Nursing Staff's Lack of Communication Complicates Care
This is the seventh
column in a 10-part series by Sacramentan Joyce Christensen on her experiences
caring for her elderly mother, Thelma Price. To
read the previous installment, CLICK
I always threw Mom a kiss as I left her room. I hated leaving her, but we were both adjusting to our new life.
One promise I made to myself was to always keep my mother beautiful. Her entire life, she had been dedicated to being well-groomed. I remember she used to say, "Joyce, always take time for yourself. You and I are blessed with nice personalities, but we don't have a lot of natural beauty. We have to make the best of our God-given gifts."
Conversations like that always made me laugh. I remember as a child what happened if I got sick. As soon as I started to get better, Mom would dress me in one of my prettiest outfits. We would go someplace where there would be lots of people. The first time I received a compliment, I felt 100 percent better.
Mom's theory: if a person looks good, shealso feels good. Add a smile, and you have a winning combination of positive thoughts. I still follow that advice to this day. It works.
Every day, I made sure Mom had her makeup on, that her hair was combed and that she had a coordinated outfit to wear. With that special few minutes of my time came a beautiful smile that said everything I needed to know.
Even if, on a rare occasion, I couldn't go to the nursing home, I left a note with a big smiley face on it for her CNA: "Please make sure Thelma has her makeup on, and wears the outfit hanging on the door. Make her feel special, because she is."
People began looking forward to see what Mom would wear each day. She was complimented often for how nice she looked. Each compliment made her glow.
The advice she gave me many years ago proved true in every phase of both our lives.
The therapists developed a daily exercise program. Mom had never been a person to work at repetitive exercising. She really tried, and I cheered her on.
Progress was slow. We went to activities together every day. Group stretching and communicating diverted Mom's attention.
But when I couldn't get to SunBridge before it was time for activities, she often was forgotten or taken in late. Mom never complained, and she smiled at everyone. I tried to understand that Mom was just one of many that needed help. Trust me, that was not easy to do. I created positive fun every day. I hoped that would give Mom an edge on receiving good care. Sometimes it did.
After Mom had been at SunBridge for a month, the director of nurses called to tell me all therapy was completed, and that Mom had "peaked."
I learned that the amount of help a patient receives for therapy recovery is determined by visible progress. At this point, she still could not walk on her own with a walker, or get out of bed by herself. Daily therapy was less than 30 minutes. Mom did not respond as quickly as some patients. What "peaking" also meant was that the insurance no longer provided funds for therapy.
I felt Mom's quality of life was much better when she had therapy. We didn't have the funds to hire a private therapist to help her. I asked if she could have "range of motion" therapy each day when she was dressed. This simple exercise of moving her arms and legs required very little coaching, and less than five minutes a day. I was told a directive was put on the med nurse's daily information sheet, and yes, "the CNA for the day would make sure it was done -- I could count on it."
That was just another way to appease me. One learns very fast that promises mean very little in a nursing home. Since the old saying, "a person is only as good as his word" is not instilled by the administrative staff, few people found it important.
Over the four months after physical therapy was discontinued, Mom's body became stiff. It was difficult to move her. She had become a "two-person transfer." I kept asking if something -- anything -- could be done to help her movement. I checked all resources to find out if a medical order for more therapy was possible. I was assured they would try.
I also was told that since she had "peaked," additional funds probably would not be approved. I watched with a deep sense of helplessness as my precious Mom moved less and less.
One day, I got a call at home. The director of nurses said she had something to tell me. I felt she was hesitant. She was well aware that I had continued to ask for some kind of therapy. What she had to tell me was, "Joyce, I don't know any other way to tell you. Your mother's body is frozen."
I was stunned! "Frozen? What does that mean?" It took me a few minutes to fully comprehend what I had just heard. I asked the nurse if this would change someday. The answer, "No -- her entire body is permanently paralyzed except for head movement and a few fingers. She will never get better."
My mother would spend the rest of her life in a wheelchair, dependent on help from others. I asked if therapy had been approved to continue, would that have made a difference? Her comment, "Your mother is getting older. Changes happen." That proved to be better than answers I would get in the future, which were no answers at all. Let's all hope none of us ever "get older."
The toughest thing for me to understand was the lack of communication between upper staff personnel and the most important cog of the wheel, the certified nursing assistants. Sometimes the CNAs shared their frustration and disappointment with family members they felt they could trust. They told us they needed daily updated information on each patient. If a health directive is changed for a patient, seldom are the CNAs told.
Often, the CNAs handle situations poorly due to lack of knowledge. Family members reprimand them for not taking good care of their loved ones. Many times I heard, "But I didn't know." I think most CNAs want to take good care of their assigned patients. Teamwork makes the impossible possible if the staff members encourage, rather than discourage, the workers.
Everyone agrees nursing home patients deserve the best care possible. It doesn't happen. Why? Because RNs and LVNs are "too busy" to review the needs of the long-term care residents on a daily basis with CNAs. The truth is, a patient review would take no longer than 10 extra minutes each shift. What a small price to pay for increased efficiency and peace of mind. It also would help if health care workers made better money.
The worst time for expectations of good care is the weekend. Nursing homes are generally short-staffed then, and have lots of excuses when things go astray.
There is minimal management on the premises to address issues of concern.
This is another reason that family involvement is important. Who is going to make sure your loved one is fed on time and changed, if needed, especially on a weekend? I do not believe my mother would ever have lived to age 90 if I had not been on board to stick up for her rights and check on her care.
Yes, all patients have rights -- but they need an advocate to make sure they get them.
Next week: Families of nursing homes residents help by getting involved and cultivating friendships.
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Last Updated 4/8/03