Wednesday, May 22, 2013

9 Things I Wish Health Care Personnel Would Do Differently

I may have lost count of the years I’ve been accompanying my parents to doctors’ offices, hospitals, and nursing homes, but I know I’ve logged enough visits to have accumulated some pet peeves. Most are small annoyances, but they add up. If hospitals and nursing homes made even a few small tweaks from my wish list, my parents’ health struggles would be just a little easier. I will add that I have also been so grateful for nursing home and hospital personnel’s compassionate, capable care for my parents. Today, however, I would like to air my wish list for improvements in hospitals and nursing homes.

  1. Please train your staff and volunteers how to successfully interact with Alzheimer’s patients. Better yet, sign your people up for the Alzheimer’s Association’s training.
  2.  Here’s one insight that might help your personnel: As Alzheimer’s disease (AD) progresses, a person loses his or her vocabulary. If you’ve just dumped 100 jigsaw puzzle pieces on the table and asked a seemingly capable AD person to help you turn the pieces right-side-up and he just sits there, don’t keep repeating the phrase “turn the pieces right-side-up” louder and louder and louder. He’s probably not deaf. He simply has lost the “right-side-up” concept. Instead, choose different words, like “get the colors on top” or “turn them over so we can see the colors.” I once witnessed a physical therapist eliciting my father’s cooperation in a quadriceps exercise for which she had placed a stretchy band around his thighs. She asked him to separate his legs. No movement. She raised her voice. “Separate your legs.” He didn’t understand. She said even louder, with obvious frustration, “Separate your legs.” Still no movement. My mother leaned toward him and whispered, “Jim, put your knees apart.” Instant, appropriate action. Call me a dreamer, but I really think a physical therapist working in the Alzheimer’s wing of a nursing home should know to experiment with different wording.
  3.  Here’s another: Know that an AD patient becomes easily disoriented and agitated. If the nursing home sends an AD patient to the emergency room, please, I beg you, someone, call the family to come be with him. The nursing home has contact numbers. The hospital has contact numbers. Call us! Don’t just strap him to a gurney and leave him. This scenario traumatized my father so severely, it was months before he recovered from the physical and emotional effects of being strapped down, alone in a strange place.
  4. Nursing home aides in Alzheimer’s units work SO hard to feed, toilet, and bathe residents, and activities directors make days lively, fun, and entertaining. By some miracle, these personnel remain SO upbeat and sweet with residents. I wish more volunteers could help overworked staff by keeping residents company, reading to them, talking to them, showing them pictures, holding their hand—any simple little companionship activity. I’ve inquired about this and been told it’s really hard to find volunteers who are comfortable talking with AD residents. I can understand this, for certainly I find that with my dad as well. I’m motivated to carry on one-sided conversations with him because he’s my dear dad. I know he likes music and sports and family talk. I’m not sure how comfortable I’d be yammering on with a stranger. Sensing my father’s loneliness, I wish I could visit him every day. Since I can’t, I wish volunteers could spend time with him and his hall mates one on one. Residents new to nursing homes typically answer lengthy questionnaires about their hobbies. Unearth those questionnaires and let volunteers know what topics might interest certain residents.
  5.  Here's one more wish for care for Alzheimer’s patients. It’s a very fun idea during a movie activity to give residents a little paper cone of popcorn. But then when you also give them a beverage, they no longer have a free hand with which to eat popcorn. They have lost the ability to think of a solution like putting the beverage on the floor—even if they could reach the floor without falling out of their wheelchairs—or steadying the popcorn cone between their legs.
  6.  I wish that every week, someone could go from room to room in a nursing home to clean residents’ eyeglasses. Lenses become so smudged from arthritic fumbling and so flaked with dry skin, it’s a wonder people can see to eat, let alone enjoy a book or TV show.
  7. Is there any way nursing homes could keep residents walking longer? It seems fear of residents' falling leads institutions to put people in wheelchairs prematurely. This robs people of one of their last vestiges of freedom and independence. I understand the tension between wanting to protect precious people from high risk for breaking bones and wanting them to maintain muscle strength. I don't have a solution, but some clever person must.
  8. Please make electronic medical records a priority budget item in your nursing home. We pay thousands of dollars to you every month; yet when we ask what medications our loved one is getting, you can't tell us. When was the last time the doctor examined him or her? You flip page after page after page in your big binder where you faithfully record every sneeze, but you can't answer our simple questions.
  9. Last but not least, lose the fragrances! When my mother was in the ICU, we could hardly breathe when a certain heavily perfumed nurse came into the room. When you’re already sick, even a light perfume can be very sickening. Hello … do you even realize that little fragrant dryer sheet you use in your laundry means all your clothes give a headache to about 30 percent of everyone you come in contact with and trigger asthma symptoms in many others? Same goes for your on-site laundry rooms; laundry scents wafting around your halls and courtyards are TOXIC for your staff, as well as patients. Small research studies have already begun to link perfume usage with cancer, and I expect evidence will grow. (Thankfully, most hospitals and nursing homes I've visited now maintain walls with at least low-VOC paint, sometimes even odor-free paint. Thank you very much!) The packages of personal wipes hospitals and nursing homes supply patient rooms with all seem to be chemically scented; wouldn't it be just as easy to use unscented wipes? And unplug those ridiculously unnecessary chemical air fresheners; your facility sparkles, it's so clean. Chemicals tax human immune systems. What are you thinking, health care institutions? For heaven’s sake, establish personnel policies prohibiting your staff from making patients sicker.