Category: Transitions in care

The Semi-Private Nursing Home Room

Viola’s face was beet red, and she was hoarse from shouting.  “How can they do this to me?  I’ve been in this room for months and now they want me to move?!”

Wheelchair Prejudice: The Social Ramifications of Wheelchair Assignment in Nursing Homes

I was a dork in high school.  Oh sure, some of the people who knew me best realized I wasn’t quite as dorky as I appeared on the outside, but to most of the kids in my class I was not a sought-after individual.

Residents in geri-recliners are the dorks of the nursing home.  For the uninitiated, geri-chairs are like chaise lounges on wheels.  They are often difficult to maneuver, take up extra room in the elevator (thus reducing the chance of being transported to activities), and make it virtually impossible for residents to go out on pass with their families to enjoy a meal at home or in a restaurant.  In addition, people tend to assume that residents in geri-recliners aren’t “with it.”

By contrast, those residents lucky enough to be able to use electric wheelchairs are like the captains of the sports teams, the shining stars.  Residents who can wheel themselves around are the jocks, people in regular chairs are the cool kids, those in high-backed chairs are in the band, and residents who need their feet elevated are in the math club.

People are given geri-recliners to reduce pain and prevent skin breakdown, as they’re easier on the body than other chairs.  There are good reasons for such chairs, but this post is a pitch for making these conveyances the chairs of last resort because of the effect they have on the social and psychological health of the residents confined to them.

If you know a method or product that allows residents to stay in other types of chairs with the same level of comfort as the geri-chair, or are aware of a geri-recliner that’s designed for maneuverability and user-friendliness, please add your thoughts in the Comments section.

Saying Goodbye

“I never say goodbye,” Mr. O’Hara told me, “because that’s what my mother said when she left me as a child. Then she died and I never saw her again.”

At 91, Mr. O’Hara was slim and getting slimmer. He began our next session as usual, discussing the procedures he was receiving from the doctors to save his fingers. “It feels like the knives are still in me.” He grimaced, gently caressing his bad hand with his good one. “They want me to come back in two weeks.”

Mrs. O’Hara appeared in the doorway, wearing her trademark red lipstick and bright suit. We spoke for a while about his health, her health, and their 65-year marriage. She came every day at lunchtime, bearing his favorite foods and spending an hour coaxing him to eat before they headed to the afternoon’s recreational activities.

On the way off the unit, I spoke to the nurse at the front desk. “Mr. O’Hara looks awfully thin lately.”

“Yeah,” she said, “the doctor wants him to go on hospice, but the family refuses.”

Alone with him a few weeks later, I asked Mr. O’Hara if he’d ever discussed dying with his wife.

“Oh no, we never talk about it. That’s a big good-bye.”

“I suppose it is. What do you think happens after people die?”

Mr. O’Hara was silent for a moment. “I’ve been taught that we’ll all meet in Heaven, and I sure hope so. I’d like to see my mother again.”

“That would be some reunion, wouldn’t it?” I glanced at the framed photo on the dresser of a stern-looking woman in a flowered dress. “Can we talk to your wife about this the next time I see her?”

“Yes. I guess that would be all right.”

“Okay then. Take care,” I told him as I left.

Two weeks later, Mrs. O’Hara arrived carrying her home-cooked meal, and I motioned for her to sit down on the bed. “Your husband and I were talking the other day, and he said he thinks we’ll see the people we love after we’ve died. Is that what you believe?”

Mrs. O’Hara didn’t even blink at the question. I was talking about the elephant in the living room.

“Oh yes, I believe that too.”

“That must be a great comfort, to know you’ll see each other when you pass on.”

Mr. O’Hara spoke up. “At 91, there are a lot of people waiting there for me. I’m going to be busy.”

“Well, you’d better make time for me!” Mrs. O’Hara joked, and we all laughed.

A few weeks later, Mr. O’Hara went to the hospital and I stopped at the nursing station to see when they expected him back. “He’s not coming back,” the nurse told me. “His family decided to do hospice at the hospital.”

“Oh,” I said, happy and sad at the same time.

Goodbye, Mr. O’Hara. Goodbye.

Relocating to a Nursing Home? A Senior Move Manager Can Help

Downsizing and transitioning into a nursing home

By: Katie Hustead

Owner and Senior Move Manager, Paper Moon Moves

Their stories are unique but share a common thread:

• A woman in her eighties finds she suddenly can no longer live independently after she falls and breaks a bone; she can’t manage with an aide in her walk-up apartment.
• An elderly gentleman has been in rehab for a few weeks, planning to return home to his house in the suburbs. But his doctors advise him to enter a nursing home instead, and he agrees this is the best decision. He hasn’t even begun to think about how to pack up all his belongings.
• A woman in her early nineties comes down with pneumonia and is hospitalized. Her doctor will not release her unless she moves somewhere where she will have care around the clock, and there are no relatives to supervise home care.

Each one has thought about moving – perhaps for years – but has put it off until now. “Now” has come and they realize that the vast majority of their belongings won’t fit in their new home. They can’t imagine how to start the process of figuring out what to move and what to do with all the things that won’t come with them.

Because these stories are being played out more and more often, an industry has evolved to provide the solution. Members of the National Association of Senior Move Managers – a countrywide organization with more than 500 members – fill in when there are no adult children or friends available to help with the stressful process of disbanding a home and moving a senior.

Most senior move managers start with a floor plan of the new residence or room. They work with the senior to decide which of their things can fit comfortably and they help decide what to do with the remaining possessions – selling, donating, recycling or shipping to the senior’s family and friends.

When a senior can’t be physically present to coordinate their own move, a senior move manager can find creative ways of helping them maintain control over the process. In some cases a senior will entrust the senior move manager to work in their home without them. In other situations, a senior will prefer to have a neighbor or relative supervise the senior move manager. All senior move managers are insured and bonded.

In either scenario, the senior move manager involves the senior as much as possible – keeping them updated on progress and helping them make decisions. For most of us, the best part of a job is making the seniors’ new home as comfortable and warm as the home they left. It can be as simple as hanging a favorite family photo or painting on the wall across from the seniors’ new bed so it is the first thing they see in the morning. And the reason we all love what we do is that when we walk out the door, the senior is comfortable and relaxed, surrounded by his or her favorite things.

Paper Moon Moves, a member of the National Association of Senior Move Managers, is a senior move management company serving seniors in the New York City area. To find a senior move manager in your location, go to www.nasmm.org.

"Transfer Package" Helps Make the Most of Stroke Rehabilitation

Dr. El interviewed by author David Solie

Listen to me and David Solie, MS, PA, author of How To Say It To Seniors: Closing the Communication Gap with Our Elders, in the program, What Do Nursing Home Residents Discuss with their Shrinks? You can hear the free half-hour BlogTalkRadio show, recorded on February 27, 2010, by clicking HERE.

What I Want My Nursing Home Room To Look Like

The Critical Period in Nursing Home Placement

I couldn’t wait to go to college.  I was ready to shake off the old me, and begin a brand new self.  No one would know who I’d been, and I could therefore be whomever I wanted to be.  

In my Psych 101 textbook, there was a picture of animal behaviorist Conrad Lorenz, followed by a row of baby geese. The goslings had found Dr. Lorenz during their critical period of imprinting, when they bonded to the first suitable stimulus they saw. Conrad Lorenz became the goslings’ mama.

When residents enter nursing homes, they have the opportunity to create new identities.  They are surrounded by strangers and novel social situations, with as limited a pull from family and friends to be their old selves as they are likely to have experienced in decades.  While most residents aren’t necessarily looking to become new people, their early nursing home contacts can affect how they settle into their environment.

Mrs. Leibowitz arrived at the nursing home depressed, but wasn’t referred for psychological services until months after her arrival.  She’d already established the pattern of spending days alone in her room, watching television for hours at a time.  She was irritable with staff members, often refusing care, or chasing them out of her room with her foul language.  “There’s nobody to talk to here,” she told me.  I had my work cut out for me.  The critical period had been lost.

Mr. O’Conner, on the other, was lucky enough to be placed in a room with Mr. Chu, the President of the Resident Council.  Mr. Chu took Mr. O’Conner under his wing (so to speak), and together they played cards with some of the other gentlemen, and attended activities which appealed to them both.  Our new resident integrated nicely into the community and never needed psychological treatment.

I’d like to see every nursing home form a welcoming committee, by residents, for residents, to help aid the transition to the nursing home.  And I’d like to get my referrals early, during the critical period, instead of after the conflicts, isolation, and other problems have become entrenched.  That way I can more easily help people take advantage of the best that nursing homes have to offer.

For Families: The Initial Transition

I recently met a new resident who demanded almost constant attention from her loved ones. Her family visited daily for hours at a time, and she’d call them soon after they’d left and tell them she was lonely. Trying to please her, they were exhausted, frustrated, irritable, and terribly sad. I reminded her tearful daughter about the recommendation of flight attendants for those traveling with people in need of care — put on your own oxygen mask first. For many families, the road to the nursing home has been long and difficult, and it’s okay to take a breath now that your loved one is here.