stay away from the nursing home as long as possible . My brother said probably ,5 years ago she should go to the nursing home . She is 94 today . I told her as long as she could get to the bathroom on her own and be able to fix a bite to eat she should stay home where she is . And so far it's worked that way . I, and my niece have done alot for her, shopping and cleaning in the house, and sometimes bringing in meals. I'm glad she's been able to stay home, due to this COVID thing seemingly to affect nursing homes more. I don't think she would like living in the nursing home . I know she would find alot of things to complain about from her limited space to her medication schedules. She lives in a small mobile home and it is not deteriorating and she's not a hoarder. If anything she gets rid of stuff when she can and doesn't bring stuff in . So every person is different . They have to think about what's best for them .
Specializes in Critical Care; Cardiac; Professional Development.
On 8/12/2020 at 7:32 AM, Emergent said:
OK, so nurses should not try to guide and influence patients towards healthier choices of living, but just "let them die on their own terms". Message received.
We should protect patient autonomy, as long as they are in a mental state that allows them to evaluate their choice and make the one right for them. If they are alert, oriented and in their right mind and able to take care of their own ADLs, we need to respect patient autonomy. I am a little amazed anyone would suggested otherwise.
This snarky remark is a little short sighted. People don't have to live the way you want them to. If they wish to live in clutter and a run down home, let them. I personally will fight as hard as I can to stay in my own home as long as I can. Why? Because I'd rather live with my own clutter than the abuse and neglect and bad cooking and miserable demise that I see happening in SNFs, because I worked HARD to pay off my house in less than 9 years and due to that my money situation is better than average and I'll be damned if it gets left to a greedy healthcare corporation who doesn't give two snits about me. If I am able to deal with stuff, maybe not to your level, but to one I am personally satisfied with that endangers nobody, why should I have to move elsewhere?
It is part of your job to advocate for the patient. If the patient wants to stay at home and it is reasonably possible without accommodation or WITH reasonable accommodation, it is a central part of your role as their nurse to maximize that potential. Don't look at why they shouldn't be there, especially not through some judgy lens. Look at how you can make them being there safer, more effective and more satisfying for all.
Specializes in ICU/ER/Med-Surg/Case Management/Manageme.
There are so many of you commenting on this thread I would love to quote...or clap when I read your comments. I'm one of those seniors not yet ready for the ALF and praying I never have to go to one. I can't imagine the horrors of that type of living after being a productive and highly functioning adult all these years. Literally makes me queasy - just the thought of ALF.
I agree, OP...sounding a bit judgemental. Come back in 30-40 years and let's see what you think then.
Specializes in LTC, assisted living, med-surg, psych.
On 8/17/2020 at 9:41 AM, Nurse SMS said:
We should protect patient autonomy, as long as they are in a mental state that allows them to evaluate their choice and make the one right for them. If they are alert, oriented and in their right mind and able to take care of their own ADLs, we need to respect patient autonomy. I am a little amazed anyone would suggested otherwise.
This snarky remark is a little short sighted. People don't have to live the way you want them to. If they wish to live in clutter and a run down home, let them. I personally will fight as hard as I can to stay in my own home as long as I can. Why? Because I'd rather live with my own clutter than the abuse and neglect and bad cooking and miserable demise that I see happening in SNFs, because I worked HARD to pay off my house in less than 9 years and due to that my money situation is better than average and I'll be damned if it gets left to a greedy healthcare corporation who doesn't give two snits about me. If I am able to deal with stuff, maybe not to your level, but to one I am personally satisfied with that endangers nobody, why should I have to move elsewhere?
It is part of your job to advocate for the patient. If the patient wants to stay at home and it is reasonably possible without accommodation or WITH reasonable accommodation, it is a central part of your role as their nurse to maximize that potential. Don't look at why they shouldn't be there, especially not through some judgy lens. Look at how you can make them being there safer, more effective and more satisfying for all.
This. ^^ I’m getting older too and I have told my kids that if I become ill or demented, to just let me wander off into the woods and allow nature to take its course. I’ve worked in ALFs and LTC and I wouldn’t let my dogs live in either one. Even the better-run facilities don’t look out for their residents as much as they do their shareholders. Bad food, meds not delivered on time, routines that are more convenient for the facility than the residents, short-staffing, and difficulties with residents who wander into other rooms and steal things are just a few of the things that can go sideways in an ALF or nursing home.
Years ago, I had a deeply philosophical discussion with a couple of friends fueled by alcohol and nachos, and I asked them if given a choice, when and where did they want to die. One girl looked at me and said “five seconds before my feet cross the nursing-home threshold”. Works for me.
registerednutrn, BSN, RN
136 Posts
Sometimes it not that they failed to prepare for the future but rather putting food on the table, cloths on your families back and a roof over their head took priority. It’s easy to say prepare for the future when you make sufficient money to do so but not everyone gets to have jobs making larger amounts of money. All you can do from a nursing standpoint is educated the patient and try to encourage them to at least accept home health type services. But it the end it is their Choice. I have not seen very many well run nursing homes and the ones that are usually cost 12,000 to 15,000 a month (yep that’s the amount they charge) plus other expenses such as foley kits or wound care and medications Medicare pays very little if any and they usually won’t accept Medicaid anymore (at least not here). And sometimes even those facilities are not that well ran.