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View Diary: Nursing Home: When it's time (99 comments)

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    •  Thanks for this diary, Clytemnestra - so thorough (10+ / 0-)

      ...and so neccesary, even if folks don't like to face it.

      (Thanks, Nurse Kelley, for pointing me this way.)

      I like my government transparent, and my beer opaque.

      by NormAl1792 on Wed May 12, 2010 at 01:22:06 PM PDT

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    •  Sorry to be so late (5+ / 0-)

      As a victim of an unscrupulous operator, I believe every word you say should be written in indelible ink on the forehead of the caregivers contemplating action here.

      A timely and invaluable resource.


      Some people make you want to change species

      by ulookarmless on Wed May 12, 2010 at 02:29:21 PM PDT

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    •  questions... (4+ / 0-)

      Assuming that family members are willing and able to take care of someone who might otherwise be a candidate for a nursing home:  Where do you draw the line beyond which a person really should go to a nursing home anyway?   Somewhere down the trail of dementia?  Somewhere down the trail of decline of physical functioning?  And what would those points be?

      From what you've seen of dementia patients, is there a point at which they appear to have lost self-aware consciousness but still be "conscious" in the sense of verbally responsive to conversation?   And is there a point where they appear to have lost free will in the sense of having lost the ability to voluntarily choose their behavior (for example unable to make simple choices such as between menu items)?  

      One thing I've found still appears to be the case in hospitals, is the pervasiveness of TV, with its tendency to pour out a constant stream of emotionally jarring content.  It's about as obnoxious as when nonsmokers used to have to endure every public space being a smoke-filled room with no respite.  Is there any possibility of a trend away from that?, or the ability to designate someone for a non-TV room?   I tend to believe that pervasive TV is producing undesirable behavioral outcomes and health outcomes in patients, but it's almost impossible to do a comparison because there appears to be almost no place in modern health care environments that is TV-free.

      •  Good Question (3+ / 0-)
        Recommended by:
        second alto, KelleyRN2, wolfie1818

        Every person who is a "candidate" for a nursing home (whether they have dementia OR a disease that makes their care highly intensive and physical, is different.

        Just like every family member as a potential caregiver and home/life situation is different.

        Where you draw the line is based on a number of factors, and there really is no one size fits all answer.

        In the nursing homes I worked for TV was generally only available in a room for a bedridden resident or one who was "pretty much" aware.  For the others TV was relegated to the common room with none in residents rooms.

        For those who are not cognitively there it was unneeded and an extra expense most families and nursing homes did not wish to have.

        This was more than 20 years ago however, but I don't think that has changed much.

        "He felt that his whole life was some kind of dream and he sometimes wondered whose it was and whether they were enjoying it." - Douglas Adams

        by Clytemnestra on Wed May 12, 2010 at 04:21:59 PM PDT

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        •  internet and telephones.... (3+ / 0-)
          Recommended by:
          Clytemnestra, second alto, wolfie1818

          I wonder about this:

          How long before nursing home patients who are physically capable of using computers, are given internet access as a routine matter?  For example a wireless network throughout a facility, where residents who have laptops can use them as freely as I'm doing right now from my desk?  

          Seems to me that would also improve cognitive outcomes because if nothing else, getting on blogs & suchlike involves using verbal skills.

          Though, there also comes a point where it would have to be restricted, for example if someone is going down the road of dementia and there's a risk they could engage in unsafe online behavior.  


          I'm a telephone systems engineer and there was a time when I had a nursing home as a client.  There were telephones in many of the rooms.  Is that something one finds in the better facilities only, or most facilities, or ...?...  

          Or are they starting to expect that patients will have their own cellphones?    BTW, cellphone audio is so shitty in three specific ways, that IMHO it causes real problems with the ability of people to communicate clearly, and I suspect this may make it appear that a person is less able to communicate than they actually are:

          One, the audio compression basically removes most of the nonverbal vocal cues to the other person's emotional state.  Those cues are essential to people understanding each other accurately.  Someone who has a partial decline in their verbal abilities, will tend to have to rely more on the nonverbal emotional cues to understand another person; so the lack of those emotional cues will make it more difficult for them to understand a conversation.  This will make it appear that they are more impaired than they actually are.

          Two, the variable delay of speech transmission causes people to make errors in anticipating the rhythm of a conversation.  This produces the impression that "the other person is being rude, speaking when I'm speaking, or not paying attention because their replies are lagging," and as a result can cause escalating frustration.

          If you're seeing problems around people and phone calls, and one or both ends of a call are on a cellphone, try getting them on landlines and see if the situation improves.  

          •  you're making it difficult on me ;-) (2+ / 0-)
            Recommended by:
            second alto, KelleyRN2

            I want to comment but I gotta finish part 2 ... will come back to this, I promise ..

            "He felt that his whole life was some kind of dream and he sometimes wondered whose it was and whether they were enjoying it." - Douglas Adams

            by Clytemnestra on Wed May 12, 2010 at 08:38:51 PM PDT

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