Feb 2, 2010

Beautiful Does Not Always Mean Better

The bottom line is more money or less money doesn’t change the hearts of the people offering to care for your loved one. They either have the right heart or they don’t.....
By Angil Tarach RN GCM

I just finished reading Do You Really Get to Choose the Facility for a Dementia Patient?

As the article started I expected it to go into what an awful place the hospital had sent Great Grams. The article didn’t go as I expected, and because of what was written, I have decided to take this article further.

In my 30+ years in senior care and advocacy I have spent an incredible amount of time in long term care facilities. I have seen the best, the worst, and everything in between.

What I know is many people base their decision or opinion of a nursing home on the décor, and the scent. People who haven’t had any experience or much exposure to long term care facilities have the idea that if the place is new and beautiful, and doesn’t smell of urine it must be good.

Let’s just address the odor and get that out of the way. There are lots of odors in nursing homes. What isn’t understood is some are temporary and some are permanent. If the furniture and/or carpet have been repeatedly soiled by urine it becomes a permanent scent in the facility and this is a definite red flag to avoid this one like the plague! You will generally only know if you see several stain marks on the furniture or floors or visit more than once at different times.

There are generally quite a few residents in any long term care facility who suffer with incontinence. There are also regular times of the day when the staff is tending to those residents, such as first thing in the morning, after breakfast and before lunch, before shift change, after lunch and dinner, at bedtime, and during the night. Typically there will be approximately 6 or so incontinence care rounds by the staff in a 24 hour period, not including individual unscheduled care.

If you visit or tour a facility at any of those times, you most likely will experience odors you would rather not. If the facility is providing great care, these will be temporary odors, but your impression will be “this place smells like urine”.

Understanding the facility schedule can help you understand that just because you smell unpleasant odors in a facility doesn’t mean this is the constant smell your family member will be exposed to. I recommend visiting at different times to know for sure whether the odor is temporary or permanent, and keep your eyes open for signs of poor care.

Now to décor. I have spent time in the most beautiful brand new facilities to the oldest and out of date places. I have always said the only difference between the “rich” nursing homes and the “poor” ones is the décor. There are 2 local facilities that come to mind. One is fairly new and beautifully decorated, the other old, run down and outdated. As you can expect the newer facility has more private pay residents and patients, and the old one has more residents on Medicaid, who cannot afford to privately pay.

Because I have spent considerable time in both I have seen a lot. What may surprise you is the difference in care. Many would expect there would be better care when a patient is privately paying because they could move themselves and their money almost anywhere. Medicaid patients have much less freedom of choice because they can only stay in a Medicaid approved bed.

How the bed/room is paid for doesn’t necessarily mean a thing. In the instance of the 2 facilities I have in mind, nothing could be further from the truth! The care in the newer and beautifully decorated facility is not good at all, and apparently is not getting any better, because we have people applying for employment with us that are telling us they are leaving or have left there because it’s so bad. They say there are little or no adequate supplies, they are extremely short staffed, and the administration doesn’t care. The staff walks around miserable, and the working environment is unpleasant. They are sad for the patients and can’t do it anymore.

The old and rundown facility cares deeply for the patients. At one time this facility had a bad reputation. New owners took over several years ago, and the care improved greatly. The sad thing is people who heard about their previously bad reputation, and have not spent time there since the new owners, still believe it’s a terrible place. When I was a hospice and home health nurse I had several patients at any given time there. My patients were always clean, comfortable, and were treated well by the staff. Whenever I had to discuss orders with a staff member they were always pleasant, receptive, and wanted the best for the patient. The staff were loving and cheerful with the patients, and created a homey feeling.

I have a current client who we have helped take care of in her home for the last 5 years. Once a year her family goes on vacation and wants her placed in a facility while they are gone. I recommended the old facility I have been talking about. By the way, this patient lives in a family member’s home who is a physician, so they are not oblivious to care expectations. Anyway, they took my recommendation and have placed their loved one in this facility for a week or so every year for the last 5 years. The family has been completely happy with the care their loved one has received while they are on vacation. This person receives meticulous care at home, so I know their expectations are high.

Do I think this patient would get the same wonderful care in the newer beautiful facility? Absolutely not! Did this family wonder where I was referring them when they first visited this old nursing home? I’m sure they did.

This is one example of thousands across the country. You will find great care and horrible care in the most beautiful of facilities, and the best and worst in the oldest and most outdated facilities.

You would now expect the difference to be the staff, and you are right, but there is more. It really comes down to the owners and administration. The difference in staff is because of the difference in the people running these facilities. If the owner(s) and administrative staff really have care as the priority, they will hire and retain great staff and not hire or terminate the staff that doesn’t meet their expectations. They facilitate the environment and working conditions for the staff, and lead a warm, caring, and compassionate team of individuals because of their example.

The exact opposite is true when the owner’s motivation is primarily financial. All owners have to take into account the financial aspect of a facility, but is it the motivation behind the facility? If you can tell me why a person opened a facility, I can pretty much tell you what kind of care to expect.

If the owner is just concerned about how much money they make, their concern is to have enough warm bodies in the building to meet state requirements, and running the place good enough to keep beds full and get through inspections and stay open. They are not concerned about how much their staff care, how the staff is treated, and whether or not they are happy in their jobs. They ignore complaints, and overlook poor care.

You can always find some people who truly care in the bad facilities and bad staff in the good ones, but either way they won’t stay.

I hope this enlightens those who will face deciding facility placement.

The bottom line is more money or less money doesn’t change the hearts of the people offering to care for your loved one. They either have the right heart or they don’t and no amount of beautiful furniture or draperies will let you know about the type of care they provide.

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Angil Tarach(RN GCM) has over 30 years of experience, and is a nationally known expert in senior care and advocacy. Angil is also the owner of Visiting Angels in Ann Arbor, Michigan.

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