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Not Just an "Old Folks' Home"

May 1, 2003
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An interview with David Fridkin, FACHE, and Eulalia Awan, RN
An interview with David Fridkin, FACHE, and Eulalia Awan, RN

Illustration: "The Bus," by Frida Kahlo, 1929 Imagine finding yourself confined to a wheelchair at age 21 because of an accident or debilitating illness. If you were no longer able to remain independent and if your family couldn't
care for your needs sufficiently at home, or if you had no family to turn to, where would you go? Most likely to a long-term care facility. How can administrators and staff help younger residents cope with the prospect of living in a nursing or assisted living facility for another 30, 40, 50 years or more of their lives? How do the needs of these younger residents of nursing homes/assisted living facilities differ from those of older residents? Nursing Homes Editor Linda Zinn posed these questions to Administrator/CEO David Fridkin and Director of Nursing Eulalia Awan, of the Island Nursing and Rehab Center, Holtsville, New York. Island Nursing and Rehab Center's under-65 population is roughly 13% of its overall population-a trend that its administration expects to continue.

Zinn: Can you give me a breakdown of the number of younger residents-defined as those less than 65 years of age-who currently reside in your facility?

Fridkin: First I'll give a little background on our overall population. We are a not-for-profit facility that opened at the end of October 2001. We are affiliated with the John T. Mather Memorial Hospital, in Port Jefferson, Long Island. Island Nursing and Rehab Center has 104 residents and patients, with a capacity to accommodate a total of 120.

We are seeing a larger population of younger residents admitted to our facility, a trend that is becoming more notable in the long-term care field. Of our current residents and patients, 7% were born between 1948 and 1982 (ages 21 to 55), and 6% were born between 1938 and 1947 (ages 56 to 65). The remainder of our residents range from 66 to 107 years of age. Of the younger people here, six are short-term patients (average stay, 25 to 30 days) who are here to receive rehabilitation services, and seven are long-term residents. Zinn: Have you made a concerted effort to attract younger residents? If not, why do you think your facility appeals to this population?

Fridkin: We really haven't tried to attract them. I believe our facility appeals to this population for several reasons: our focus on rehabilitation medicine, our special unit for ventilator-dependent individuals, and the appearance of our building. It does not look like a typical nursing home; it looks more like an assisted living residence or a hotel. There is abundant space, and the rooms are airy and sunny, not dreary.

Zinn: It must be difficult for younger residents to come to grips with the fact that they will probably live in a long-term care facility for many years-perhaps several decades. What do you do to help them make the adjustment from their former independent lifestyle, and how do you help keep their spirits up day by day?

Awan: Some of the younger residents are extremely depressed from the time they're admitted. Initially, many of them are hoping only to be here for short-term rehabilitation, but we know at their admission that they'll be here for the long term. These residents need help adjusting. Because the signs and symptoms of depression are so common in this population, we provide psychological and psychiatric services for them.

Fridkin: Some other psychological and behavioral issues are also rather typical of this population and need to be addressed. For example, some of these residents resist standards we have for their safety. Naturally, they want to try to retain the independence they've enjoyed in the outside community. So they want to smoke alone, go outside without assistance, and go outside more frequently than older residents. Therefore, we have to provide more nursing assistance and more surveillance so that they don't hurt themselves.

Awan: Staff members from our social services department also meet with these residents on a regular basis, and there is a great deal of interaction with their families. We work as a team to accommodate the younger residents' needs.

Zinn: I'm guessing you can't keep your younger residents happy merely with bingo games and sing-alongs. How do you gear activities to suit them?

Fridkin: We have a computer on the unit, because these younger residents are computer-knowledgeable and want computer access as a means of communicating with their families and friends. We also have a Web cam, so that the residents can participate in "visits" with their out-of-town loved ones or those who can't visit in person. This allows the participants to see each other in real time. Video games are also very popular with this group, and we have painting classes and other activities that are appropriate for their ages and functioning levels.

We also try to hold group discussions for the younger residents. Frankly, few of them are interested in associating with the older population, so we have to provide different activity programs to meet their needs.