Things I Learned About Nursing Homes and Rehabs for the Elderly

 Life as you know it can change in two seconds.

Step the wrong way and break a bone in a foot. Fall and break a hip. Car accident. As fast as you can blink, life as you know it can change, sometimes it can feel like forever to recover. 

Recovery can go three ways: short term, long term, or never the same again - chronic.

Whether it be a nursing home where your elderly loved one will remain until they die, or a rehabilitation center to recover from their serious injury, like a broken hip, there are some things those places have in common that aren't spoken aloud or mentioned - if they are, I've been looking in the wrong places.

The commonalities I've noted in both nursing homes and rehab centers for seniors:

They are understaffed.

Staff are overworked because of it.

Third shifts have skeleton crews. If a resident is going to experience neglect, a verbally harsh caregiver or a rough caregiver, there's a good chance it'll happen then.

It is very common for residents to develop incontinence. Bodily functions wait for no one, and when there is no one to assist, or if a resident alerts a staff member and they are told they'll be back in a moment, and that moment turns into a hour, or two, the ending is the same. The resident empties into their diaper. It becomes par for the course, and they have to accept their new reality - they regress to being treated like babies - they void into a diaper.  Eventually their bodies lose the ability to control the functions. Unlike babies, there's no attentive mother or father to scoop them up as soon as it happens or noticed, and immediately take care of their needs to prevent diaper rash or other complications from sitting in their own feces for extended periods of time.  

Residents better hope they have attentive families. Why? 

Families have to provide boxes of tissues and a way of disposing of the used ones (tape a bag to the end of the table used to serve their lunches) and other basic hygiene necessities.  Put your loved one's name on EVERYTHING.

Families have to clean hair brushes of accumulated hair - if they are lucky their family member even has staff at the facility to do basic haircare.

Families need to monitor clothing - 90% of the time, their loved one's clothes will go missing, whether their name is written on them or not. Families need to commit to doing their own loved one's washing if they want it done not only right, but to make sure their loved one has clothes left to wear. Socks and underwear seem to be common casualties. 

Families need to monitor food.  Does your loved one hate coffee?  They'll usually be served it anyway. 

If the resident has gout and should stay away from beef, shellfish and other trigger foods, they'll experience increased gout pains and suffering because the facilities tend to serve food as One Size Fits All. 

Families need to monitor their loved one's food for another reason - starvation. The One Size Fits All food service also leads to residents not eating.  If they don't eat their meal, they don't get second chances. The food is thrown away and the resident has to wait for the next scheduled feeding time.  Why would the resident not eat? If your loved one despises peas, hates broccoli, is sick of mushy carrots and bland oatmeal, or is served food they never ate in regular life - they will have no appetite for it. It's quite possible that a man who enters a facility at almost 300 pounds, will drop to 267 pounds in one month.  

Families need to be prepared to bring in foods/snacks their loved one will eat to offset their lack of eating facility foods. 

If the resident suffers from Dry Eye - they'll be miserable. Being understaffed means no one pays attention and drops are hardly ever applied when they are needed most - if the discomfort is noted at all, or if the resident is even listened to. Even if they are able, residents lose their autonomy to rectify things themselves. They are 100% dependent on staff. 

Residents who are dependent on staff to put on their shoes and socks so they can do their exercises may find some staff members forgoing socks which is more than likely if the socks end up among the mysterious missing. The results are blisters from friction and those blisters may not even be noticed until they bleed and become infected.  

If families or residents have no money, they are more than likely to be treated like shit.

If the elderly resident is difficult, whether from them being hard of hearing, from mental or emotional issues, anxiety or panic attacks, are loud, opinionated or super needy, the resident is more likely to be treated like shit. 

If a rehabilitation resident is discharged on a weekend, they'll be treated like shit. No automatic support personnel or assistance to escort the patient to a family member's vehicle,  no VNA services or home care aids set up. Families can be left scrambling, trying to deal with an elderly loved one whose safety status is at risk and there's no support system in place. Especially hard when there's no money for a nursing home. And, even if there were funds available, there are no open beds in a 50 mile radius, and wait times are estimated 6-months to a year.  

After the rehabilitation center:

Be prepared - it's a parttime job to pursue all the needs of a discharged rehabilitation patient for aftercare. Support and charity agencies are overworked and overburdened with backlogs of applicants needing help and options for care are slim. Be prepared for calls not returned. 

Families need to be prepared for the rehab center to order the wrong sized bed. 

Families need to check the med list on the discharge paperwork - some medicines can accidentally be left off of the list.

Mix-ups happen.  Families can end up with a round commode instead of an oval commode ($165) and when calling to find a way to correct it, being told that the company doesn't switch out parts, you'll have to buy a whole new commode. Don't be surprised if the wrong wheelchair is delivered, that the home does not have enough care supplies for continued home recovery. Remember incontinence requires waterproof pads for the bed, chairs and in your car, and lots of adult diapers with tab closures.  A mattress protector will be needed to protect the hospital bed rental if insurance will cover it. The requirement of a ramp to even get their loved one back into their own home can cost up to $10,000, and in the case of an expedited discharge, a three day window to get it built.

Families need to be prepared for the average rate per hour for a home health aide = $35 per hour.  And the minimum commitment is six hours a day, three in the morning and three in the afternoon.  However don't be surprised if the agency pushes for an eight hour commitment.

If their family member needs 24/7 care to be safe, that requires a live-in healthcare professional. Your home will be investigated and judged by the agency as appropriate or inappropriate for a live-in option. Families need to be prepared to spend serious money to get their home up to standard to be accepted for the live-in option. Of course if your loved one does not have money, this won't be an option, and you're back to begging elder care support agencies for help. That's a part-time job too.

Those are just the highlights. 

The thing I learned about nursing homes and rehabs for the elderly: It's scary and horrifying to be old, injured, and broke.