SAN DIEGO — Nursing homes are often associated with the last chapter in people’s lives. But at least these days, involved families will consider making changes when they identify deficiencies in a nursing home’s care, are dissatisfied with placements made during hasty hospital-discharge planning or see patient abuse.
Although change is difficult, given what we know about longevity today, caregivers can lobby for high-quality care and cognitive-enrichment programs or find a more suitable home.
At the Gerontological Society of America’s (GSA) 65th annual scientific meeting last month, presentations from experts on caregivers, longevity, long-term care and optimal aging were particularly poignant for baby boomers. As the next generation of nursing home or assisted-living residents, the boomers will demand change for the better.
Reducing the trauma of change
One concern about making a nursing home change is the perception of “transfer trauma.” Robert L. Kane, M.D., who chairs the Long-term Care and Aging Department of the University of Minnesota, said there has been a belief that nursing home transfers, such as to a hospital and back or from a home care situation, are beleaguered with setbacks.
“What we know about care in general is that change introduces an opportunity for bad things to happen,” he explained. “You counter this by preparation and engaging the resident in the decision as much as possible.”
Kane advised, “Caregivers should recognize the importance of arranging for the information transfer of medical history, medication and behavioral records. The caregiver is the only person who really knows what is going on, and the more you can compile, the better the chances for success at a new home.”
While family caregivers may fret with worry, Kane, author of The Good Caregiver (Penguin, 2011) added: “We do know that humans are incredibly adaptable. However, if a person is happy in a situation that is not good, how do you weigh the benefits against the disruption? And keep in mind that you as ‘the weigher’ are already biased.”
Fighting abuse, finding positive change
Meanwhile, at last month’s GSA conference, Iris C. Freeman, associate director of the Center for Elder Justice and Policy at William Mitchell College of Law, in Minnesota, noted real difficulties families may encounter in dealing with elder abuse. She pointed out the difficulties that state and county agencies have in making some abuse findings hold up against appeals.
“We have seen cases where adult protective services or the health department document emotional abuses by a caregiver, but the findings are reversed on appeal owing to the subjectivity of documenting harm. These cases are very disheartening,” she said.
But there is much positive news, even for people with dementia. The documentary “Alive Inside” shows social worker Dan Cohen bringing iPods to nursing homes. Those who did not usually speak sang. Those with walkers danced.
After a screening of the film at the GSA conference, Jan Maier, a research analyst in aging, disability and long-term care, said: “Although it’s limited, research seems to indicate that people with dementia may retain their ability to participate in the arts. In particular with music, it seems the ability to sing, play an instrument or listen to music is preserved, even for those in later stages of dementia.”
She explained, “Music and other arts may offer an enjoyable way to cut through the cognitive fog of dementia and re-open a bridge of human-to-human communication so often lost when people can no longer converse.” Maier is also a musician and singer.
Whether to determine an initial placement in a care facility or identify a new home for a loved one, caregivers have found making comparisons to be challenging because of how information is presented on state and national websites.
Online tool to inspect nursing homes
However, recently a tool was devised that appears on the website of ProPublica, the nonprofit investigative journalism organization. Called Nursing Home Inspect, [http://projects.propublica.org/nursing-homes] the tool lets users easily examine trends at the facilities.
Charles Ornstein, a reporter who helped spearhead the project, said, “This tool makes available more than 58,000 nursing home inspection reports from the past three years, encompassing over 262,500 deficiencies.”
Getting a handle on the nursing home situation is critical for boomers. A member of the MacArthur Foundation Research Network on an Aging Society, S. Jay Olshansky said, “As this generation of those ages 55 to 64 move into retirement within the next 10 to 15 years, they are going to experience levels of morbidity, disability and frailty that are higher than the generations that preceded them into retirement” because they will live longer. He is also a professor in the School of Public Health at the University of Illinois at Chicago.
However, even as boomers try to achieve the goal of “successful aging,” many in the huge boomer generation will experience more events likely to send them to nursing homes or rehabilitation centers.
The facilities we see today will be there unchanged tomorrow unless boomers demand new models. Boomers will expect care facilities with cognitive-enrichment programs that involve serious music, exercise and other activities that focus on aging gracefully, aging with dignity.
Rita Watson, MPH, wrote this article for the Providence Journal through the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America.
