Culture change and person centered care are the buzz words of long-term living today. Here’s why.
Nursing Homes care for elders has greatly improved with OBRA 1987. Elders began receiving a higher quality of care and improved quality of life. Nursing homes adopted the hospital model of care, systems were developed based on staff efficiencies in the care of the residents.
Management, health care professionals, and staff were the decision makers for the group of residents in the nursing home. The physician prescribed the therapeutic diet, as most suffered from some malady that was improved with a healthful diet. Immediately a system was set into motion, nursing notified dietary, dietary entered the data into the cardex, a tray card was developed, and the tray card was cataloged with the other resident’s tray cards to be placed on a food tray during the tray line. Residents received the food that had been planned for the day and their prescribed diet, served on an institutional hot holding tray system. On the clinical side a vast array of paperwork was set in motion; MDS, RAPs, Care Plans, RD referrals.
The RD would act upon the referral by completing more paperwork, briefly talking with the resident, and if the resident suffer from increased nutritional risk a supplement (an commercial, oral, fortified liquid) was recommended by the RD, then ordered by the physician, and followed the resident through the rest of their natural life (or so it seemed).
This is what the elder had to look forward to in their new “home.” No wonder my father never wanted to set foot in a nursing home, so when diagnosed with ALS opted for a 24/7 caregiver. As a health care professional in the nursing home I never saw beyond the systems until my father’s terminal decline. It was then I saw the world from the other side. It was heartbreaking to say the least, but a simple swallow evaluation by a student of Speech Therapy was the most revealing. The student offered my father water thickened with a powder that was not completely dissolved, therefore leaving lumps. Watching my father gag it down gave me an insight into eldercare that I had never considered before, and that is when my Journey began.