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Details in elder care will always matter

by Isabel Fawcett, SPHR

If there is such a thing as exemplary assistive care, and I believe there is such a thing, attention to the many details of care make all the difference in the world. Whether in nursing homes, in elders' homes, elder adult day programs, or elsewhere, the real test of care will always be measured by carers' attention to required details. Elders' lives, health and public safety always hang in the balance.

A Tightly Regulated, Some Say Over-Regulated, Industry

When things go wrong in long-term care, as may occur in isolated instances, it may be easy for some members of the general public to overlook or forget that the industry has long been tightly regulated by each state. Though the regulatory standards may vary from state-to-state, the threshold of care for nursing home residents is pretty high. That standard and public expectation is as it should be, in my opinion. Ultimately, it protects the public's interest and society's most vulnerable elders who are chronically ill, some nearing the end of their lives. They deserve the best our society has to offer.

Nursing Homes' State Inspections

Nursing homes regularly undergo announced and unscheduled regulatory inspections and visits. State Health Departments also have nursing home and elder abuse and complaint hot-lines. Nursing homes' licensing and ability to maintain profitability and remain in good public and regulatory standing always hang in the balance.

As far as I am concerned, the system has excellent checks and balances, though as with anything else, there is always a need for continuous improvement and needs assessments to ensure that elders' and consumers' needs are safely and ethically met.

Larger Care Picture

It would be impossible to enumerate or share all state-regulated and inspected categories in the nursing home industry. Generally speaking, facility cleanliness, staff-resident-and family interactions where applicable, resident and building safety, activities available to nursing home residents (or lack thereof), policies, procedures and practices governing daily operations, administration, and direct care, accuracy of clinical record-keeping, availability and timely referrals to elders' physicians, resident bruising and/or bedsores in context of clinical records and reasonable custodial and supervisory expectations, elders' grooming, facility odors, evidence of housekeeping practices and many other factors are on the short-list of inspected categories for U.S. nursing homes.

Details in Eldercare

If in-home care and institutional long-term care work in the way they should, immediate and sustained attention is required in performing endless care-related tasks. Checklists, such as the published U.S. Department of Health and Human Services' (DHHS) "Nursing Home Checklist" online, offer a public glimpse of the many details involved in providing direct care to elders who reside in nursing homes.

The DHHS checklist is comparable to my own eldercare practices, tasks and considerations in my home. The primary difference as I see it is that I don't use DHHS's, or any other, eldercare checklist. I am a walking, breathing, eldercare-advocating, caregiver-live-checklist in the trenches. (Might be a good Saturday Night Live opening line?)

Providing assistive care in the trenches in an elder's or family member's home requires the ability, skills, and sustained mental focus to manage details successfully without being dependent on reading from any checklist. Therein lies the challenge for all assistive care providers, whether we are unpaid family caregivers or paid nursing home or agency staff. Real-life requires adrenalin and skills.

Just considering the following, nursing home staff may have the upper hand over those of us who choose to be family caregivers.

  • Regardless of nursing home staffing shortages, there will always be more than one staff person on duty. While there could be a day when no one shows up to work in a nursing home somewhere, what is the probability an entire staff of no-call, no-shows happening? (I'd love to hear from nursing home administrators regarding staffing realities in this context, however.) By contrast, more than a few family caregivers regularly express considerable frustration at their real or perceived lack of sibling involvement in eldercare.
  • Long story short, in the home, you and I, and our elders, may very well be on our own. Scary thought?

It needs to be a scary thought if carers are realistic, I believe. That doesn't mean that family caregivers need to shun the eldercare challenge. I'm just saying, be sure you give the DHHS Nursing Home Checklist significant advance thought to ensure that you have what it takes to fulfill a comparable in-home role.

Even if you have what it takes, are you physically, emotionally, and mentally prepared to take on such a life challenge for any period of time, let alone for any extended period of time? One of my acquaintances lasted all of 2 weeks before he contacted an assisted living facility for his Dad. It happens.

Housekeeping is housekeeping whether an elder is institutionalized or at home. So are overwhelming odors. So is a hospital bed in your home or your elder's. Caring for elders requires commitment, thought and planning, though not necessarily in that order.

If you need help in thinking through in-home or nursing home care and whether you ought to commit to becoming a family caregiver, a good place to start might be initiating contact with a nursing home or in-home care agency provider in your area. Be sure to ask them all of the tough questions. I promise you they will give you answers that will make you think. Only then, will you be able to make an informed care decision that is best for you and your elder.

Whatever your decision, you remain one tough caregiver and eldercare champion. Sometimes it's so easy to forget that not-so-minor detail.


U.S. Department of Health and Human Services, Library