Elderly Homes vs. Home Care Essay

For those who are not familiar with nursing home , nursing homes is occupied by residents of all demographic 65 years and older with low function morbidities on their activities of daily living like eating, bathing, dressing, toileting ,transferring and continence. However, nursing homes provided other services like skilled nursing ,this are services that provided for non-permanent residents .non-permanent resident are patients that come for a short period of time due to need of medical services. Usually, the length of stay Lange from 90days and above depend on their prognosis. The main reason these patients are admitted to the nursing home facility for short stay is to receive post hospitalization and post-operative care like intravenous medication, physical and occupational therapy. Each year, millions of older people 65 and older fall. In fact, more than one out of four older people fall each year. One out of five falls causes a serious injury such as broken bones or a head injury. Each year, 2.8 million older people are treated in emergency departments for fall related injuries.Elderly Homes vs. Home Care Essay

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With the aging population growing faster every year many families must make a difficult decision whether their loved ones should live in assisted living or nursing home facilities. I can relate because I made the decision to care for my mother at my home. Some people do not have the money or resources to care for their parent so they must live in a facility for health and safety reasons.Elderly Homes vs. Home Care Essay

These facilities are regulated by the state and federal government and these regulations protects the senior residents. For example it is mandatory for the facilities in Texas to provide mandatory services such as daily living activities like dressing, feeding or help prepare meals and cleaning. Depending on the facility license the staff would have to assist with financial management and certain medical services. Even though the federal government developed guidelines the state can make their own as long as it complies with the federal government. Some organizations may accept private pay while others accepted Medicaid. Regulations are developed to protect residence that from being in an unsafe environment. As a result some assisted living and nursing homes are unable to continue services by having fines or closing for an unknown amount of time. Since each state has different set of regulations I will focus on the state regulations in Texas because it is the state I reside in. The organization in Texas that regulates assisted living and nursing homes is the Department of Aging and Disability services(DADS).Elderly Homes vs. Home Care Essay

Negative stereotypes of older age and nursing homes persist in our society. Common misconceptions include the view that older adults are lonely, bored, or dissatisfied with life and that nursing homes are lifeless institutions (Gugliucci & Weiner, 2012). Suffice it to say that the later years of one’s life may be challenging, and if one moves to a nursing home, residing there may not be the “home” of choice. However, as complex as nursing home environments may be, social and developmental opportunities abound, and operations are under constant scrutiny to create culture change. For this review each book (leg) offers components of life lived in nursing homes. The Learning by Living project is but one integration point. In short, Beaulieu’s book provides the staff perspective and the details of what staff needs to be aware of in providing social work care in the nursing home environment; Gaffney’s book represents one person’s experience of nursing home living, in a variety of homes for the remainder of her life; and Doll’s book offers specific insights into sexuality, a real issue that could enhance nursing home residents’ quality of life.Elderly Homes vs. Home Care Essay  My credentials for this essay include being a gerontologist, a member of a nursing home board of trustees, the principal investigator for the Learning by Living project, sharing countless experiences with students, and, maybe most importantly, having cared for a parent in a nursing home. I suggest each leg of this review represents important issues that need to be considered if we are to create a nursing home environment in which we undo the negative stereotypes of both older age and nursing homes.Elderly Homes vs. Home Care Essay

Defining Long-Term Care
Long-term care (LTC) and nursing home care are two terms that erroneously get used interchangeably. LTC is the umbrella term, describing the provision of care for people who have disabilities or chronic care needs, including dementia, over a long period of time. However, those needing LTC may or may not require 24-hr professional care or need to reside in a nursing home. The services may be provided in a variety of settings, such as the person’s home, in the community, in assisted living facilities, or in nursing homes. Nursing home care is one form of LTC and usually is based on a medical model. It is the provision of 24-hr care with licensed professional nurses in a residential setting. Residents tend to have physical, cognitive, or mental health issues that keep them from performing at least one (usually more) of the activities of daily living (ADLs) (i.e., bathing, dressing, eating, walking, toileting, and grooming). Nursing home professional staff includes medical directors, nurses, geriatric social workers, activities directors, and registered dieticians, and sometimes physical, occupational and speech therapists.Elderly Homes vs. Home Care Essay  Certified nursing assistants assist with frontline resident care. It is important to note that short-term or rehabilitative care, even if provided in a nursing home, is not LTC. Instead the person may need assistance and/or rehabilitation after surgery, an illness, or an injury. This care can be provided in the person’s home, in a rehabilitation hospital, or in a skilled or rehabilitation unit in a nursing home. When a person is admitted to a nursing home for LTC, she/he becomes a resident of the nursing home. It is preferable not to refer to the person in this situation as a patient. However, if a person is admitted into a nursing home for a short-term stay, skilled care, or rehabilitation, then the person is considered a patient.

The Seat of the Stool: Learning by Living
The University of New England College of Osteopathic Medicine Learning by Living Project (referred to as Learning by Living in this review) was piloted in 2006. It was designed and implemented as an experiential medical education learning model by the Director of Geriatrics Education and Research within the Medical School’s Department of Geriatric Medicine. Since its inception, medical and other health professions students have been “admitted” into nursing homes to live the life of an elder nursing home resident for approximately 2 weeks—(24hr a day/7 days a week)—complete with a medical diagnosis and “standard” procedures of care. Thus far, 28 medical students, two social work students, one gerontology student, and one student of architecture have participated in the Learning by Living project in 14 nursing homes in four states.Elderly Homes vs. Home Care Essay

The Learning by Living Project utilizes qualitative ethnographic and autobiographic research designs, whereby a unique environment or “culture” (nursing home) is observed and life experiences of the medical student are reported by him/her while living within the environment. Medical students “admitted” into the nursing home as a resident are asked to answer these questions: What is it like for me to live in a nursing home; What does it mean to me to be a nursing home resident? The Learning by Living ethnographic immersion has three stages: (a) Pre-fieldwork—getting ready for the experience; (b) Fieldwork—living in the environment with a diagnosis, standard procedures of care including a “medication” regimen, toileting, bathing, transferring with assistance, eating pureed foods, and engaging in activities and relationship building; and (c) Post-fieldwork—reflection on what occurred during fieldwork (Denzin & Lincoln, 1994, 2005).Elderly Homes vs. Home Care Essay

The Three Legs
Leg #1: A Guide for Nursing Home Social Workers, 2nd Edition, by Elise M. Beaulieu
In 2005, 12% of students in California social work programs were taking courses on aging compared with a national report of 7% by the Council on Social Work Education and an earlier 1993 national survey of 3%. Still, the number of social work students training in gerontology remains less than the needed numbers (Damron-Rodriguez, Ranney, Goodman, Min, & Takahashi et al., 2013, p. 235). Most students in social work programs say that they plan to work with children, but given the jobs available, many of these students end up working with older adults. It is inevitable in our society. Beaulieu’s book, originally published in 2002, clearly articulates what on-the-ground nursing home social work practice involves. According to Beaulieu, social workers who work in nursing homes are faced with two key challenges (a) the health care system bias toward community care rather than nursing home/institutional care; and (b) the press of national regulations in shaping nursing home care. This book is divided into six parts: Social Work in Nursing Facilities; The Interdisciplinary Team; Nursing Facilities and Governing Oversights; Diagnosis, Treatment, and Care Issues; Ethics; and Community Liaisons. The appendix provides examples of standardized forms that are part of the social worker’s responsibility, and the book includes online resources and a glossary of terms and abbreviations. These resources are useful as it is rare to be exposed to this type of information or detail during one’s educational training.Elderly Homes vs. Home Care Essay  In the Basic Orientation chapter (Chapter 2), Beaulieu presents the landscape of responsibilities for social workers in the nursing home setting, which includes counseling, resource allocations, advocacy, planning and treatment, mediation, and of course psychosocial factors. The importance of these supportive roles is underscored by the experiences of the Learning by Living students, who reported that social workers often aided them in their adjustment to nursing home living:

Mary, the social worker, explained a lot of things[about living in a nursing home] and also asked many “social history”-type questions. She also checked in on me, which I appreciated very much. I appreciated it so much that I wondered whether every new resident had a “go-to” person when they were first getting settled … it didn’t feel quite so much like every person who walked in the room was yet another new face, here to do yet another new thing. It is nice to know that there is someone from the “inside” among all the new faces, thinking specifically about you, who will check in and be familiar when you may not have family around (Female medical student, 2012).

The social worker’s scope of practice is wide, working with patients, the family, the staff, and the state regulators. Regarding the residents, social workers address a wide range of concrete and emotional issues such as affiliation, identity, empowerment, privacy, self-esteem, and space (Beaulieu, 2012, p. 14).Elderly Homes vs. Home Care Essay

Almost immediately as the social worker (Sandy) came in, I started crying and I don’t even know what started it. I admitted to it just being so much in one day and so much different than what I thought [it would be] and how all I wanted was to just have a glass of water that didn’t taste or look like hair gel [the student was prescribed thickened liquids]. I was scared. My crying stopped almost as quickly as it started. Sandy shared stories about struggles in the nursing home, and praised me for volunteering for this experience. She went on to explain the paperwork that she does with new patients. She also wanted me to know that if I felt that I needed to talk or vent or if I needed anything at all that I could go see her. This made me feel good because I felt that, although I am “alone” up in the middle of nowhere Maine, I had someone I could talk to in person (Female medical student, 2011).Elderly Homes vs. Home Care Essay

Beaulieu does a nice job of presenting the details that social workers must master if employed by a nursing home, including ensuring proper documentation, care planning, state surveys, minimum data sets, as well as being well versed in nursing home-associated legal issues, the Ombudsman Program, state and nursing home policies and procedures. Room changes (i.e., moving residents from one room to another) are fairly common within nursing homes and happen for a variety of reasons; some are based on health issues, whereas others are related to social issues. Although nursing home rooms may look alike to the untrained eye and a move to another room may not seem like a big deal, it can be a significant challenge to a nursing home resident. Factors such as roommate changes, light from the window, location on the floor, placement of the bed, staff changes, proximity to key nursing home identifiers (nurses’ station, activity room, elevators, etc.) add up to make either a smooth or challenging transition.Elderly Homes vs. Home Care Essay

I moved rooms today. The woman moving in to my space would better get along with my roommate, so I got booted. It did make me feel a bit nervous. Even though I was waking up every 2 or so hours, it was what I got used to. Also, I wouldn’t know if my new roommate and I would get along (Female medical student, 2006).

Beaulieu reveals layer upon layer of social worker roles, responsibilities, and important tools. This is a comprehensive guide for social workers. And, though the writing tends to be technical and thick, so are the regulatory standards for nursing homes. For administrators and other health professionals who work with older adults and want to understand the inner workings of a nursing home, this book will provide a lay of the land.Elderly Homes vs. Home Care Essay

Leg #2: Making Myself At Home by Sandra J. Gaffney
Sandra Gaffney was a wife and mother of two daughters who attained degrees in college counseling from the University of Minnesota. In 1980, Sandra was diagnosed with amyotropic lateral sclerosis, also known as Lou Gehrig’s disease. This degenerative disease of the central nervous system results in the wasting away of voluntary muscles often leading to total paralysis, which precipitated Gaffney’s transition into nursing home living. This book is written as a resource to families when faced with decisions about LTC for a loved one, guiding them through the decision-making process and challenges with transitioning into the nursing home environment. Gaffney’s goal was to help families develop their own strategies for such transitions.Elderly Homes vs. Home Care Essay The secondary goal was to offer the resident’s perspective of life lived in a nursing home. Key points as expressed by Gaffney include maintaining self-identity, personalities of staff and residents; along with administrative ideals and how the nursing home mission and vision are expressed and carried forward. Nursing home regulatory standards, the protection of human rights, and services available to nursing home residents are supported by nursing home administration and staff. In the Learning by Living project, students reported feeling the tenor of the staff; they know when something is going on, even when unspoken, as one might feel changes in an environment they are familiar with. One student stated:Elderly Homes vs. Home Care Essay

I am MUCH more comfortable knowing what’s going on in the home than not knowing. Staff is not at all concerned with what we residents hear them saying. They will yell up and down the hallway to take care of things. My personal feeling here is that I actually feel safer knowing what is going on (Male medical student, 2011).

Sandra Gaffney talks about the importance of learning about the residents’ life history, life expectations, and how they deal with the hand that has been dealt. She mentions that living in a nursing home living limited some of her autonomy but felt that her decision to move there ensured that she had dependable staffing and care. Regardless of living in the nursing home, she felt her life was still fulfilling and enjoyable. She viewed herself as a resident rather than accept the other familiar labels of “patient” or “client.” Orienting oneself to becoming a “resident” in a new community was similarly experienced by Learning by Living students. On Day 4 of his admittance a male student stated:Elderly Homes vs. Home Care Essay

I was asked if I wanted to be evaluated to use a walker and leave my wheelchair. I’m so frustrated being cooped up in this chair. But, some of these individuals have been in their’s for years. I can’t do it, I can’t leave the chair. I wouldn’t be at eye level anymore. And that is critical. Almost 90% of the residents are wheelchair bound. I wouldn’t be one of them anymore. If they are ever to be my family, if this is ever to be home, then I can’t flaunt my ability to walk in front of them. If this is to truly be a learning experience, then I stay in the chair” (Male medical student, 2008).

Gaffney resided in a nursing home as one might reside in an apartment or home and illustrated throughout the writing of this book that a “new normal” (p. xi) life is possible. Even in his short tenure in the nursing home, the student quoted directly above reflected on his “new normal.” On Day 8 of his experience he went on to say:Elderly Homes vs. Home Care Essay

Wow. The things I’ve seen, [I’ve] experienced, … the friends that I’ve gained. The understanding that I’ve received. The human connections I’ve made in times of stress, anxiety, fear, joy, happiness, and laughter. They all come together into this. This feeling I have right now, that if I ever needed it, I could live here, not as a pretend patient, but as a family member. Who’d be my family? Everyone in here, staff, residents, all of them (Male medical student, 2008).

Leg # 3: Sexuality and LTC: Understanding and Supporting the Needs of Older Adults by Gayle Appel Doll
It is important to note that regardless of age, certain aspects of life, such as the basic drives (e.g., libido), continue unchanged, whether or not the person has the desire or ability to act on them. The older adult, like the young adult, experiences the need for physical comfort, love, and status (Gugliucci & Weaver, 2012). We are who we are throughout life—hopefully gaining wisdom as we move through the ages, but still essentially the “same person” inside.Elderly Homes vs. Home Care Essay

In Sexuality and Long-Term Care, Gayle Appel Doll provides a breadth and depth of information to augment learning about older adult sexuality and sexuality as a life-long theme. First, it is important to be clear that this book focuses on sexuality for older adult residents in LTC settings; as such it addresses the many inherent barriers in these environments such as personal views and opinions, organizational mores and policies, social stigmas and messages, and political issues regarding resident sexuality. Second, sexuality is defined quite broadly, including feelings about oneself, body image, the need for intimacy, touch and connection, and the traditional definition of sex is expanded to include any mutually voluntary activity with another person that involves sexual contact, whether or not intercourse or orgasm occurs (Lindau et al., 2007). The author intends this book to be used to guide discussions about beliefs and stereotypes related to nursing home resident sexuality, provide ideas for staff sensitivity training, and encourage organizations to develop policies regarding resident sexuality (p. xi). Of utmost importance is that readers will view each resident as a whole person. This book is user-friendly and well-written, offering direct content on the topic of older adult sexuality, clearly stated definitions, useful figures, tables, and key points (identified in the text with a picture of a key and presented in a separate text box). Elderly Homes vs. Home Care Essay Additionally each chapter offers “sidebars,” that contain quotes, tidbits of information, short stories, and/or research summaries that aid in supporting the chapter focus. Each chapter ends with an activity that can be done individually or in groups, providing an opportunity for experiential learning and information integration. Topics range from staff attitudes, family influences, health issues, sexual behaviors, Lesbian/Gay/Bisexual/Transgender resident populations to environments and policy. This is a comprehensive book on older adult long-term resident sexuality and a tremendous resource for long-term settings, family members, and health professions staff and students who work with older adults.

Not surprisingly, only three of the Learning by Living students wrote about sexuality in the nursing home. These quotes were from male students living in veterans nursing homes. Female students spoke of intimacy between residents, but the word “sex” was not used. Did you know that:Elderly Homes vs. Home Care Essay

Hugs are so much easier to give if both people are standing. If one person is in a wheelchair, they tend to run over the standing hugger’s feet. If both are in wheelchairs, it’s difficult for both to lean over enough to wrap your arms around each other (Female medical student, 2013).

One male student, early in his stay, wrote the following:

Whatever possessions and place in society that they [the residents] used to have are all gone. Very few relationships that they’ve made still remain. All they have left is themselves and maybe they can’t even be themselves because of the lack of privacy and personal space. And as for schedules, they don’t even get the option of making that for themselves. They’re not stuck in mud, they’re cemented”(Male medical student, 2010).

This student made it a point to find out if the nursing home had a “conjugal” room and what their policies are on relationships in the home. Before his nursing home stay ended, he met a resident couple who began their relationship in the home. He not only talked with them about their desire for privacy but assisted in getting them to talk with staff about accessing the conjugal room. Another student wrote:Elderly Homes vs. Home Care Essay

What about sexuality? I know I am in my sexual prime, but how do these guys do it? Tonight my roommate called his lady friend and talked to her for almost an hour. Doug’s wife comes in and visits often. I know sexuality isn’t all about having sex…it’s about other things as well. How do these men satisfy those urges? Or better yet that passion in their lives? It can’t just go away. I just wonder if the feeling arises, how do these guys deal with it for months on end of being in these places where their privacy is neverprivate? No one really has talked about it. … I think sexual arousal is normal…. I also wonder how they fill the void of passion and that sexuality of needing a hug or embrace. I guess it gets filled with other things that make you happy like family, or grandchildren. I don’t know I am not there yet (Male medical student, 2011).Elderly Homes vs. Home Care Essay

One male student encountered a gay veteran resident. This is the only time in 33 Learning by Living journals that the word “gay” or “homosexual” was mentioned. There is no question that sexuality, intimacy, and emotional nurturing between loved ones in a nursing home environment are constrained. Even in those homes that are progressive, there is still the risk that some staff may feel uneasy about resident sexual needs (in the broadest sense of the term). This book should be required reading for nursing home administrators and staff, and periodic training programs on resident sexuality would be beneficial at each nursing home.Elderly Homes vs. Home Care Essay

These three books and the related Learning by Living student experiences remind us that older adults experience the reality-driven content of aging—a dynamic “truth” that books are unable to impart. An important component of preparing those who will provide care for older adults is the provision of opportunities, structural and contextual, for gaining a better understanding of aging through closer and extended contact with older persons. Those who work with older adults will become acquainted with the self-determination, individuality, purpose, and choices exercised by older adults; regardless of their physical ability or frailty. Familiarity with these books, along with hands-on experiences with older adult nursing home residents, will increase chances for improved care models in the future.Elderly Homes vs. Home Care Essay

Oh, by the way, an important Learning by Living outcome not yet mentioned is that students were not eager to leave the home. Instead, they were sad and had trouble leaving their “friends.” They had established heart-to-heart connections that transcended age differences, ability to speak or hear, or the limitations of frailty or disease A representative quote (for both female and male students) captures the overwhelming feelings that are associated with leaving:

I have been saying goodbyes all day. Everyone says that they’ll miss me, but I feel sure that I’ll miss them more than they will miss me. My roommate has been amazing and turned out to be one of my two best friends. I have not yet packed my suitcase. I stalled but finally had to ask someone to get my suitcase down from the closet. It is sitting on my bed, empty, and every staff member that comes in asks if I am all ready. Not at all. I haven’t even started to pack and I’m not ready to do so. How am I going to say goodbye to everyone that I love tomorrow! (Female medical student, 2011).Elderly Homes vs. Home Care Essay

The residents and staff became their friends and family, the environment their home, and the wheelchair their freedom to explore.

So pull up a three-legged stool, have a seat and prepare to teeter to and fro as you enter the culture of nursing home living—rail or rationalize, confirm or challenge, learn and lead—but please think critically and thoughtfully and keep complacency or conviction in check to aid balance. Above all, take what you can learn from reading these books and apply that learning in the nursing home setting. Elderly Homes vs. Home Care Essay

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