Part of the education nurses and PSW’s receive include ways of encouraging independence of their charges. The saying “if you don’t use it, you lose it” is often repeated. Unfortunately this runs smack into the interpretation of “Residents Rights” which management and the ministry believes says that resident can have and do anything they like even if it includes being hand fed while lying in bed like Caesar. (Maybe, not quite like that).
How much will staff do
Is it surprising that there are a number of residents in Nursing Homes who do not have dementia or debilitation conditions. Many are mentally delayed or have some form of mental illness. But you would be shocked at the number of residents who would be more appropriately placed in a group home or in assisted living of some kind. These residents are very capable but have lost some abilities. They cannot concentrate enough to finish a task but they can do the task with assistance. The expectation of the Long Term Care staff is that they complete the task for this person if the person says they cannot do it. I’m routinely told that these people have “fallen through the cracks” in the system. No matter how they ended up in Long Term Care residents like these quickly learn how much the staff will do for them.
Encouraging
So instead of encouraging a resident who is physically able but might have some mental illness, who is in the home on government assistance, to set the tables in the dining room or help with the coffee cart, this person is waited on. He or she doesn’t actively participate in anything. Since activity staff are in short supply there is little guided activity. I often hear these people or their families (if they have any) state that they shouldn’t have to do anything that resembles chores like folding laundry, making their bed or setting the table, because they “pay their way”. Even those who have the beginnings of dementia where they cannot be left alone need to be physically active.
Every home has physiotherapists that attend residents but all the resident has to say is “no” and they do not have to attend.
Stay active
Those residents who are considered cognitively well but may have a physical disability also understand how it works in a nursing home. Many are told and believe that the nursing staff are there to serve them. In fact, I was in a meeting once where our new administrator said that the residents were right to consider staff as their servants.
With this belief firmly in place they demand! They demand extra servings or a different choice at meal time. :where’s the corn on the cob?” when that wasn’t on the menu. “I’m not eating this slop”. The “slop” being Chicken Cordon Bleu or steak. Sometimes it’s shepherds pie. Sometimes it’s liver and onions – and who wants that – but it’s far from “slop”. Are they frustrated that they are not able to cook for themselves? They cannot have simple meals that they would have if they were home. The reason they are in a home is that, mostly, they wouldn’t make their own meal anyway.
Who cares?
It is not unusual for these residents to criticize the meals loudly in the dining room in front of other residents. They don’t care to know or care at all that this could affect whether those with dementia eat or not. So, how are we encouraging Independence?
Conclusion
A common belief among those who work in Long Term Care is that it is a catch all for those who do not fit anywhere else, that is group homes or assisted living or at home with their families. The unfortunate reality is these residents have the advantage in the system they have fallen into. They are catered to, wiped and washed. Verbal abuse and voiced discontent toward staff is common.
Nursing staff who are encouraging independence ultimately are treated like servants which they are not. It is not a win for these people. Eventually they lose muscle mass, gain an extraordinary amount of weight or decline physically and mentally. The old saying is true. If you don’t use it, you lose it!
