Many elderly people who move into care homes are suddenly faced with very few choices in how to live their lives. They are told when to get up in the morning, and when to go to bed, what to eat and when, what they are expected to do throughout the day, and even when it is convenient for them to go to the toilet! When choices are taken away from a person like this it can have a very negative effect on their well being. A person can become depressed and see no point in living. Incontinence increases as do behavioral problems, as this is sometimes the only way a person can take any control over their own lives.
It is very easy for a care home, whether nursing or residential, to fall into this trap. You only have a certain number of staff on shift at any one time and there is an awful lot of work for the staff to do during their shift to ensure all the residents receive the care they need. With strict budget restrictions placed on the home by the owners, changing a routine that appears to work so that the staff get all their duties completed in the alloted time can seem like an enormous undertaking, and even impossible!
Institutional abuse occurs when a home is run to suit the staff rather than the residents. By not offering any choices to the service users of the home, their needs are not being met. Health and well being issues are over looked, service users are over medicated and staff tend to be stressed in this environment because the residents are displaying behaviours that are difficult to deal with. This kind of environment breeds abuse either unintentional or intentional, so the systems and processes of running the home need to changed.
Good carers can turn into abusive carers without even realising it, due to stress, time restrictions and bad management of the home!
Time for Change!
Whether your home is rated poor, good or excellent, your systems and processes of running the home need to be reviewed regularly to ensure that the staff are not falling into institutionalised routines that could be harmful to the well being of your service users. Here are the choices that should be offered to all the individuals living in the home on a daily basis, and some ideas in how to implement them.
Establishing Person Centred Routine
Routine can be very important to an elderly person who has moved into care, especially if they have memory problems and health issues that need to be taken into consideration. However, each individual will need their own routine, not the same as all the other service users. This can be established when they move into the home, but remember, people have the perogative to change their minds! Here are some questions that should be asked:
- What time do they like to get up in the morning?
- What do they like to eat and drink, and when?
- What are their interests, what activities can you offer them that will keep them active and alert?
- What time do they like to go to bed?
- How do they want their personal care to be delivered?
- How can you meet their individual health needs whilst still respecting their individual choices?
Lets look at how to respect these choices in a little more detail.
Getting Up and Going to Bed
- People like to get up and go to bed at different times, so the staff need to organise their time to account for this. It's easy really, if someone likes to get up early, then attend to them first, leaving the people who like a lie in until later.
- If someone likes a lie in, it is important to check on them early to ensure they are ok to be left lying in bed. Do they need a pad change or a trip to the toilet so they can sleep for a couple more hours comfortably and without the risk of pressure sores developing? Do they need turning? Do they actually want a lie in that day? It won't always be the same people each morning that want to get up early or want longer in bed. Offer the choice!
- Management need to organise the shift times according to the needs of the residents, which do change over time! It's no good starting the early shift at 6am, if no-one likes to get up until after 7am, and vice versa. Staff need to be flexible so that shift times can be changed to reflect the busy periods within the home.
- The residents should not be expected to go to bed by a particular time i.e. before the night staff arrive! If you have lots of service users who like to stay up watching tv, or chatting regularly, then adjust the shift times to account for this.
- People like to eat their meals at different times of day. Breakfast should be offered when they get up. There should be no restriction on how late breakfast is served, it's not a hotel, it is the residents home!
- There should be menu choices for all meals, and snacks available at all other times. Elderly people often end up in care as a result of not eating properly, so it is important to offer a well balanced healthy diet as well as tasty treats such as cake to encourage people to eat.
- People have different dietary needs due to their health, culture and life choices. For example a vegetarian needs to be offered as many choices as a meat eater. Special diets need to offered to reflect health issues such as diebetes.
- Ideally there chould be no set meal times. It should be individuals choice as to when they have their lunch or tea. However, it is beneficial to the service users to promote socialising and some routine, so having a meal in the dining room with others can become an enjoyable activity, that encourages people to socialise and to eat! So meal times need to be flexible to reflect the needs and wants of the people living in the home. Someone who does not want to eat at the same time as most of the others, should be able to have their meal whenever they are ready for it.
- "Tea rounds" are commonplace in residential and nursing homes, they happen at specific times throughout the day. They are important for ensuring that the residents are offered enough to drink and do not get dehydrated, which can lead to an increase in falls and other health problems. Tea, coffee or a soft drink should be offered to each individual on every tea round! People change their minds, they may usually want tea but they are quite within their rights to decide they want coffee for a change! Drinks should also be offered and available at all other times of day!
- There should be an activities program that reflects the interests of the residents of the home. A choice of group activities need to be available every day, as well as things that people can do alone according to their likes, interests and abilities.
- An activities coordinator needs to be employed to ensure that all residents have enough to do to stop them getting bored and to keep them active and alert, and to keep the activities program up to date.
- Ask people what help they want or need with their personal care. Independence needs to be encouraged, so even if it takes longer for them to complete a task by themselves, it is preferable to a carer doing everything for them. This is important for a persons self respect and dignity.
- All service users should be offered a choice of what to wear, every day! It can be an informed choice i.e. you've told them what the weather is like or what activities are on that day that they may want to take part in and dress appropriately.
- Individuals should be able to bath or shower morning or evening as they choose, and as often as they choose! Of course sometimes staff need to encourage residents to bath or shower regularly, this can be addressed in the individuals care plan.
- Toiletting is important, and although staff will be sticking to set times for some pad changes, there should never be an occasion when the staff are too busy to assist someone to the toilet if they wish to go!
- Culteral needs are important to consider, for example, in some cultures women would never let a man other than her husband see her undressed. To ignore this in an elderly person can cause great distress, so should be considered when organising who does what amongst the staff team.
Every aspect of an elderly persons life in a care home should revolve around choices they have made. The staff need to be suitably trained and have enough time to implement these choices whilst ensuring that all their duties and paperwork are completed by the end of their shift. There are many good carers out there. They need to be feel valued by the management of the home and have enough time to do their jobs properly to ensure that the residents are well cared for and their choices are respected. Management can create a happy working envirnment for the staff, thereby creating a happy living environment for the residents by ensuring all training is up to date, necessary equipment is available and working, and by listening to what the staff say and talking to the residents to ensure their choices are being met.
Some Further Reading
Jennifer Stone (author) from the Riverbank, England on November 14, 2012:
Hi tabrezrocks! I agree with you completely, there are lots of brilliant carers out there and also really good care homes! I myself used to manage one for years that was rated "excellent" by our inspectors! This hub is really aimed at service providers to show that you should always strive to improve the service you provide, and that it is really easy to fall into bad practice without really realising that is what has happened.
Thank you for reading and commenting, all the best, Jen
Md Tabrez Alam from Calcutta, India on November 13, 2012:
Hey Jennifer Stone great hub, but one thing is that you mention in the hub, I am not agree with you. Not all the home care agencies do these stupid stuffs, If Someone hire well known and reputated care agencies, they give more than what we provide our elder at home.
Jennifer Stone (author) from the Riverbank, England on June 07, 2012:
I'm glad you enjoyed my hub and found it useful Shara, thanks for stopping by!
Farhat from Delhi on May 24, 2012:
Thankyou for these wonderful tips...its one of the best hubs, which is not only informative but inspiring too, that i'm sure will motivate people for taking a gud care of their elders & other elderly people around us.....i'm really happy it will help me a lot in taking a better care of my 97 yrs old MIL rather say my mother as i've spent more time of my life that is 30 yrs with her than my own mom and we are so close to each other that i can't think of the life without her. its my MIL who after my husband's death gave me & my children her full support morally as well as financially and she encouraged me for doing job & starting a new life... today whatever i've achieved in my life is all bcoz of my MIL..i'm really thankful to God for his blessings & I pray Him for her well being & a long happy life to be with me for ever!
Jennifer Stone (author) from the Riverbank, England on April 20, 2012:
Living Senior, you are so right! There are many options for the elderly in how they receive the care they need. When they need to go into a care home it is really important that they receive respect for the lives they have led, and are still allowed to have control over their life in the home! Thankyou for reading and for your feedback.
Starme77, It is discusting how some elderly people sre treated, and I do think your mother in law is lucky to have you! Some people can't cope with it, the health needs of their parents can be really difficult to deal with, so that is when the interventon of a good home, with well trained staff who do the right thing and involve the relatives in the care as much as possible can be invaluable. Usually families of residents feel really guilty and there is a lot of work in talking to them and making them realise that their loved one is well cared for, and that they are always welcome. The bad homes get all the press and people don't realise that there are good homes too. The bad homes need to change their ways which is why I wrote this article...
Destiny Rose on April 20, 2012:
well its actually my ex mother in law - haha my divorce was final in February - whatever with that - she been my mother in law for 22 years so she may as well just b my mother now haha. Anyway I plan on writing a hub rewriting the song where have all the flowers gone and replace the word flowers with elders .... I mean seriously when I go out and about I don't see many elderly people and people stare at me funny when I wheel my "mother" into the grocery store - people sometimes just run up to me and start making excuses as to why they put their parents in a home - why? I didn't ask - but for some reason they feel guilty enough to just start blabbing off like that its sad - our parents took care of us and when its our generations turn to care for them they are being shrugged off and drugged up and its seriously disgusting - what ever happened to the old saying - respect your elders
Jennifer Stone (author) from the Riverbank, England on April 20, 2012:
Starme77, it's great what you're doing for your mother in law! It is a very sad fact that nursing homes and doctors over medicate their patients as they think it makes it easier to care for them, but it just causes more problems! I never understood why just because someone gets old, people seem to think they all want to go to bed early and stop treating them as human beings (well the homes anyway!. I used to run my own care home and we had people taken off their meds, had parties for the residents and loads of fun every day, so the good news is there are good homes out there for people who really can't cope at home!Thanks for taking the time to read my hub and for your feedback, your mother in law is a lucky lady to have you! :-)
Destiny Rose on April 20, 2012:
That it! You got it :) after the nursing home killed my father in law I brought my mother in law to live with me - she was on 16 meds and it took me two years of research and doctor shopping and now she only takes one thyroid med just one - she didn't need the other 15 meds and as a matter of fact the one thyroid med was not one of the original 16 meds - she was hard to care for at first because of all those meds - they even had her not walking and said she never would again - well guess what? She walks now :) haha Im going on my 4th year of caring for her - she absolutly loves to stay up until midnight watching tv with the children - she dosnt like to eat big meals - she is 88 years old and simply can't digest as much at a time so she eats small snacks and small meals throughout the day and oh boy does she love her chocolate! Nice hub thanks for writing it I wish more people in the world would think this way about the elderly