August 18, 2008 | by I Advance Senior Care

Thoughts on the negative connotation of nursing homes

I remember, growing up, that my parents called the county nursing home the "poor house." They told me that older folks were housed there by the government because they could no longer afford to live on their own or take care of themselves. From the outside our county home looked inviting. It was a large white frame house with a wraparound porch and was surrounded by the remains of a small farm. One or two folks were always sitting on the porch during the summer, enjoying the weather while watching the cars pass on the state highway.

My first visit to a nursing home came during my sophomore year of high school. Our girls' glee club and mixed chorus sang at several nursing homes that Christmas. That was quite a revelation. There were no large nursing homes in our little town in the 1960s. Those we visited appeared to be former homes or apartment buildings. The residents were usually in a hospital type bed which looked really out of place with the rest of the room.

I thought our singing would make these people smile. A few of them did, but not many. Our last visit that day was to a small storefront, men's nursing home downtown. These fellows did not seem to be as ill and they enjoyed us very much. We liked the appreciative audience so two or three of us went back a couple more times before Christmas on our own and sang for them. But we realized the emotional toll it was taking on us and we decided not to go back.

In my 20s I went to a nursing home for physical therapy. This home was newer, larger, and very modern. It was built in the early 1970s. It had a large lobby where residents sat along with visitors. Some residents were tied to their “gerry” chairs. The nurses explained that if they did not restrain the residents they would not be able to sit in the front lobby safely. It seemed strange, but I felt it was better for the residents to see other people than to stay in their rooms all the time. There were a few times that residents wanted to leave with us. Sometimes a resident went out the door as we came in. The staff would quickly bring them back in, but my mother and I would still feel a twinge. In time I learned to walk right through the nursing home without becoming unduly upset by the constant challenges of resident care.

A more positive slant on nursing home life was our visits with Pop (my mom's dad). His Pennsylvania nursing home was in a two-story former hospital building. It sat on the hillside of a small river town. I know Pop did not want to be there, but he was a double amputee due to circulatory problems and he realized the care they provided was necessary for him. Because of visual impairment, Pop had not been able to read or watch television for years. He had a private room where a portable radio was his constant companion. It kept him informed and he could always converse about the news and his Pittsburgh Pirates. Pop kept active with his care and transferred himself for as long as he was able. He did not appear to be isolated or sad, although I am sure he felt that way sometimes. Pop usually looked out his window and watched people walking on the sidewalk below, particularly the young ladies.

Nursing homes denote illness and isolation to most people. It is not a very nice thought. No one wants to think about the day when they are ill or not able to care for themselves. There is no pride or power in that. I guess we all feel rebuffed or at least guilty about the entire situation. We do not have a positive image of older people unless they are still vital. Unfortunately, nursing homes are institutional in nature. No one would want to live in a hospital-like environment all the time. Many people think that a nursing home is a place where residents wait to die. They also know that residents' lives are ruled by those who take care of them.

As a resident in a nursing home, I feel a more positive image would feature social services kicked up a notch. The social worker should involve family members more and not just at care conferences. Better end-of-life care with families would assist nursing homes to have a more positive impact on the frailest members of their community. I have thought for years that there should be a meditation room, a large community room, and a cemented outside area with tables and umbrellas for residents and family to congregate. Residents need something to do and a hobby room where they can return to work on their projects would help with that. Over the years I have discovered that residents seldom know the nursing home's rules. Therefore a brief handbook stating those rules would be quite helpful. Residents also may need assistance with financial resources and families need assistance on where to go for information on transitioning from private pay or Medicare/insurance to Medicaid.

Nursing homes have a difficult job to do. Pleasing the residents on a good day with very good circumstances is difficult. I could expound further but it might enter the realm of fantasy. However, attitudes are never easy to change. The perception of nursing homes has developed over many years. It will take many years for that negative connotation to change. But I feel that nursing home management needs to start it from the top down.

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