Wednesday, February 26, 2014

How I Visit a Friend in a Nursing Home

I went to see my dear Miss S at the nursing home earlier this week.  She was thrilled with my surprise visit. (I have stopped calling in advance because she gets garbled on her dates and times.)  We chatted for more than an hour, mostly about news of people we know and also the NYTimes, which she reads cover to cover everyday.  I'm sure her memory is slipping, but it wasn't very obvious; though, I wasn't testing her either.  She says "that" and "it" for nouns and pronouns for people she can't remember.  And she nods and says, "I know," a lot, even if she probably doesn't.  Still, she knew me on sight and that is still better than I thought it would be.

As I was talking to her, indeed through many of my nursing facility visits with her and my hospice patients, I've made up a mental list of advice.  So here are some informal tips for visiting a nursing home or assisted living facility (for lists aimed specifically at families, see here and here for examples):
  • Dress in layers--many facilities are overheated for the comfort of their cold-sensitive residents.
  • There's almost always a sign-in folder, sometimes a tag to wear.  The receptionist can point you in the right direction, especially because there is something confusingly labyrinthine about even the most straightforward-looking of these facilities.  I always get lost going in and coming out the first few times.
  • Yes, it stinks.  Oftentimes of cleaners, sometimes of soiled diapers and illness.  Take a deep breath before you enter the space and then try not to think on it.
  • And yes, it can be depressing.  People's bodies and minds are in various states of deterioration, which we don't often see because they are in facilities like this.  It can be overwhelming.  It can also seem callous, with numerous residents lined up in hallways, staring off listlessly or moaning or talking to thin air.  The staff is always overworked, shorthanded, and probably underpaid and undertrained, which is just as depressing.  With our current state of medicine, which allows people to live longer lives, even with illness, past the point of when they can remotely care for themselves or be cared for by non-professionals, and our cultural norms that hide away illness and death as well as our societal structure that is dominated by two-person working families (also, there are older parents with younger children who have young children--the sandwich generation!) who can't (and don't have the skills) to care for people at home, these places are a(n oftentimes unpleasant) necessity.  But by visiting, I'm taking a little bit of light and happiness to one person.
  • Locate the public restrooms because it can be awkward or even difficult to use the restroom in the resident's room (rooms are often shared and there is usually medical equipment inside.)  Sometimes the public restrooms are locked and you need to get the key from reception or the nurse's station.
  • Take something to discuss or share--books, magazines, photographs (I find my smartphone is good for that--we can look at several photos together.  I also read or sing from it with patients.) 
  • **Take a small gift--a magazine, hand lotion, snacks (but only if you know that's ok--some residents have restrictions or are on thickeners to avoid choking), seasonal decoration, homemade artwork/pictures for the wall.  I avoid flowers because they need to be cared for/watered and they can die so quickly.   And I always ask at the end of the visit if there is something particular I can bring the next time.  (**This is mainly for my friend, not my hospice patients, though hospice has lotions and blankets and such for us to distribute.)
  • Knock on the door, even if it's open.  And announce yourself.  So, (knock-knock) "Hi friend, it's Jamie!"  If there is a roommate, say hi.  
  • I never wake a sleeping patient (regardless of what Jessica Tandy says in Fried Green Tomatoes!)  I will wait in a common area for awhile, or even sit next to them (good chairs are SO hard to find, just like parking spaces--WHY do they build these beautiful new facilities WITHOUT enough parking???), but often that means I'll leave without a visit.
  • I always ask if it's ok before I sit on the edge of the bed.
  • If a nurse needs to attend to the resident, step outside while assuring them you'll be right back.  Note: don't go too early in the morning--that's get up, breakfasted, and dressed time.  I usually aim for after 11 ish, which gives them time to rest from the morning's brouhaha.  Oftentimes, depending on the health of the patient, after lunch or afternoons are hard because they're tired.  I try not to go at mealtime, though, at my friend's current place, if I'm there anywhere near lunch, they bring me a tray, too, without charge (this is not standard; and I never eat during hospice visits.)
  • It might just be me, but I never hesitate to turn down a missing roommate's tv (which are always on when the roommates are out of the room!!!)  Nursing homes are noisy enough.
  • If possible, get them out of their room--go for a walk, go sit in the common areas, attend an activity together.  Sometimes this takes a little coaxing.  It's also ok just to stay in the comfort and safety of their rooms (especially if you are unsure about their mobility.)
  •  If you run out of ideas for chatting (my friend loves to gossip, but I only ever have so much news!), talk about their pictures or knick-knacks, items on their bulletin board (most rooms have them), community calendar, what they had for their previous meal, what I did last weekend, what the weather is like outside, the last holiday, etc etc etc.  Of course, sitting in companionable silence or even watching tv together as a last resort is just fine.  I don't correct or argue, especially if they misremember or are misinformed about something; I want the visit to be pleasant.  And I just nod and smile when a story is repeated  . . . again and again.
  • I usually aim to stay about an hour (which is too long for many, and too short for some!), always giving a 10-15 minute warning.  Of course, I'm prepared to leave if they're not up for a visit.  Goodbyes are hard and I always feel guilty about leaving them alone again.  My friend is especially lonely and always walks me all the way to the door.
  • BTW, some doors especially on dementia floors have security codes to leave--ask at the nurse's station.
  • I find it's easier to greet with words or a smile everybody I pass, especially other residents--so few of them get outside visitors.  Sometimes they want a quick chat, which is fine.  If they seem confused or won't stop talking, sometimes I have to excuse myself.  If I can't completely understand them, I just smile.
  • If in doubt about anything, ask the staff.  Nicely.  Unless you are the legal guardian, they won't be able to give you privacy-protected medical information for the patient.  But, you can always ask the staff how the resident is doing that day or alert them to any (really pressing) concerns you have. Otherwise, unless it's really important (or falls under my hospice work parameters), I try not to interfere with the care.
  • Go.  When in doubt, go.  Time passes so slowly . . . and so lonely . . . at nursing homes that most residents welcome company and attention.
  • Unless you are sick--meaning any symptoms, not just confirmed fever or flu--gastro and respiratory illnesses spread like wildfire in these places.  Sanitize with alcohol rub or handwashing on the way in and the way out.

1 comment:

  1. Having spent way too much time in nursing homes last year... I have to say that all of this is excellent advice. Well said and worth repeating! :)