It's an impasse that leads to big decisions and uncomfortable conversations, and yet so many families are struck with the fact that they can no longer care for their mom, dad, or loved one.
Lots of emotions surround this topic; namely guilt.
Usually people turn to group homes of some kind. “That’s everyone’s first thought,” said Lisa Gwyther, the veteran social worker who directs the Duke Family Support Program in Durham, N.C. “Everyone says, ‘My mom doesn’t belong in a nursing home,’ so they think assisted living, regardless of her medical needs or prognosis.”
But assisted living is not for everyone, either. Ms. Gwyther and Dr. Hawes are now speaking out to give guidance on which older people are likely to do well at such facilities and which will need the greater supervision and higher staff ratios that nursing home can offer.
“Nursing homes have gotten a bad rap,” Ms. Gwyther said. There are good ones, and there are seniors who need them.
For instance, “anyone with moderate to severe cognitive impairment and problem behaviors like resisting care or becoming alarmed if someone tries to help them shower generally belongs in either a dementia unit with well-trained staff or in a nursing home,” Dr. Hawes said. In assisted living, “there’s not enough staff to help.”
This also goes for seniors with complicated medical conditions that require frequent monitoring. Assisted living doesn’t provide much health care, so residents risk becoming what Ms. Gwyther calls “frequent fliers — they’re going in and out of hospitals for conditions that could perhaps be treated in a nursing home.” This not only increases costs for the family, but also increases the change of their loved on being exposed to the harmful bugs (various contagious illnesses, antibiotic resistant bacteria, etc.) within the hospital.
Assisted living can pose a problem for seniors with incontinence as well. Although most assisted living facility will accept someone who’s incontinent, what they mean is 'as long as they can change their own briefs'. Dr. Hawes cautions against assisted living, "(If) what you mean is, ‘She needs help getting changed four times a day and needs the sheets changed every other day.’” Housekeeping staff in assisted living typically change linens weekly.
Furthermore, federal regulation provides greater protection for nursing home residents. State regulations govern assisted living but they vary widely.
Nevertheless, assisted living can work well for people with mild cognitive problems, who particularly cherish privacy, and who are sociable and alert. They usually offer interactive programs that create an environment for socializing and the creation of new hobbies.
I urge you, for the sake of your loved one, regardless of their location (including home) don't ignore the warning signs. If you notice that they smell of urine or feces, if they're becoming increasingly (and unusually anxious or lethargic for a length of time, or simply just not themselves; speak up.
It won't hurt to ask questions. It certainly won't hurt to get a second opinion. If anything, it may even prolong their life or save it.
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Share this report and increase the awareness of the differences between assisted living and nursing homes. This post is not intended to discourage or encourage one or the other. It's purpose is to simply inform, so your loved ones don't become like one of the grim stories from the PBS report.
To your wellness,
Leah Korkis, BSN, RN