The heroes we care for - treating nursing home residents with respect and dignity

Nursing Homes, Sept, 1998 by Karen L. Bonn

You never know just when or where you will learn the very important lessons in life. I recently attended the funeral of a man who, since I had known of him, had been brought to church by his wife. When he would make "noises" during worship services, his wife would look at him lovingly. When he would drool, she would patiently wipe his mouth. He was to me, and I am sure to others who did not know him and his wife intimately, an elderly man who had great care needs, and she was a kind spouse.

At the funeral service a man stood and gave a eulogy that gave me cold chills. The deceased had been a retired lieutenant colonel in the United States Army. Among his experiences he was the third man to enter one of the large Nazi prisoner of war camps when it was liberated at the end of World War II; was awarded a Purple Heart and three Distinguished Service medals, as well as various other medals for service - not only in World War II, but the Korean War and Vietnam.

In Vietnam he took it upon himself to watch over an orphanage located behind enemy lines that, during one period of the war, was without food for the children. This man drove a truck full of food and supplies a great distance into enemy territory, risking his own life, in order to supply food to the orphans. The speaker pointed out that he could have sent someone in his command but chose instead to risk his own life.

I will never forget how I felt as I sat there listening to this man's story and thinking of all the people in nursing homes who have their own stories. This man could not verbally communicate due to amyotrophic lateral sclerosis type symptoms (which also resulted in his having a feeding tube), but he could understand everything said to him until the day he died. His life was a success even though his body failed him miserably. Did people look at him in his last years as a hero or as simply an unfortunate "burden"?

Relating to a nursing home, the term "success" means many different things to different people. Hopefully, everyone's top priority is always the health, welfare and happiness of our residents. But there are other definitions. To the administrator, success must mean making a profit for the nursing home. After all, this is a business that must be successful or the residents will have no home and you and your staff will be unemployed. You, the DON, might view success as having a schedule with no vacancies, a deficiency-free state survey and no calls from the nursing home over the weekend.

One important measure of success these days might be bringing your residents back from an acute care stay in better condition than they were when they left. Recently, I visited a local nursing home resident who had been hospitalized. She was 95 years old, diabetic and had shingles. She had been in bed all day and told me that she had on a "nice thing instead of panties" that allowed her to just "go" while she was lying in bed instead of having to get up (although there was a potty chair in her room). Her heels were red and mushy and she said she felt very weak. There was no lotion in the room and her water was well out of her reach.

I wondered, in what condition will she return to the nursing home? If she loses ground at 95 years of age, will she ever be able to regain that strength? Are bed sores and contractures on the way?

What policies can the nursing home develop to address this? Perhaps you can meet with staff at the hospitals where most of your residents are admitted to discuss ways to improve continuity of care. Does your facility have a policy, for example, of informing the acute care staff of this resident's "normal" condition so that they have some measure of the patient's status? Does someone from your facility call each day to check on the resident and see if the staff has any questions?

We have to think carefully about our "successes" - how we measure them and how we achieve them. The bottom line is that the people we care for in our facilities are parents, grandparents and maybe even war heroes. Everyone is important and deserves to be thought of and treated with respect and dignity.

Karen Bonn, RN, ROF, a former director of nursing, is founder and president of Restorative Medical, Inc., Brandenburg, KY.