Sleep is an integral part of life. You can’t live without sleep. Sleep becomes even more vital if your body is in recovery from an injury or surgery. Most, if not all, residents of short term and long term care facilities are recovering from something. Be it a cold, an injury, surgery, or emotional trauma, sleep is a vital part of recovery for all seniors in homes.
It becomes more difficult to sleep when you are in a new environment. On top of being in a new, and unfamiliar, environment, seniors are often interrupted during the night by care-giving staff. Nurses come in to check vitals, IV’s, other health stats, take blood, and various other medical procedures and checks. Most commonly, the reason for these sleep-interrupting procedures is a habit and “the way things have always been done.”
As time has gone on, studies have been done to understand just how important sleep is to residents and patients in short term and long term care facilities. A recent study has found that a lack of adequate and restful sleep has been linked to the worsening of dementia, diabetes, depression, anxiety, aggression, and cardiovascular diseases in seniors.
As these medical issues worsen, residents and patients increase their need for more medications. These medications have side effects, which ultimately worsen the quality of life for the patient or resident. These medications can also be quite costly.
The importance of sleep is well-known in most senior care facilities. Many residents and patients are put on sleeping aids. Sleeping aids come with increased fall risks, especially for seniors, who already have the highest fall risk of all the population groups.
Over the past decade, studies have been done on the noise level of hospitals and skilled nursing facilities. Medical services often make a great deal of noise in nursing homes and hospitals. If one lived in a residential home, they wouldn’t face these noise problems. Nursing homes, much like hospitals, often have tile floors, centrally located nursing stations, and rooms that are grouped together.
In order to improve the quality and quantity of sleep of residents, a few solutions that have been found are to:
- Decrease the noise (conversations, opening and closing doors, etc.) of the nurses and other night-staff.
- Residents who are unable to sleep at night should be given a quiet activity or a removed place to go in order to lessen the noise in the more heavily populated areas.
- Televisions, alarms, and music (from either staff or residents) should be kept below 30 decibels of sound at night.
On top of improving the noise levels in nursing homes, there are many health practices that are in practice that are dated. Many of these practices require waking up residents. For example, incontinent residents must be woken up every 2 hours to make sure they are changed. This rule was implemented many years ago when pads and diapers were much less absorbent and advanced. This practice could be changed without adverse effects on the resident or patient’s health, and it would increase their sleep.
As always, the most important aspect of care in short term and residential nursing homes is individualized care. When the staff is aware of resident struggles, both sleep and otherwise, the quality of life of each resident improves. As staff is more conscientious of sleep needs, patient and resident health will improve.
In the senior healthcare world activities are extremely important. Having the patients and residents involved in activities helps with their overall treatment. As activities are more personalized, residents can feel more included in their little community, find purpose, and contribute to those around them.
Generally, most facilities have a life enrichment director that works closely with an activities director. These two are in charge of activities, and all social aspects of the long term and post-acute care residents.
Life enrichment and activities have drastically changed over the past few years. With innovative technology, the new generation of elders, and as facilities put a more individualized focus on residents, activities have evolved. Arts and crafts activities can use instructional YouTube videos, trivia can use iPads, and smart TVs can stream thousands of movies that were previously unavailable.
In Washington D.C., Linda Moreno is the Life Enrichment Director for two facilities. She gave an example of personalized life enrichment. Moreno recounted that a group of residents was reminiscing about how they missed going to Starbucks. This lead to Moreno having staff take all the coffee orders of interested residents and bringing back the treat for the residents. They also do this with restaurants, like Subway. This is a great example of individualized activity planning. The staff listened to the residents, and they adapted the facility plans based on what would be the most uplifting, fun, and personalized for the residents.
Technology has evolved long term and post-acute care facilities. One example is the use of smartphones. Many staff members keep apps on their phones that residents are interested in. Moreno mentions especially having an app with jokes on it. Another example is the use of videos online. Moreno mentions that a favorite activity of some of her residents is watching virtual tours on real estate websites. This leads the residents to talk about the homes they owned in the past, and they get to look at beautiful houses!
Another change in resident life is that the residents have a greater mental capacity. This means that instead of just doing a painting, they want to be taught about the artist they are recreating, hear about surrealism, and learn about the techniques instead of just simply painting.
Facilities are also starting to recognize that not all residents like the same things. This means that there has been an emphasis on the diversity of activities. Some long-term care facilities can have as many as four activities going on at one time, and often have at least 8 activities in a day.
While creating diverse selections of activities, life enrichment directors and activity directors also need to be able to plan activities that benefit the residents mentally, physically, emotionally, and spiritually. One example of this is a facility in Texas. The recreation director had 2 desktop computers installed and spent time teaching residents how to use them. This gave the residents the freedom to use the computer to search their personal interests, and maybe send emails to loved ones.
In conclusion, activities in the long term and post-acute care facilities are vital. These activities improve the quality of life for each resident, and in turn, can improve their overall health and their willingness to do physical therapy and treatments for health problems. Enrichment and activities directors are doing an impressive job of incorporating personalized activities for residents, and it is improving the overall quality and resident satisfaction of facilities.
“Most people feel satisfaction and fulfillment when giving their time and attention for the benefit of others.” For nursing home residents, this can be a hard feat to achieve. Often, residents of short and long term care are focused on recovery, wellness goals, and other health concerns. This often can lead to not feeling fulfilled. Long-term care centers have been working on helping residents find and enhance the meaning of their lives.
Long-term and post-acute care residents have lived a long life, and they have a lot to offer the community if the providers can facilitate and foster these opportunities. An important aspect of helping residents give back is to focus on their strengths and abilities. A resident could share their knowledge about a career path they took, or maybe they have a talent for floral arrangements. If providers and caregivers understand their resident’s strengths and abilities, it can help them find specific and personal ways the residents can give back. When these opportunities are found and executed, it helps residents have a greater purpose, and it improves their social, mental, and emotional health.
Many long-term care facilities are seeing improvement in the effectiveness of the treatment when their patients and residents have a better quality of life. Long term and post-acute care centers have been participating in bake sales, bazaars, craft shows, and collections of various items. Having a wide array of activities really allows each resident to showcase their specific talents and skills, and after funds are raised, the residents can choose which charity to donate the proceeds to. Donations can vary from natural disaster relief to food banks, to treatment of a sick child.
Giving back and finding meaning in resident’s lives can come in many forms. In Minnesota, a facility has put together a resident-run music program. Residents give lectures, recitals, and music lessons to their fellow residents. In Michigan, several of the residents were civil servants. The facility has put together a resident council, and they can participate in similar activities that they used to take on when they worked in the local government. In Illinois, residents can take university-level courses, and choose what role they would like to take on in their facility. Another facility in Michigan opened a thrift shop for a resident who had spent her career working in retail. All proceeds from the thrift shop go to the community’s benevolent fund. There are also many facilities that have resident-run art classes.
In conclusion, residents and patients of long-term and post-acute facilities have a lot more to offer than just focus on their health concerns. When residents are given personalized opportunities to give time and talent to enhance the lives of others, they increase the quality of their own lives. Residents of facilities have worked careers, cultivated talents, and are capable of many diverse actions. If providers take the time to get to know their resident’s strengths and facilitate these actions, other residents, the outside community, and many others around them can benefit.
There is an important link between psychosocial care and overall health in seniors. In the past, residents of long-term and post-acute care facilities were given attention based only on their medical needs. While medical needs are the first and foremost priority of care facilities, providers now understand the fundamental importance of meeting resident’s and patient’s social and emotional needs, on top of their medical needs. The facilities that truly “embrace the time, space, and action needed to recognize and investigate changes in residents’ emotional states” see the biggest improvements in their resident’s overall health.
Being in-tune with the resident’s emotional, social, and medical needs could be small changes, like adjusting the blinds in a patient’s room, to large changes to their care plan. These actions lead to an increase in resident satisfaction, fewer complaints, and, most importantly, a higher quality of life.
The best thing care providers can do to meet the resident’s emotional, social, and medical needs is to pay attention. Too often we find ourselves stuck in the monotony of life. Care providers should strive to pay attention, listen intently, and remember that each resident has an individual and very different psychosocial needs.
Psychosocial needs are an array of social and emotional needs. Psychosocial needs have a strong correlation to mental health disorders such as depression, anxiety, dementia, and delirium. All residents in a care facility are in a new environment, they experience loss of relationships, loss of personal control and identity, adjustment to the facility, and continuity of care. These adjustments can be very difficult on residents, and when their psychosocial needs are met, they can be given the opportunity to thrive.
Medical, emotional, and social needs in a care facility are intertwined. As a patient receives a new diagnosis, this affects their emotional state and can have implications on their social needs and social ability. As care providers are aware of each change and implication, they can help residents and patients navigate changes, and day to day life, as successfully as possible.
Providing excellent, attuned psychosocial care is not something that can be done by one person alone. Excellent psychosocial care is a culture that must be fostered by care providers. Every member of the staff must work towards the goal of meeting each resident and patient’s psychosocial needs. Social workers are an important aspect of facility care, but they cannot be wholly responsible for psychosocial care.
Residents can grow and flourish in a facility where they feel emotionally safe and secure. Important factors in creating a culture that promotes psychosocial care are: how people are addressed, how much time staff spends with residents, communication with families, how complaints are addressed, and being conscientious and careful with room assignments.
In conclusion, successful post-acute and long term care facilities strive to meet each resident’s psychosocial needs. When residents’ psychosocial needs are met, they are more fulfilled, more secure, and more likely to have a higher quality of life. Care providers must strive to focus on each resident’s emotional, medical, and social needs.
Approximately fourteen percent of Americans suffer from some degree of kidney disease. The highest populous of people in this group are those of the elderly community. Those who suffer from Chronic Kidney Disease, and reach stage 5 (end-stage renal disease), require dialysis or a transplant. Because surgery and other risks are higher when people are above a certain age, most elderly people who suffer from end-stage renal disease must get dialysis.
When living in a skilled nursing facility, and participating in dialysis, residents must schedule their precious time, find transportation, and spend long hours receiving treatment, and then schedule transportation home. This is why many skilled nursing facilities are beginning to offer dialysis on-site.
Dialysis is the process of using a machine to filter out water from the kidneys. When kidneys lose function, they are unable to filter the water themselves. There are two types of dialysis for those with kidney failure. Hemodialysis and peritoneal dialysis. Hemodialysis is the type that skilled nursing facilities are offering.
When skilled nursing facilities offer dialysis, the residents get the benefit of staying on-site, eliminating the commute time, waiting room time, and inconvenience. Residents also get the benefit of staying in a familiar, quiet, comfortable place, which is an important amenity for elderly residents, especially those who are recovering from surgery, injury, or suffer from memory loss.
In-house dialysis is often complex, so many skilled nursing facilities are opting to partner with dialysis centers and have a registered nurse travel to the facility a few times a week to complete the dialysis for the residents.
When skilled nursing facilities operate their own dialysis care without partners, there are many rules and regulations they must follow. The skilled nursing facility must “ensure that an ESRD facility, maintains direct responsibility for the dialysis-related care and services provided to the nursing home resident consistent with the ESRD Conditions for Coverage requirements as well as the terms of an applicable agreement with the nursing home.” Requirements, education, and training are closely monitored and regulated.
The three most important regulations for dialysis at skilled nursing facilities are: onsite supervision of dialysis must be provided by a registered nurse; qualified, trained personnel must be present for the entire dialysis treatment, with the ability to see the patient; and if the skilled nursing facility is, for whatever reason, unable to provide scheduled dialysis for a resident, the nursing facility must notify a dialysis center and get the resident dialysis off-site in order to avoid delays or cancellation in treatment.
Offering in-house dialysis for residents improves the quality of their life. As the quality of life improves, residents increase their fulfillment and functional ability. Skilled nursing facilities strive to provide the highest quality of care, and offering in-house dialysis is another step towards improving the lives of residents.