Five Things to do when visiting a nursing home this Thanksgiving
AAA projects 54.3 million Americans will travel by care at least 50 miles from home this Thanksgiving. A great many will visit loved ones in nursing homes for the first time in many weeks or months. On this week’s episode, nursing home abuse attorneys Rob Schenk and Will Smith discuss five tips for keeping your loved on safe this Thanksgiving.
Schenk: Hello out there. Welcome back. Hope you are preparing for Thanksgiving. My name is Rob Schenk.
Smith: And I’m Will Smith.
Schenk: And we are your hosts for this episode. A couple things I want to give a shout-out to – November is Alzheimer’s Awareness Month as well as being National Caregivers Month. So I just wanted to throw that out there. I think we’ll probably have an episode dealing with Alzheimer’s here coming up and just to highlight how important that is to raise the community consciousness on that issue. And then National Caregivers Month, that includes nurses and CNAs and all types of people, so give them a huge, give them a shout-out, a high five.
Schenk: All through the month of November. So this episode, because, like I don’t know – I don’t have the stats handy – but a billion people will be traveling by plane, by car, by boat to somewhere to celebrate Thanksgiving to be with their families, and a good portion of that billion people is individuals going to visit family members who are in long-term care facilities and nursing homes. So some people, this is going to be one of the only times they see their relatives in nursing homes or long-term care facilities due to locations, that kind of thing, so this might be the only opportunity that you have to basically investigate whether or not they’re being taken care of in that facility. So that’s kind of who this episode is for is what to do when you go in there.
Smith: Yeah, and remember that a small portion of that billion people too are the people who work at these nursing homes. So in conjunction with Caregivers Month, remember when you’re going there the first time that those people are away from their families are taking care of, hopefully taking care of your loved ones.
Schenk: That’s right. So…
Smith: And I guess we can segue with that into what we’re…
Schenk: The first of the five.
(1) GET TO KNOW NURSING HOME STAFF
Smith: Yeah, the first of the five – one of the things you need to do when you visit a nursing home, when you have a loved one in a nursing home, and that is to get to know the staff. So when you are visiting with them this Turkey Day over the holidays, you know, bring the staff some pizza. Order them some pizza. They can’t accept tips and things like that, but you can always bring cakes and the staff love that, but just show them some appreciation. But most importantly, get to know the CNAs, get to know dietary. These are the people that interact with your loved one and their care plan the most frequently, because dietary makes them meals every single day, three times a day, and then the snacks in between, and then the CNAs are the ones that are getting them up out of bed, that are brushing their teeth, that are giving them a shower, that are handling their dentures, that are handling their eyeglasses, that are handling their clothes. These are the individuals that have direct and constant and frequent access to your loved one.
But also get to know the nurses, the floor nurses for sure. They’re the ones that are giving the medicine to your loved one. But getting to know the staff and getting comfortable with them and getting friendly with them, that’s one way you’re going to get a lot of things done. That’s one way you’re going to meet a lot of solutions to problems you have.
Schenk: That’s right. And in the future, if you ever need to call there or get a call, you can put a face to the name, and it’s just a good way to do business. And anecdotally, we’ve talked about this in the past, but the squeaky wheel gets the grease. I feel like the person who tries to win people over with honey rather than vinegar, their loved one will be treated a little bit better. If you brought the pizza in there, if you know everybody’s name, if you’re friendly with them, maybe they remember that, and anecdotally, maybe they’ll take care of your loved one a little bit better.
Smith: Yeah, and it’s a sad state that we live in that that’s the way that it is. Everybody should get the same amount of care and that amount of care should be the best possible. That simply isn’t what happens though.
Smith: So it’s a hard job being a CNA, being a nurse in a nursing home. It’s tireless. It’s thankless. It’s understaffed and it’s underpaid. So like Rob said, you catch more flies with honey than vinegar. Don’t go in there after you haven’t – for the first time all year – just because it’s Thanksgiving and start making outrageous demands or yelling at people. Get a feel of what’s going on and who the players are. You can solve a lot of problems by getting to know the staff, like, “Hey, listen, Mom doesn’t – I don’t like Mom wearing this shirt on this day,” for whatever reason, “I want her to wear the nicer shirt for the holidays.” Okay, no problem. You just have to talk to somebody.
(2) DO A HEAD TO TOE ASSESSMENT OF YOUR LOVED ONE’S BODY AND SKIN!
Schenk: That’s right. And the number two thing to do would be to really put some eyeballs on your loved one, the resident. Observe what they look like, what the room looks like and their behavior. So observing what they look like, if your loved one is bed bound or is in a wheelchair for most of the day, if possible, if there’s a changing while you’re present, take a look at the skin because…
Smith: Insist on seeing the skin while you’re there.
Schenk: Right, because a lot of times, well not a lot of times, but people don’t know what they don’t know, so we don’t have X-ray vision, but if someone is bed bound and they’re not turned or repositioned or they’re in a wheelchair and that’s where they spend most of their time, there’s the possibility that a pressure ulcer could develop, but we have clients that never know that because you can’t see them if they’re sitting on them.
Smith: And they’re required to notify interested family members when there’s a change of condition. CFR-483.10 lists when they’re supposed to do that. That doesn’t mean that they do it. There’s not like a really bad – there’s not really good enforcement of that either. So don’t expect, “Well if there was something wrong, they would have told me.” No, maybe they just didn’t because at the end of the day, they’re probably not going to get fined for that, or if they do, they’re going to be able to appeal it. So you just have to – when you get there, be friendly to everybody, meet and greet everybody, shake hands, be that diplomat and then check out your loved one. “Hey Mom, let’s go in the room and talk for a while.” Check them out. Physically check them out from head to toe. Touch their legs. Touch their ankles. Touch their hands. Look into their hair. It seems like something that you know you would do if you had a child and I’m not equating the elderly with children except to say if they’re your loved one and they have diminished capacity to care for themselves, then in many ways, it’s incumbent upon you to take that lead and to check them out.
Schenk: That’s right. And aside from checking out your loved one physically, observe their behavior. If generally they’re talkative or can answer questions specifically but now are only can say a few words or maybe if they could observe you or check you out when you walk in but now they’re not following you with their eyes, ask the staff what’s going on. There could be several reasons for that. It could be medication. It could be a head trauma. It could be depression. It could be something that shows a significant change. So behaviorally is just as important as a physical – how are they reacting to you? Are they reacting to particular staff? That can be a sign that a particular staff member is being inappropriate with them. So you want to make sure you get a full picture of how they are.
Smith: And that not only is important to detect abuse, but you are – you should be a member of their interdisciplinary care plan team. So maybe you notice a change in behavior that nobody at the facility noticed for whatever reason. So that could be something important for their health as well.
Schenk: That’s right. So definitely you’re going to be, as a family member, you’re going to be their number one advocate. And so be their advocate. Take a look at their body. Take a look at their attitude, their behavior. Like I said, take a look at the room. Is the room hot? Is the room cold? Would you want to live in there? – that type of thing and really advocate for them.
(3) LOOK FOR RED FLAGS AT THE FACILITY
But the third thing is, in general, is to observe the facility itself. How many people are there? What does it smell like? What does it look like? Is it dirty? Is it well lit? Every nursing home in the country, particularly in Georgia, has to be safe from just a general standpoint. There can’t be lawn furniture – not lawn furniture – lawn equipment laying on the ground, like you can’t step on a rake. It has to be free of hazards. It has to be well lit. Are the doors locked? How easy is it for someone to get out? These are the types of questions you should be asking yourself as you walk around.
Smith: Yeah. And because, I was talking earlier this week with a lady who called for an attorney – she wasn’t really sure if she needed one or not – for her mother who was in a skilled nursing facility, and she didn’t need an attorney, because she had intervened early on and said, “I started going and I noticed the place started, the standard of the place started falling, and so I got her out of there and I put her somewhere else,” and I was like, “You have solved it then. You have noticed the ship was sinking and you got her off there.” But yeah, make those observations.
(4) UNDERSTAND YOUR LOVED ONE’S MEDICAL CONDITIONS
Schenk: Okay. Number four is to – and Will kind of hinted at this, but educate yourself on your loved one’s medical conditions. And you do that by requesting to see the care plan. Understand what exactly is the medication that your loved one is taking? Why is she prescribed that medication? What are the interventions that they’re currently undertaking for whatever conditions that she has? Because we’ll have a client call and – we’ll have a client call – that’s the one – we’ll have a client call and I’ll ask simply questions like, “Did your grandfather have dementia or Alzheimer’s? Did your mother have diabetes?” – basic diagnosis questions that they don’t have the answer to. And it’s important, at least while you’re there, to get caught up, because there might have been the change that they didn’t call you that you should know about that’s going to affect what medication they take, that’s going to affect the type of interventions and plan of care that they enact for your loved one.
Smith: Yeah, and I’ll often see people that after their loved one has died, I’ll tell them, “Well hey, your mom had this disease, which can give someone a proclivity to creating bedsores or pressure ulcers,” and they’ll argue and say, “Well I didn’t know that she had that disease,” and they’ll say, “Well she never had that, I mean that’s a mistake.” It’s too late for that now. So get to know what diagnoses and what the diagnostic history the nursing home has of your loved one. So while they’re alive and in the nursing home, if you say, “Mom’s never had XYZ disease.” Okay, well that’s your time to discuss it with them, find out why they have that listed and maybe talk to the doctor so that you can all get on the same sheet of music, which is what you’re trying to do.
Schenk: Right, and generally you can participate in those meetings by phone. Just call in and say, “All right, I’m on speaker. Now we have the DON, we have the doctor there, so okay, what’s going on?” And you include yourself in the care plan process, but at minimum, find out what’s going on from a health standpoint with your loved one?
(5) UNDERSTAND THE GRIEVANCE PROCESS FOR THE NURSING HOME
The fifth thing to do, and this just depends on what happens when you go there, but the fifth thing that we recommend is at least in the state of Georgia, every nursing home is required to have a formal grievance process where you go in and you file a complaint with that nursing home and it goes up the chain of command and they’re required to respond to it and say yes or no or the reason they don’t think they should change something or XYZ. But that’s important because you at least want to let the nursing home know that you know what’s going on and that you want this situation addressed. So if in fact you do get there and you notice something that is wrong and you bring it up to the staff and maybe the staff blows you off or whatever it is, then you go to the front and say, “I want to file a formal grievance against this nursing home for XYZ reason,” and they’re required to help you through that process. So that would be the fifth thing.
Smith: And I want to add something on here to go back just a second on number one, which is acquaint yourself with the staff. Also acquaint yourself with other families. The more people you know, the better, you have more eyes on. So if your mother is in Room 13 and then there’s another family in Room 14 that you can get to know, get to know them and call them up and go, “Hey, did you get a chance to go see your mom when you were there? What did you notice? What’s going on with mine?” or vice versa. So that’s also something extremely helpful.
But yeah, so I mean it’s not necessarily an exhaustive list. It’s just some general ideas of…
Schenk: I know what I was going to say. I blanked there for a second.
Schenk: I was going to say along the lines of getting to know the other people, I think something nice to do on Thanksgiving is if you’re going to go visit your loved one with food or with your family or loved ones is to maybe include another resident in your festivities that maybe is not being visited by somebody.
Schenk: I always think that’s something nice to do if possible.
Smith: Because a lot of these people are lonely and it’s easy to put somebody out of sight and out of mind and put them in a nursing home and visit them on the holidays, but you have to think that the rest of the time, 11 months out of the year or 10 months out of the year, they’re not getting a lot of visitors, and it’s even worse for people who get no visitors. So on those days where everybody’s got family even though it’s few and far between, they feel even worse because there’s nobody there for them and it just stands out more. So take it as your tithing. You’re tithing your time. Not only does it benefit you because you build a relationship with other people that could be assets to you and your loved one, but it’s also the right thing to do. Be charitable during the holidays with your time and your energy.
Schenk: That’s right. And…
Smith: And I think it goes without saying that especially on a holiday like Thanksgiving, bring your loved one all the food that you want, and at the end of the day, they have the right to eat whatever they choose. No one can tell them what they can and can’t eat. That being said, make sure you understand and you talk with the staff before you start giving them food, because they may now be on thickened liquids or maybe the staff happens to know they can’t chew and swallow whole pieces of turkey. Maybe their diabetes has kicked in or their sugar and insulin levels have been out of whack, and here you are shoving some pie in their face and it may cause some problems. So make sure you’re talking with the staff if you bring treats, especially if you’re giving them to other people, other residents. Right, you have to check with the staff on things like that because food can be dangerous. If you’re diabetic and your sugar has been out of control lately, then you don’t need to be consuming a lot of refined sugar.
Schenk: So we hope you found this episode informative and we hope you take some of it to heart when you go and visit your loved one in a nursing home. One quick shout-out I want to give and that is to the Long-Term Care Ombudsman Program here in Georgia and actually across the country. They’re going to be celebrating their 41st birthday.
Smith: We are the same age.
Schenk: Will Smith, Rob Schenk and the Georgia Long-Term Care Ombudsman Program across the country are all 41 this year in 2019.
Schenk: So December 1st is their birthday, so everybody give a big shout-out to the Georgia Long-Term Care Ombudsman Program and Melanie McNeil who leads that up.
That’s going to conclude this episode of the Nursing Home Abuse Podcast. Hope you have a fantastic Thanksgiving. And when you’re traveling, maybe you can listen to some old episodes.
Smith: Right. You can go to Stitcher. You can go to Spotify. You can go to YouTube Red, which is the YouTube app that plays without commercials and it also plays even if you close out of the app.
Schenk: Oh, get out there. There’s no way now. They’ve changed something where you can’t close anything out.
Smith: No, no. It’s once you’ve made that decision to open up YouTube.
Schenk: You’re watching it.
Smith: That’s all you’re watching. And if you find yourself in that predicament, at least click subscribe and like on our station.
Schenk: That’s right. And with that, we’ll see you next time.
Smith: See you next time.