NURSING HOME RESIDENTS -----------PROBLEMS FAMILIES HAVE ENCOUNTERED by Roberta Mikles To begin, let me state, very clearly, that although the following does not happen all the time, there is a strong basis of reality. Through my experience as a Registered Nurse with specialized certification from the ANCC in psychiatric and mental health nursing, I have seen, certainly, more than I ever wanted or imagined. I want to share with you my research, as well as frequently asked questions I receive. Over the last several months I have had many family members ask (or tell) me of situations their loved one is experiencing as a Resident in a nursing home. Hopefully, these answers will help either you, or someone you know who is in need of assistance. The bottom line is that you, the consumer, family member, patient or friend become an educated consumer with a good knowledge base that will be helpful should you ever have to be involved in nursing home care. The following are some of the many questions I have been asked.  Question:  I went to see my husband the other day. He had a hip replacement and is in a nursing home for rehab. Before he went to the nursing home, he was fully independent and did everything for himself. He has been in the nursing home 6 days and I have not been able to get any information about his treatment. Answer: Communication is the basis for receiving good care, as well as being an informed consumer. First, make sure that your husband has informed the nursing home that they can provide you with information. Due to the new confidentiality and privacy regulations, there is a lot of hesitancy on the part of nursing homes. This is due mainly to the process of educating all nursing homes employees, as well as some confusion in just what is expected from the regulations. Once it is established that the facility can provide you with information, focus on the following: Ask to be involved in the planning of his care. The nursing home is required to have a plan of care for each resident (careplan).  This careplan is what guides the Resident's care. Any staff person who is providing care should be knowledgeable as to what the careplan states.  The careplan tells staff how to provide care, i.e. if the resident requires two people to assist out of bed, versus one or if a lift is needed. If a resident needs to be turned every two hours, what type of diet, how often the person attends activities, etc.  In other words, whatever the Resident does throughout the day should be written on the careplan. This includes treatment, i.e. physical therapy, oxygen, bowel and bladder care and any special treatments. As an aggressive educated consumer and family member, my personal response to someone providing care for my loved one is........"What does the doctor's order and careplan say. If the person giving the care does not know, request to speak with someone who does know and tell the person that you are not comfortable with he/she providing care if they do not know what the Resident needs are. This sounds a bit harsh to many, however, remember if   the wrong care is given it could be deadly. A simple thing as giving a sip of water to someone could result in major negative outcomes. No one should be giving care any Resident without knowing about that Resident. In other words, the careplan.  Nursing homes will involve family members when the have a care planning meeting. This meeting should be held routinely. At this meeting you will know everything about your loved one's treatment and care.      Question: My mother is in a nursing home and needs assistance to get out of bed. She has a difficult time with the help of one person and I am afraid she is going to fall. If she does not get out of bed, she will not get better. What can I do? Answer: As if the first answer, make sure that you are aware and involved in her careplanning process.  Ask the nurse  providing care what the careplan says related to getting your mother out of bed. If the careplan states two person transfer, then there should be two people assisting your mother. If there is one person assisting, the facility is not providing the needed care, as well as being out of compliance with Federal regulations. The staff getting your mother out of bed should be familiar with the careplan. The bottom line is that your mother can  fall or her condition can deteriorte if this is not done appropriately. Keeping in mind, the level of assistance needed to getting out of bed, transferring to a chair, etc is done after the Resident is assessed. This assessment determines the level of care and then this information is placed on the careplan. Question:  The other day I went to visit a friend at a nursing home. It was afternoon and her lunch tray was still in front of her and she was sitting in bed. There was food on her chin, clothes and only a few bites of food had been eaten. I asked the nurse why she had not eaten. The nurse did not know why. Answer: Feeding has been a major problem in nursing homes. Recently there was a change in regulations in order to allow nursing homes to hire staff who only feed residents. Mealtimes have always presented a challenge to nursing homes. Not enough staff, Residents who need more help than others, time restraints, etc. Hopefully, having "feeding assistants" will solve the problem. These individuals must have 8 hours of specialized training in feeding Residents, including knowing how to do a Heimlich maneuver for choking. Again, speak with the nurse and request to know what the care plan states. Again, there are many Residents who eat slow, have difficulty chewing, swallowing as well as require special precautions when being fed. This should be part of the careplan, if not, again the facility would be responsible for anything that would happen. We do not want wrongdoings due to uneducated staff. Ask, ask and ask... it is your right as well as your loved one's right to know the care being given is appropriate and that all staff providing care know what they are doing. Request a meeting to review the careplan with the interdisciplinary team. The careplan is a joint effort of various disciplines within the nursing home (nursing/physical therapy/activities/dietary).  If the nursing home does not follow their plan of care, they are liable for any negative outcomes. However, keep in mind, there are always those circumstances that have extreme extenuating situations. Question:  My sister is in a nursing home and fell when she tried to get out of bed. The side rails were up and she called for help. No one came to help her and she had to get to the bathroom right away. She was on the floor, after falling when she climbed over the side rail. No one came to help or check on her for over two hours. What can we do? Answer: I am sorry your sister had to experience this, however, this is one of those realities that does, in fact happen. In my research, as well as professional career, I found that when residents call for assistance, they do not always get immediate attention. The reality is that one staff person (nurse or nursing assistant) can't be in two places at once, therefore, if the assigned person is with another resident, they can't be with your sister. Another nursing assistant or nurse can answer the call bell to see what your sister needs. This is one of the major complaints I hear.   Remember, the care plan tells "IT ALL".. Ask and ask again and again, for those who do not ask, do not know and never know what care really should be provided.