Navagating Long Term Care

THINGS TO CONSIDER

The New Environment

• Recognize that 24 hour care seven days a week is not one-to-one care by the long term care staff. Often care is provided by Certified Nursing Assistants (CNA) who have several residents assigned to them.
• Mealtimes and change of shift periods require that the CNA perform additional duties which limits their availability.
• Personal care does not equate to doing everything possible for a resident. Any level of independence the resident has is encouraged to preserve functional ability and promote self-esteem.
• Recognize that the staff at long term care have very challenging jobs that includes lifting and moving people who cannot do it for themselves, communicating with residents who may be confused or agitated for a variety of reasons, and experiencing the emotional toll of losing residents they have provided care for, sometimes over a period of years.
• Visiting at various times of day and participation in care fosters goodwill and lets the staff know how much the resident is loved. Providing mealtime assistance, helping with personal care such as nail clipping or hair grooming, providing engagement activities, and reaching out to other residents and family members help to build community within the long term care setting.
• Take responsibility for overseeing and managing any outside appointments, providing adequate supplies such as replacement clothing, and managing the resident’s affairs. Be an advocate for preserving quality of life and quality of care.

Communication

• Physicians do not make daily rounds to see residents. The nurse is the point person to communicate health concerns with physicians, including changes in a person’s health status and lab and test results. If there is a medical concern, request to speak to the on duty nurse.
• If changes in medications occur, follow up with the nursing staff to be sure the change is made. Let other physicians who are actively involved in the care of the resident know when medication changes occur.
• Designate one person in the family to communicate with the facility for any questions, concerns, or updates. The staff are limited in the amount of time they have to repeatedly communicate similar information. Often the healthcare power of attorney (HCPOA) acts as the point person but this is not required. If someone else is the point person, be diligent in communicating with the HCPOA in case an emergency arises and a medical decision needs to be made on the resident’s behalf.
• Plan to meet key administrative staff such as the Executive Director, Director of Nursing, Social Services Director, and Dietary Services Manager shortly after admission to understand their roles and responsibilities and provide an opportunity to discuss any special issues or concerns.
• Attend care conferences which typically occur a minimum of every three months. This is a great opportunity to express personal preferences, needs and concerns.
• Get to know the nurses and CNAs that are providing care to the resident. Establishing a relationship builds trust and allows for easier communication if a concern arises.
• The role of the family member is to communicate preferences and care needs to the staff recognizing that the wishes of the resident take precedence over those of the family unless the resident is not capable of making decisions independently. For example, a family may insist that a person attend an activity, however if the resident prefers not to, the staff will abide by that. Discussing concerns and strategies with the resident and the staff encourages working as a team.
• If the resident has a roommate, be especially considerate when in a shared environment. Visiting in a different space may be necessary. If there are serious roommate incompatibilities these should be addressed with social services.
• Discuss any concerns about the resident’s care promptly to the CNA or on-duty nurse. Keep a notebook to document date, time, problem identified, who the situation was discussed with and outcomes. Being specific allows for a greater opportunity for something to be corrected.
• Approach care needs as problem solving and not complaining. Also be aware of whether the resident is upset or concerned. For example, an outfit not being color coordinated may be of no consequence to the resident and therefor may not need to be addressed.
• Be polite and friendly when approaching staff with concerns, recalling that providing care to multiple individuals with physical and behavioral needs is challenging. Follow the chain of command if a problem is not resolved by the hands-on caregivers. If concerns continue to not be addressed, contact the local ombudsman by searching www.ltombudsman.org
• Research has shown that trusting, collaborative relationships occur when caregivers feel listened to, responded to, and valued. Consider ways you have developed similar relationships in the past and work to build the same with the long term care staff.