Partners in Caring
A Door Opens
Phases of life often begin with change.
At Santa Anita Convalescent Hospital we know that life changes – one door opening as another door closes – can occur at the most unexpected times, in the most unexpected ways.
And our doors are open to help you deal with the changes that you and your loved ones are experiencing.
Santa Anita Convalescent Hospital’s Family Education Program: Partners in Caring focuses on answering questions, offering information and insight, and helping you or your loved one through the admission process into one of our nursing homes, whether for a short-term stay or for long-term recovery.
Our aim is to convey facts about what to expect, listen to your concerns and, above all, open the door to reveal what life is like at a Santa Anita Convalescent Hospital.
Creating a Partnership
Partners in Caring is designed to educate, inform and assist in the formation of realistic expectation about nursing homes. The first step is to outline what must occur in order for the client and his/her family to make realistic decisions about long-term health care. Entering a nursing home requires adaptation on the part of the client and his/her support network. We can help by informing you about what to expect as this new life phase begins. Our objective is to teach you and your loved ones by listening to your questions and concerns and by giving you as much information as possible about aging as well as about choosing a nursing home and the quality of life it offers.
A nursing home generally includes two types of clients – those who are receiving short-term rehabilitation to recover from an injury or illness, and those with multiple medical, cognitive or emotional problems or illnesses who are receiving long-term care.
Whenever possible, the short-term client is sent home. In some cases, they resume their lives and continue their recovery; in other cases, they may experience a relapse or another health issue and be readmitted.
Realities of Aging
There is no fountain of youth, no magic potion to diminish the effects of the aging process. Aging inevitably brings on physical, mental and emotional challenges for the people who are aging as well as the loved ones caring for them. Hearing and vision are almost always affected to some degree, and even a mild infection can have a serious impact on a client’s fragile state of health. Many mental changes are a normal part of the aging process, including decreased memory and slower thinking. Pain from a joint or muscle problem also becomes more frequent.
Fear and apprehension about these changes can be reduced by open, honest conversation. And the support of family or friends is very important in several ways:
- To keep the client engaged in what is going on around the nursing home as well as engaged with his or her family
- To assist caregivers in keeping the client comfortable
- To help the client maintain a balance between independence and appropriate risk
- To provide valuable information to caregivers and staff about the person’s unique characteristics, including family and work history, food preferences and activities they find enjoyable
- To alert the staff to any history of falls or wandering.
Upon admission to a nursing home, a client might feel disoriented and stressed over the new environment. Moving at any age is difficult, and sometimes a move to a nursing home may have overtones of finality or at least semi-permanence.
Very few family members admit their loved ones to a nursing home without experiencing feelings of guilt – even if caring for that loved one at home has become an overwhelming task. This stage of life is filled with conflicting emotions, and guilt is a natural part of that. One way to deal with any guilt feelings is to stay involved through regular visits, by getting to know the staff and by acting as an advocate for your loved one.
As we Age…
Through the efforts of researchers, physicians, and other caregivers, we know and understand more about how we age than ever before. Because many of the elderly have multiple health, psychological and emotional issues, it’s more difficult to diagnose and treat illnesses. In addition, a longer recovery time makes it difficult to determine if treatments are working.
Although this list certainly is not all-inclusive, here are a few effects and risk factors involved in aging:
Bone Density Decreases. This is a fact in virtually all women and men from about age 50.
Risk of Falling Increases. Each year, over 30% of senior citizens experience falls at home.
Appetite May Decrease. The change in the sense of taste and smell that most people experience as they age may lead to a diminished appetite.
Risk of Dehydration Increases. As people age, their ability to sense thirst can lessen, making dehydration more difficult to detect or diagnose.
Skin Becomes More Fragile. As we age, our skin becomes less elastic and the layer of fat under our skin decreases.
Mental Status/Ability to Change. Even senior citizens with no history of Alzheimer’s or other dementia experience some normal mental changes as they age, including decreased memory, confusion, or a decline in intellectual function.
Incontinence Problems May Develop. Whether through decreased awareness of bodily function or muscle weakness, incontinence occurs often in the elderly.
These conditions and risk factors are discussed in detail in the following sections.
Decreased bone density can lead to an increased risk of serious injuries, such as broken bones, caused even by simple movement. Bones become more porous as we age, and slower to heal in the event of an injury. Women are four times more likely to develop fragile bones, but men can suffer from it as well.
Taking such steps as consuming adequate calcium and exercising can slow the loss of bone density, but the decrease is a natural effect of aging, and as bones become more porous they are more prone to breaking. Such fractures can be caused even by simple movement and can heal slowly or not at all, depending on the age and the health of the individual.
Osteoporosis is a condition that causes thinning and weakening of normal bone. More than half of all Americans 50 and older have low bone mass, which puts them at increased risk of developing osteoporosis and related fractures. The percentage increases drastically, especially among women, as people age. Source: National Osteoporosis Foundation
A simple fall is not normally considered a health risk. But among the elderly – especially those who have reduced muscle mass and brittle bones due to osteoporosis – falls can be serious and even be disabling.
Falls are common among those 65 and over, whether or not they live at a nursing home. Each year over 30% of seniors are reported to fall at home. There are several reasons:
- A decrease in safety awareness as we age
- Changes in vision, hearing, muscle strength, coordination, and reflexes
- Health disorders – diabetes, heart condition – that affect the balance
- Disorienting effects of some medications
In a nursing home, a fall can often result from a client’s impatience or reluctance to ask for assistance in walking or getting up to use the restroom. While no program can prevent falls, our Falling Star program is aimed at minimizing the number of falls and the severity of any resulting injuries.
Ways loved ones can help include:
- Reporting changes in the resident’s stability, strength or gait to the staff
- Encouraging the client to take it slowly
- Expressing empathy; a common reaction to a fall is fear of falling again
How We Can Help
Our Falling Stars program is designed to alert staff members about clients who are at special risk for falling. We research specific patterns, situations, and behaviors associated with falls, and we use colorful symbols to establish a common method of communication to alert the staff about who is at risk for falls. Unfortunately, the only way to avoid falls would be through the use of restraints that severely restrict independence.
In assessing the best approach to reduce the risk of falls, we strive to achieve a balance of the client’s independence, freedom of movement, dignity, and safety. For more information on Falling Stars, contact the Administrator or the Director of Nurses at your nursing home.
In 2001, more than 1.6 million seniors were treated in emergency departments for fall-related injuries and 373,000 were hospitalized. The chance that a fall will cause a severe injury requiring hospitalization greatly increases with age. Source: www.cdc.gov/ncipe/factsheets/falls.htm
Although every effort is made to keep clients fed and hydrated, the ability to take nourishment is affected by the desire to eat and drink and the perception of whether someone is hungry or thirsty. Several factors can influence appetite:
- Sadness, grief or depression
- Tooth loss or ill-fitting dentures
- Reduced ability to feed oneself
- Certain medications that can mask hunger or contribute to dehydration
Hydration is especially important in aiding the body’s ability to recover, and dehydration is not always easy to recognize or diagnose. Many symptoms do not appear until the significant fluid has been lost. In addition, if a resident becomes dehydrated, the cause may be also related to medication, illness or swallowing problems.
Loved ones can play an important role in helping a client by:
- Alerting the staff of any risk factors, such as swallowing problems
- Keeping fluids within the client’s reach
- Informing the staff about a client’s beverage and food preferences
- Continuously encouraging the client to eat or drink
Dehydration is one of the most frequent causes of hospitalization for the elderly.
One-third of people over age 65 are affected by nutritional deficiencies. The incidence of protein-calorie malnutrition is higher among the elderly than any other segment of the population. Sources: Columbia University Medical Center.
As the body ages, it undergoes changes that affect its ability to heal. Our skin becomes drier and less elastic, and the layer of fat under the skin decreases, resulting in increased bruising or tearing. Diseases such as diabetes can increase the risk of skin problems and wounds. Pressure ulcers (bedsores) can develop, especially in elderly bed-bound people who are unable or unwilling to move.
At the same time, it’s more difficult to tell if a treatment regimen is working because recovery time slows from wounds or other injuries. Nutrition also has an impact – without proper food and hydration, the body’s ability to heal is affected. It’s also important to remember that since older adults may suffer from multiple medical problems, they can have different types of pain.
Loved ones can help residents and caregivers in several ways:
- Assist with skin-care prevention measures such as turning the resident, massage, the range of motion exercises or bathing. Of course, any assistance should be done in close coordination with staff to avoid injuries.
- Report observations to the staff about skin tears, rashes, discolored areas or bruises.
- Encourage the resident to participate in physician-ordered therapies and physical activities.
- Support residents as they recover, with the awareness that they may not return to their prior level of functioning.
There is a growing emphasis on pain management, including more detailed assessments and plans of care. It is estimated that a third of all Americans will have severe chronic pain at some point in their lives, but that it often goes unrecognized or under-reported. You can help by becoming aware of the resident’s verbal and non-verbal responses to pain, including grinding of teeth or resistance to being moved.
About 9 percent of residents in healthcare centers have pressure sores.
An estimated 50 million Americans live with chronic pain caused by disease, disorder or accident. An additional 25 million people suffer acute pain resulting from surgery or accident. Source: U.S. Department of Health and Human Services
Although many mental changes are a normal part of the aging process – including decreased memory and slower thinking – depression, dementia and Alzheimer’s disease are examples of more severe mental changes that can be stressful, frustrating and frightening. And, experts estimate that as many as two-thirds of nursing home clients have some sort of dementia. In addition, many of the medical and physical problems discussed on these pages are complicated by cognitive impairment.
It’s important to note that Alzheimer’s disease is not a part of normal aging. It is a disease that affects the brain, specifically nerve cells, or neurons, which send messages through the body.
Alzheimer’s disease disrupts normal brain function and affects memory, communication, and personality.
Alzheimer’s is an irreversible, progressive brain disease. An althoughno cure is known for Alzheimer’s, progress is being made on almost a daily basis to find its cause and cure. A therapeutic environment such as a healthcare center is supportive rather than curative. Special measures can be taken to help lessen the impact of Alzheimer’s and give the client a feeling of comfort and safety.
Here’s how loved ones can help:
- Alert the staff of any changes, no matter how subtle, that you notice.
- Inform the staff of a client’s historical information – likes and dislikes, and former occupations.
- Encourage the client to take ordered medications and participate in planned activities.
- Seek assistance from outside support groups.
Problems with control of one’s bowel or bladder are widespread in the elderly. The reason may be muscle weakness or a decreased awareness of bodily function. Whatever the reason, however, incontinence can be embarrassing as well as uncomfortable.
Incontinence is an emotional as much as a physical issue – the fear of losing bladder or bowel control can keep a loved one from participating in social events or even from daily interaction. Fortunately, there are protective and preventive measures to help deal with incontinence, such as absorbent undergarments and scheduled toileting.
Two nursing home studies have identified a 45% to 47% prevalence of fecal incontinence among clients. Studies suggest that incontinence contributes to the decision to institutionalize elderly patients. Source: International Foundation for Functional Gastrointestinal Disorders
Health care team members in a convalescent hospital:
Registered Nurse (RN): Nurses perform health assessments, give medications, monitor (check) vital signs, change wound dressings, provide wound care, and teach family caregivers basic skills to care for the patient at home. You may see new nurses each day as most work in 8-or 12-hours shifts. The nurse is often the best person to talk to if you need something or have a question.
Nurses’ aide or nursing assistant (CNA): These team members work under the supervision of RNs. Their job is to take blood pressure, change bedding, assist patients going to the bathroom, give baths, and help make sure patients are clean and comfortable. They work in shifts (like nurses) and you may not see the same aide each day.
Social Service Designee: The social service designee assesses the need of each patient and family. He or she helps with health insurance problems and, as needed, plans for social or psychological services. The social worker is often the person that helps with discharge planning. This includes transportation home or to another facility as well as referrals for care after discharge.
Discharge Coordinator/Planner: Discharge Planner coordinates with the interdisciplinary team, resident and family arrangements for post nursing and rehabilitation care. Planning in advance is crucial to the overall success of the residents return to home or next level of care.
Dietitians (Nutritionists): They provide counseling and assessments about nutrition (food and diets).
Therapists: They include: physical therapists (PT) who help patients with walking and regaining strength; occupational therapists(OT) who help patients with skills like eating, getting dressed, and using assistive devices; speech therapists (SLP) who provide specialized care as needed.
Some Final Points
As you consider admitting yourself or a loved one to a long-term healthcare center, continue to keep these points in mind:
- A nursing home is not a hospital. We provide care to our clients through nurses and nursing assistants. The care is augmented by contact with the client’s physician. But a nursing home does not usually have an on-site physician or the sophisticated medical equipment found in a hospital.
- Every effort is made to retain qualified staff. Santa Anita Convalescent Hospital nursing home is staffed with dedicated caregivers committed to providing quality care.
- For the elderly, change is a fact of life. Physical, mental and emotional changes – often include incontinence, progressive dementia or falls – naturally occur as people age, regardless of whether or not they are in a long-term care facility.
At Santa Anita Convalescent Hospital, we believe that education is the key to providing information about long-term care and about what to expect as a loved one ages. Our skilled nursing care is taking care of people who cannot take care of themselves, and it is a mission we take very seriously.