All posts by Ann Catlin

Quality of Life in Nursing Homes—What Matters Most?

Individual preferences determine if one feels they have a high or low quality of life.

Nursing homes often stress that they strive to maximize the quality of life for those elders who reside there. Over the years I’ve heard the term quality of life so many times that it seems rather vague now. Has it become an overused phrase that lacks a meaningful context? What is it anyway and how do we know when we’ve achieved it for anyone other than ourselves?

Quality of life is hard to define, therefore we all have our ideas about it. For one it may be associated with physical function or being pain-free. Yet the next person may stress having regular connections with family or friends. And still a third will say it’s having a clear mind and being able to engage in spiritual practice. The most basic definition I found states says that quality of life is “how good or bad a person’s life is.” I find that sufficiently vague to be meaningless.

So if the quality of life is subjective, then what matters most to individual residents in long-term care? One research article tells us that “The majority of the elderly people evaluate their quality of life positively on the basis of social contacts, dependency, health, material circumstances, and social comparisons.”  Other researchers found that “dignity, spiritual well-being, and food enjoyment remained predictors of overall nursing home satisfaction.”

An especially exciting publication called Quality of Life: The Priorities of Older People with Cognitive Impairment reports that nursing home residents most value:

  • Frequent contact with family
  • Privacy and being able to spend time alone
  • Socializing with others, including staff and visitors
  • Being active
  • Having meaningful activity
  • Engagement in religious or spiritual practices
  • The staff treats them with respect
  • Feeling like staff members see them as individuals

In conclusion, there are many layers of daily existence to take into account when trying to measure if a person’s quality of life is at a high level or is lacking. The bottom line is that we really can’t judge it through our lens; however any attempt to know the person is in the right direction.

If you work in long term care, what’s something you do to help ensure each resident’s quality of life?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Dignity in Elders in Long Term Care: Three Ways to Foster It

Foster dignity to improve quality of life.

Respecting a sense of dignity in elders living in long term care is vital to their quality of life. Dignity is the state or condition of being worthy of honor or respect, both of oneself and others. An organization called the National Consumer Voice designates October as Resident’s Rights Month to focus on and celebrate awareness of dignity, respect, and the rights of each resident. The 1987 Federal Nursing Home Reform Law requires nursing homes to “promote and protect the rights of each resident” and stresses individual dignity and self-determination.

How can we foster dignity in those we serve? I offer three ways to shape our attitudes and actions.

Focus on the Individual. It is looking past the “story” of the disease or condition. A person’s point of view, physical, emotional, or cognitive state changes many times over a lifetime. However, the individual exists through all these changes. Many think of old people as “former people” but each is still who they have always been. Pay attention to the person inside. I’m saddened when a resident’s room has no personal belongings, as opposed to someone whose room is full of things reflecting what’s important to them. Encouraging individual expression in the resident’s living space helps us to relate to them as a person.

Watch Your Language. Words matter and shape our attitudes, beliefs, and even actions. Some words used in long term care are cringe-worthy. At the top of my list is “lockdown” to describe a secure memory care unit or neighborhood.  I’ve heard staff and family members say it. “She needs to be in lockdown.” The definition of lockdown refers to the confinement of prisoners and an emergency measure because of a threat. It’s hardly fitting for people living with cognitive impairment needing a secure, supportive environment! Karen Schoeneman offers suggestions for changing the language of long term care to one that is more respectful.

Convey a Positive Tone of Care. Balancing proficiency in our skills with the human side of care isn’t easy. A study of elders’ perceptions of caring behaviors revealed that technical competency, combined with caring expressions of empathy, most conveyed dignity-conserving caregiving.

With this in mind, I try to act from the belief that our elders deserve to live a life with dignity. Some days, I succeed more than others. What do you think is essential in fostering a sense of dignity in those you serve?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

 

How to Prevent People in Nursing Homes from Becoming Invisible?

People in care can often feel invisible.

People living in nursing homes become “invisible” when they are regarded as feeble-minded and lacking in the ability to contribute to society in a meaningful way.

I once met a man named Frank, who lived in a skilled nursing facility, and his memory still haunts me. I noticed him because he wasn’t particularly old, and he was tall and muscular. He was sitting in a corner in the hallway near the nurses’ station. By his appearance, it seemed he had suffered a stroke.   The following day I noticed Frank sitting in the same spot– for hours, just sitting there.  He had no real interaction with anyone and pushed restlessly on the wheelchair footrests. He couldn’t propel the wheelchair himself. Lots of people passed by, but no one paid him much mind. To me, he seemed lonely, frustrated, and, yes, invisible.

I felt drawn to offer him a Compassionate Touch. I pulled up a chair introducing myself. He immediately looked me in the eye. He had trouble with language, but he could, with effort, carry on a conversation. A Vietnam veteran, Frank grew up in Illinois. He believed his age to be 37, moreover, other signs of confusion were there, too.  I held his stroke-affected hand. He was receptive to the touch. I gently rubbed his shoulders and back, and he told me it felt good.

At the end of our time together I asked him if he would like to sit somewhere else. He pointed to a spot about six feet away that was near a table, so, I maneuvered his wheelchair around so he could reach the table with his hands. He reached out took hold of a newspaper, and proceeded to read it. He engaged in something purposeful.  The restlessness stopped.   As I left, he said, “thank you for stopping.”

Frank still haunts me. He likely sat in that same corner spot the next day, invisible again. So, how do we prevent people like Frank from becoming “invisible”? In closing, Alisoun Milne, a gerontology academic in the UK, tells us, “There is evidence that well-trained staff can build up relationships with residents that help to reduce reliance on medication and the need for acute medical care. Because the more you know about the person in that chair, the more likely you are to see them as rounded human beings, and the less risk there is of neglect.”

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Alzheimer’s Disease: What Would Maslow Say?

Human needs remain intact regardless of age, situation, or condition.

Abraham Maslow was an American psychologist who taught that survival needs must come before social or spiritual needs. Alzheimer’s disease impacts all these needs, for instance, as in a woman named Faye.

The need for physical survival. Faye relied on caregivers to assist with physical needs. 

The need to have personal security and to feel safe.  Faye didn’t recall recent events, so she didn’t realize where she was. Memories of past experience faded.

The need for a sense of belonging and connection to others. Faye had been active in her church.  The move to a nursing home separated her from familiar people and consequently became withdrawn and anxious.

The need to express feelings and have them acknowledged.  Alzheimer’s decreases a person’s ability to express thoughts. Faye was frustrated because care-partners didn’t understand her.

The need to give to others and to be treated with respect.  We all need to feel useful. We thrive with mutual understanding and respect.  However, people with Alzheimer’s may believe they have nothing to contribute.

The need for a sense of self and a connection to spirit. Many assume that Alzheimer’s robs people of their identity.  Although memory and cognition become impaired, it appears that the person living with dementia seems to retain a sense of self—the essence of who he or she is.

In conclusion, understanding human needs may help us to be a little more empathetic with people living with Alzheimer’s disease.

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.