After my last blog, I kept thinking about dignity and long term care, and I decided to write a little more about it. Dignity and respect when dealing with the elderly can be a delicate subject. The very mechanics of long term care can almost negate dignity in a way, as our residents need to trust us to perform personal care and more. My last blog discussed what dignity and respect mean in respect to human rights. In this second chapter, I would like to spell out common situations that may occur in care that fail to provide respect and dignity. I thought that it might help us all to translate what it all means into our daily practice.

As health care professionals we are obligated to protect our clients/patients from abuse and neglect, as well as to provide care with respect and dignity. Through communication and involvement, we can help to provide care with dignity to all we see. We can also foster independence whenever possible to enhance self worth. Here are some examples of how we may unwittingly infringe upon human rights in our day to day work. I am not saying that this occurs every day, nor I am saying that this is an issue for all facilities. However, these situations do happen at times, and I think that if we place it into a context of abuse of human rights, rather than poor practice, it might hit home with our staff.

• Leaving a patient without a means to alert or communicate with staff. Forgetting to place the bell within reach, or switching it off. This does happen by accident, but often it is a response to a difficult patient that likes to ring the bell frequently.
• Not answering or ignoring call bells. Even if you are too busy to get there right now, answer the bell and let them know that you will come as soon as you can.
• Not giving unpaid caregivers the respect they deserve. These people are a valuable resource and should be appreciated, and treated as such. I have seen these people shooed out of the room to allow staff to work. They should be included whenever possible and at the very least be kept aware of what you are doing with their loved one.
• Making incorrect assumptions regarding a person’s ability to understand what you are saying and allowing this assumption to result in the patient not being involved in their care. How many times have you heard staff chatting about their weekend while caring for a “complete” patient, rather than talking to the patient and explaining what they are doing? Not involving the patient in their care by not talking to them or even by failing to explain what you are doing as you work is not acceptable.
• Not ensuring that the fundamental daily care is given, for example, having eye glasses clean and within reach, cleaning dentures every day and dressing people in their own clothes. We should not have to tell staff to clean dentures daily, but I have still had to have that talk with staff.
• Leaving people lying in urine or feces or putting them to bed at 7 p.m. because it is better for staff. I know that it is impossible to keep everyone dry at all times. However, I have seen staff on night shift skip a room on rounds because a difficult resident is sleeping and they do not want to wake them up. I have also seen facilities that do a generic round of putting people to bed whether they want to go to bed or not.
• Failing to chart and/or document in a timely and accurate manner. Working where I do, I do both long term care and acute care in the same shift. I am fully aware that charting is not always at the top of the priority list, especially so in long term care. However, we have to keep accurate records not only for the legal implications, but also because it is a right of the resident.

It is up to all of us to try and prevent these types of violations from becoming standard practice in nursing home care. Need I say more?

By Aurora Cyganik-Barker RN, BN.  Aurora has worked in all aspects of long term and seniors care for over eight years. Currently, she works in a rural facility that has both acute beds and a long term care wing that houses 20 residents.

If you are considering a new rewarding job in senior living or in senior care nursing, therapy or administration, be sure to search NSLPN.com for the latest senior care jobs available including Home Health Jobs, Hospice Jobs, Nursing Home Jobs, Independent Living Jobs, and Assisted Living Jobs.

There are a lot of changes coming up in the next couple of years for the Long Term Care Industry.  MDS 3.0 starts this October, QIS survey’s are already in place in some states and will start for the rest within the next 2 years, Electronic Health record requirements are also looming.  These changes are causing lots of anxiety for professionals in Long Term Care.

I spoke with one computer programmer that is trying to get ahead of the 3.0 requirements and told him how excited I was for the changes that are coming with the new MDS.  He was shocked that I was so pumped up about the changes…he stated that in the 10 states he does business in, I was the first one that he had spoken with that was embracing the changes.  He said he gets no less than 10 calls a day from LTC facilities that are in a panic about the new requirements.  I gave him my take on what is coming and how it is going to positively impact long term care and he teasingly said I need to go on a promotional tour to ramp everyone up for 3.0.

I have been doing just that within my organization and the facilities I consult for.  This new process is the biggest thing to hit Long Term Care in the 24 years I’ve been in this industry.  For the first time that I know of, the changes that are present on 3.0 are going to be resident centered and resident driven.  I don’t know about everyone else, but this is why I got into LTC.  It’s for the residents….not for the pay, not for the glory, but to make a difference in what I do.  3.0 is going to allow all of us to do that.  Almost every section of the 3.0 requires some sort of assessment and resident interview.  This is so very important for where our industry is now.  I know that most of the facilities I deal with have a higher number than ever of Psychiatric residents, because there are just no services out there.  One way that I foresee 3.0 having a huge impact is that when the new Quality Indicators/Quality Measures are available, the government will see from the numbers submitted that this area of health care is woefully under-developed.  I’m optimistic that this will give LTC the support it needs to provide for those residents or that new programs will be developed because of this.

As a consultant and Corporate Nurse, I also am very excited about the levels of care that 3.0 is going to force facilities to embrace.  It is going to force our nursing departments to utilize Critical Thinking and manage not just the disease but the causative factors.  This to me is one of the most exciting parts of this change.  I know as a Corporate Nurse, I get very frustrated by what often seems like the lack of follow-through in problem conditions.  Well, the assessments that come along with 3.0 plus the Care Planning process will require the facility to dig deeper.  I think this challenge will be just what our industry needs to move forward into the 21^st Century and will raise the standard of care.  This will put us in the forefront of media in a positive way instead of the negative light that our industry is sometimes portrayed.

October 1 is getting very close…if you haven’t already attended a training seminar, find one soon.  Don’t let the most important changes to our industry sneak up on you and find you unprepared.  It’s ok to be nervous….I wouldn’t be telling the truth if I said I wasn’t nervous about parts of the changes to come.  But, if you are at least as prepared as you can be, there will be less anxiety come October 1^st!

By Michelle Voss.  Ms. Voss is an RN with 20 years experience in Long Term Care and is the Director of Clinical Operations for Stein LTC, a Long Term Care management group, where she services facilities in 7 states across the southern United States. With expertise in not only general nursing practices, she also specializes in education, Skilled Nursing services, reimbursement and staff education and motivation to provide that higher level of care we all seek to provide.

If you are considering a new rewarding job in senior living or in senior care nursing, therapy or administration, be sure to search NSLPN.com for the latest senior care jobs available including Home Health Jobs, Hospice Jobs, Nursing Home Jobs, Independent Living Jobs, and Assisted Living Jobs.

Once I had a bad day as a visiting poet in a 7^th grade classroom. A friend met me after work and took me to a tropical fish store. My raw edgy feelings were eased by the languid swimmers inside their safe aqua lit orbs. Their dreamy reality lifted the weight off my shoulders and freed me (however temporarily) from my human bound pickle.

Nature gives us many cues that reduce stress. It is reported that most people imagine themselves outdoors in natural settings when they are trying to calm down. We work in healthcare industries and cannot get outside to natural panaceas enough. What can we do to care more for ourselves and others in interior environments?

Bring seasonal offerings to your care partners. There is no end to the rhythmic treasures we can harvest. Often these surprises are free for the taking – springtime pussy willows, golden forsythia, purple violets, pink apple blossoms, mint leaves, lilacs, strawberries, apples, autumn leaves, bright orange pumpkins for carving.

Stanley’s beloved wife passed away a year ago. This first spring as a widower he gave out bundles of rhubarb to people who would promise to bake a strawberry rhubarb pie and give him a piece in memory of his dear wife who made the best pies ever. He praised the widow who sat next to him at support group. “She made a five-star pie!” he said and smiled thankfully as he put his arm around her for a moment and patted her shoulder.

Even those who are on restricted diets can enjoy summertime corn on the cob. Shuck it together – touch the cool yellow kernels and slippery silk.

This practice helps maintain cultural roots and identity throughout life. Keep track of familiar and favorite sensory experiences so that appropriate interventions can be offered when needed.

Herbalist Colleen K. Dodt is the author of “The Essential Oils Book.” In a section entitled “Caring for the elderly and sick,” Dodt suggests peeling a fresh orange beside the bedside of an ailing elder or sprinkling rosemary essential oil on a hair brush and enjoying your elder’s response to an aromatic hair brushing.  Dodt writes about doing all these things when she was acting as guardian to a woman in a nursing home: “Mildred’s whole sense of being would change after these times together. I know the quality of her stay was greatly enhanced by the use of pure essential oils in her room.”

“I also think the nurses were so attentive in part, because of how comfortable her room felt with its sweetly scented contents.” Not only will your elders sense of being change when sensory experiences are heightened, but also the quality of care given will be enhanced, herbalist Dodt testifies.

By Julia Soto Lebentritt.  A published poet and producer, Julia Soto Lebentritt is author of As Long as You Sing, I’ll Dance: Using lullabies and creative arts in activities for older adults to be released autumn 2010 and a Bereavement Facilitator at the Community Hospice of Rensselaer County.