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A salute to the stalwarts of long-term care

April 5, 2012
by V. Tellis-Nayak, PhD
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The idea behind this column is to recognize and celebrate the commitment of tireless caregivers in long-term care. Over the months we have profiled programs and people, who, with scarce resources, unflagging commitment and a fertile imagination, have invented simple solutions to stubborn challenges. Long-term care is replete with many such exemplars who, day in and day out, without fanfare, perform minor miracles in the service of our elders.

The on-site nursing home managers—the director of nursing and the administrator—serve as a deserving illustration of such unsung LTC stars.

A nursing home is a community unlike any other. It is an artificial creation held together by an uneasy coalition of interests and needs. A nursing home starts as an assortment of individuals whose most common denominator is old age, frailty and dependence. The elders, experiencing a loss of faculty, function and roles with the accompanying intimations of mortality, are now uprooted from family and friends; they are shaken by the thought that they will live their last years with strangers. Researchers have documented suicides precipitated by an impending move to the nursing home. Passive suicide may be common.

The staff that serves them complicates matters. To begin with, the staff often differs markedly from them in age, race, ethnic culture, social class and even in country of origin. Furthermore, they are assigned a task that is demanding, ill-paid and that pegs them at the bottom of the esteem ladder. 


This complex situation notwithstanding, we still expect nursing homes to transcend these divisions and contradictions; we expect them to be reborn as person-centered communities.

Culture change is a tall order. That transformation has to begin with the precarious encounter between a CNA and the resident. Here are two parties with contrasting backgrounds, both socially the most powerless and the least esteemed, who spend significant hours each day in close and even intimate contact. It is from the chemistry of their odd interchange that we expect nursing home managers to generate the wondrous culture of person-focused quality.

Brave DONs and administrators32,00 across the nationhave answered the call. Daily, in 15,600 nursing homes, they bear the awesome responsibility of mentoring 650,000 CNAs, 130,000 RNs, 185,000 LPNs and 400,000 other staff in the art of adding quality to the life of our elders. They build trust across the cultural and social gaps; they calm their anxious and reluctant new residents. They deal with agitated families. They create an inviting work environment that softens the hards demands of a CNA's personal life. They create policy, design protocol, invent ways and foster practices that make up the greenhouse that tends to and nurtures the nascent community of trust.


The experience is edifying. You witness a veritable miracle unfolding within the walls of many nursing homes. Caring managers guide a silent, unobtrusive transfiguration of an assorted collection of transient strangers into a community of residents and caregivers who become connected in warm friendship. This singular, everyday feat seeks no limelight, it makes  no headlines and its authors go unsung and unrecognized.