Friday, July 29, 2011

Improving Nursing Home Ethics

A recent conversation with a friend about his father's nursing home experience taught an important lesson about nursing home ethics. Here's the story:

His father suffered from severe Alzheimer's and required full time supervision. A local nursing home that had a mediocre reputation some years back was said to have improved, and the family placed his father there.

The nursing home was in another part of the country, so my friend could visit only intermittently. On each visit he was impressed with the attentive, loving care the residents received.

His father lived in the nursing home for a few years before his death. When my friend made a final visit to collect his father's belongings and to thank the staff, he was invited to look at the nursing record. The final entry said it all with regard to the ethical ethos of the home:
May God grant peace to his gentle soul!
I teared up when he told me this and teared up again as I wrote it.

My friend spoke with the administrator who had turned the home around. He asked how this had been accomplished. Here's my reconstruction of what the administrator told him:
When I came here, we weren't caring for the residents the way I wanted it to be. I made a point of getting to know everyone on the staff in a personal way. I listened to their impressions and concerns about the home, and what they hoped for. I tried to treat everyone the way I would want to be treated, in the spirit we wanted our residents to receive. When I decided who we should build our future around and who had to go, the staff understood what I was doing, and felt I was being fair.
Improving quality doesn't need to be rocket science. My friend's father was cared for the way the staff was cared for. Ethically guided, respectful treatment of staff cascaded through to the residents, right up to the blessing my friend's father received at the end of his life.


eric said...

Jim--this video speaks to your post. What are our values? Is it important to us to keep our nursing home elders clean, dressed, fed, engaged; or would we rather focus our investment in studying new "me-too" drugs? What systems will better support our care-givers?
"CNA Wisdom" by Michael Perkins (23 minutes).
Thank you.--Eric

Jeannine Hill, R.N. said...

This has truly touched me,on a personal level as well as on a professional one. Healthcare and its delivery has become complex over the years. Driven by a stressed economy, healthcare facilities have had to evolve as well including reductions in staff. Staff feelings of stress of having to do more with less takes it toll on the individual caregiver which is then transferred into the quality of the care provided to the client leading to unintended neglect of basic needs. It is easy to see how nursing homes, or any institution for that matter, can get get a bad reputation. We did not go into the profession with the intention of providing less than quality care, however, due to circumstances beyond our control, we may end up in doing just that leading to a moral dilemma. I admire your friend who demonstated such a moral concern for the clients and staff he was responsible for that he took the necessary steps to foster change. This is quite commendable and demonstrates a perfect example of ultimately putting the client first through proper education and support of the caregiver through actual steps and not just intention on paper. This should be a model for other institutions as well. Cudos to your friend and to you for bringing it public.

Jeannine Hill, R.N.

Jim Sabin said...

Hi Eric

Thank you for the link. I've not yet been able to upload the video, but will try again on another computer during the week. But your question points to the sad skewing of our health "system" - our big bucks go into areas of low human value while at the same time we neglect simple aspects of quality of life like those you cite. And, as you suggest, this pattern of choices about where we'll invest doesn't support front line caregivers.



Jim Sabin said...

Hi Jeannine -

Thank you for your comment. I see that you are a nurse, and nurses as a group experience the stresses of the U.S. system as much as or more than any others, given their central role in front line patient care. Over the years I've learned the term "moral distress" from nurse colleagues and the nursing literature. Sometimes that distress is from staffing reductions and increased patient to nurse ratios, and sometimes from being caught between physician-prescribed overly aggressive end-of-life treatment and a sense of the suffering the regimen imposes on the patient.

I share your sense of respect for the leadership of this particular institution, based on the fundamental nursing values of respect and care.

Thank you for your comment - I appreciate hearing from you!



Tony Sexton, Site Administrator said...

I think one sentence of this great story says it all, "the resident was cared for the way the staff was cared for". And indeed, it need not be rocket science.

Tony Sexton

Jim Sabin said...

Hi Tony

Thank you for your comment. Since it comes from someone directly involved in nursing home care, I'm honored that you found the story meaningful. I re-read the post myself, and it again made me tear up.

Via this comment, I want to encourage readers to go to your website. I'm going to send you a separate note via email.



Hold my hand: a social worker's blog said...

Goodness! I'm so touched as well by this story. This administrator has all my respect. Caring for the elderly shouldn't be just a matter of numbers and reimbursements but quality of care, compassion and true vocation.

Thank you for this wonderful post.


Jim Sabin said...

Hi Doris -

Thank you for your kind words. I especially appreciate them because from going to your excellent website I know that you work with nursing home folks and that we share the same values.