Please help me respond to this disturbing article

Published

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_washington/20021020watank4.asphttp://www.post-gazette.com/neigh_washington/20021020watank4.asp

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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 [email protected] or 724-746-8813.

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Konni,

Many of you here at allnurses.com have helped me be the nurse I am today.... and given me the courage to continue to fight. If I don't work in LTC ..... I may write that book some day! Thanks for being there.

Carrie

Konni,

Many of you here at allnurses.com have helped me be the nurse I am today.... and given me the courage to continue to fight. If I don't work in LTC ..... I may write that book some day! Thanks for being there.

Carrie

I haven't worked LTC in ages, and then only did it rarely -- per diem, but would like to make a few comments that might be apropriately included in the content of a response to either article. 1) People who are placed in nursing homes are there because of multiple problems for which multiple medications are prescribed. Even those who are there only for a short period of time may require meds in addition to the everyday pills they take simply to treat the condition that required the change of residence from home to LTC. 2) Yes, LTC residents may sleep longer periods of time than you are used to their sleeping at home. Boredom and depression both may contribute to this. Those who are not "pemanent residents", but who are there because of a temporary although long-term condition probably don't feel well either. Don't we all tend to want more sleep when we're not well? 3) I would respectfully suggest to anyone who is concerned about the amount of personal attention available to each resident to volunteer their services to help feed, accompany a resident to the outdoor patio for a change of scenery, and provide some company to someone who has no family or friends to visit. This could not only be of benefit to the residents, but has the potential of helping change the future of LTC care by giving the public more of an insider's view of what the problems are.

I haven't worked LTC in ages, and then only did it rarely -- per diem, but would like to make a few comments that might be apropriately included in the content of a response to either article. 1) People who are placed in nursing homes are there because of multiple problems for which multiple medications are prescribed. Even those who are there only for a short period of time may require meds in addition to the everyday pills they take simply to treat the condition that required the change of residence from home to LTC. 2) Yes, LTC residents may sleep longer periods of time than you are used to their sleeping at home. Boredom and depression both may contribute to this. Those who are not "pemanent residents", but who are there because of a temporary although long-term condition probably don't feel well either. Don't we all tend to want more sleep when we're not well? 3) I would respectfully suggest to anyone who is concerned about the amount of personal attention available to each resident to volunteer their services to help feed, accompany a resident to the outdoor patio for a change of scenery, and provide some company to someone who has no family or friends to visit. This could not only be of benefit to the residents, but has the potential of helping change the future of LTC care by giving the public more of an insider's view of what the problems are.

I have worked in LTC facilities and I am sicken how we treat our elderly. With the youth worshipping society we live in it is no wonder our facilities are nothing more than dumps for the elderly. I loved working with my residents but the lack of care and greedy grubbing hands of the administrators were too much. They only cared for their money and the poor families assume that their loved ones are in good hands. If they only knew. I know all LTC aren't bad unfortunately there are too many that are. I have tried to make the most of it but when saftey issues were being neglected not to mention setting up my licensure to be jepordized I had to go. The whole system itself needs to be revamped big time. I truly feel for families who have to put their loved ones there. I know I couldn't put my mom or dad in one of those mills they call hospitals. Because knowing my personality the state would have to pitch a tent there......... just my 2 cents.

Way back, 5 years or so ago.. before I was a GN, I thought I could "maybe do LTC"... I really did not get that oppourtunity till last year when I lived in a very small community. The local hospital was most dishonest and controlling of scheduling and yadda yadda... they said to me, "What are you going to do? Work in the Nursing Home"? well.. given that challenge the way I did.. that is exactly what I did....

I really thought I could do it... it was too hard.. too depressing... too sad....

I was physically beat up twice; one of those times it was with a steal brace kicking me while I was backed up to a wall. The other time the poor dear lady was so frail I was afraid she would hurt herself when she kept slapping me. Had I had a shot of something I would have gladly injected it to both of my patients.

What are the answers? I do not know.

I just know it is too hard and unrewarding for me to do that kind of work. I applaud and am in awe of nurses who do that sort of thing.

I can sometimes still hear and remember the screaming and moaning of those individuals. Some were lucky and did have family coming regularly. Most were there because no one else could care for them or some simply had family who did not care.

I for one, pray to God, that I go nice and quick and do not have to end up that way... sad but true...

Oh and the "Administrator" would tell us we obviously were not utilizing "interventions" to control negative or inappropriate behavior.. the dog....

I could go on and on.. but I will not...

Thank you for letting me vent....

Another thing that gripes me about the state and LTC is the way they look down on anti-depressants in the elderly.. For crying out loud, why wouldn't most elderly people be depressed? My 84 y/o grandmother (who is still at home) has every reason in the world to be depressed. Let's see, in the past 10 years my grandma has endured: the death of a grandson, the stillborn death of a great-grandchild, the death of a son-in-law, the deaths of 2 of her siblings, been diagnosed with CHF, afib, and had a pacemaker placed, suffered a cardiac arrest post pacemaker placement, lost her ability to drive, has been told that she has macular degeneration, glaucoma, went from taking zero drugs to 7 or 8 daily including Coumadin, and last but not least has been told in the last month that her oldest daughter has cancer, and probably is terminal.......

That is enough to depress anyone....but no, according to our wonderful government people (who don't have a freaking clue!!) accuses health care of giving unnecessary mood altering medications. If I had been through HALF of what my grandma has been through the last decade, I would be depressed too. A lot of elderly folk have been through hell and back the last few years, why not give them medication to help lift their spirits? Hell, I would need the drugs and the key to the liquor cabinet if I had been through all that......

I had worked in LTC for a short time...When the families came in and the client happened to be in my hall..it was total chaos...I would love to spend more 1 on 1 time with these folks...but it is virtually impossible.. but that doesn't stop me for trying my best..maybe I am too ambitious...but I tell the families exactly this..."I treat everyone in here as if they were my own."

Carrie, You bet I am going to write this reporter. I worked in LTC for 5 years from floor nurse to DON. The prof. quoted in this article appears to not have been a floor nurse since the 1970's.

Think this, given the average patient load for a CNA in LTC and the average length of time to get patient's up and in the dining room for breakfast, it gives CNA's just over 8 minutes per patient. I can't manage to get myself ready in 8 minutes. Do the same thing given the average patient load for nurses and divide that into the allowable time span for meds and nurses have just over 2 minutes to see each patient to pass all the meds. The inability of staff to truly interact with patients beyond the most mundane things will lead to great depression among the elderly, studies show that one of the biggest issues for elderly is depression, in and out of nursing homes. And many of the hallmarks of major depression are sleeping, not interacting or participating with outside stimuli, etc...

Then of course there is the idea that LTC is equipped to deal with mentally ill elder citizens. Behavior modification can never work as long as there is not enough staff to do it. On too many occasions I have seen residents who were violent sent to a mental health facility, back in 3 weeks on a variety of meds, just for us to have to wean them off so as to not get a citation and then we have the violent resident who attacks both staff and other residents. A vicious cycle. All patients who are on pyschotropic meds have to be tracked with behavior sheets, as well as being flagged on med sheets. It is my opinion that we are denying useful medications to our elders at this point for fear of being cited for overuse of medications. In not one area of nursing have I worked in have I been physically abused by patients as often as I was as when I worked in LTC, including when I worked in a Neuro ICU unit.

To me the majority of activities in a nursing home are a joke. We expect elderly people to play games as if they were children. In the Eden Alternative there are several things going on at the same time allowing the resident to pick and choose what they would like to do, the vast majority of homes that say they have gone to the Eden Alternative most certainly have not. Putting a couple birds or dogs in a facility with some plants is not the Eden Alternative.

For every problem there is in LTC the solution could be found in appropriate staffing. In Michigan the minimum staffing guidelines are 2.25 hours of direct care per patient in a 24 hour period. There are many states that are even less. Most homes, for want of a better word, staff so close to the minimum's that one call in can then put staffing below minimum's. There is no way to meet the needs of the multiple issues the elderly in LTC have with that type of staffing.

In LTC the inability to medicate appropriately with physcotropic medications has led to deaths of residents. In Michigan a couple years ago there was an elderly woman who strangled her roommate to death. There was all sorts of hoopla over that, with the media questioning how a woman who had a known violent history was not appropriately watched. I think my husband got tired of me talking to the TV when this happened. Let me think, this happened because there was not enough staff to watch her, this happened because the appropriate medications were withheld from her, something that would not have happened had she been much younger. The ability to restrain a patient has basicly been taken away from us, regardless of whether the patient is violent, will fall repeatedly out of their wheelchair or bed, or if they are harming themselves. With long term mental health facilities basicly none existant anymore there will be more and more mentally ill, and often plain deranged elderly being placed in nursing homes that are ill equipped to deal with them, who can not medicate them. The idea that the elderly in nursing homes are sedated or overmedicated makes my blood boil, because unfortunately the opposite is true. The patients who are asleep in their chairs are likely depressed, for which I may not be able to medicate them for, they may simply be tired because their bodies are old, and as we get older we do not sleep in the same rhythms as when we are younger, instead older people tend to cat nap through the day and often through the night. That can be found in any textbook and the good prof. should know that.

Then of course the demented, wandering patient has to be thought of. The ones who constantly are out the doors so that the already thin staff is running 50 times a day to get them back into the building. Wish I had a dollar for every time I chased a resident down the block trying to convince them to come back inside, could go on a great vacation. Some will become physically violent towards you, so you are ducking and diving to avoid being a punching bag while convincing the resident who is determined they are going home or to work, that really they have to come with you. Most of the time this is done alone, because other staff are too busy doing other things.

The family member who wants to know why mom is allowed to keep falling and injuring herself. Well, the state says she has the right to fall. By state regulations we are not allowed to give any chemical restraints, nor physical retraints. Then of course the family member looks at you like you have three heads. Did I mention the family members who scare the bejesus out of you? But you can't bar them from the facility either.

After the 5 years I spent in LTC I am so burned out in that area that the only way I would go back to it is if that were the only way I had to feed my kids. The inability to provide appropriate care to the people who built this nation to what it is now became too much for me. The paperwork requirements are so heavy that if we were able to put the nurses on the floor that are now engaged in only paperwork then there would be at least 4 more nurses available to do direct care, and that is based on a middle sized nursing home. Across Michigan, at least, the use of mandatory overtime is more frequent in nursing homes than in hospitals because staffing is already so low that a call in or a scheduling error drops you below minimums. This of course leads to more staff turnover. It amazes me that the industry is allowed to continue to function in the manner it does. The guidelines for nursing homes are not bad per se, they are simply enforced at the whim of the inspectors. What was ok one year may get you a citation the following year. It is a guessing game, and because of that facilities come up with new and improved, read more, forms to try to appease the inspectors.

They all cry proverty, that is simply not true. What is true is that if they staffed based on the actual care and acuity of the patients it would cut into profits. Read the Newsweek article under activism. It only solidified what I believed. Ultimately I believe it is much cheaper to staff appropriately than it is to pay fines, or get an inspection that is so poor that the facility closes to admission and readmission of patients. Then in Michigan if a facility have citations of actual harm, then the state can send in a state administrator and however many consultants it feels is necessary, they can order any equipment they feel is needed etc... and the cost of this is paid for by the facility itself. I know of one facility that paid over half a million for 30 days for this. The real interesting part of this is that the consultants are actually a private group hired by the state, and most of those consultants used to be state inspectors. Talk about croynism. There are a whole lot of people benefiting from the system as it stands, but it sure as hell is not the frail elderly that is supposed to benefit. And as Carrie found out, the nurse who speaks up is told they don't know anything, even though they are the ones who are actually doing the work and knowing they are not providing what is needed. If they opt not to quit, they will likely be pushed out one way or another.

Carrie, I say write this journalist. I plan to.

Helen

Thanks for being there for us. I plan on speaking of this to my adminstrator, too. The words "you will go into the community and speak of this place bad" came from her mouth when I brought this up. Patient care is not the concern, only the census. She said we are not making money. Where can I find out what there profit margin is. I am burning mad, but with all your support, I have just begun to fight.

Blessings,

rncountry-i absolutely, positively, 100% agree with every word of your post!!!

bravo!!! bravo!! bravo!!!

Specializes in Corrections, Psych, Med-Surg.

rncountry--excellent post, as usual.

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