Nursing Home Hacks

November 5, 2009 10:34 AM

What are some good nursing home/hospital hacks?

My grandmother recently settled into a full time nursing home after living in the same house for 50 years. When we moved her in we brought as many things as possible to make her new room feel a little more like home- pictures of our family, some little tsotchkes my grandfather gave her, the comforter and pillows from her bed, as well as some small luxury items- nice hand cream, a bag of candy, a bigger TV, etc. While the nursing home is what she needs and is staffed with friendly, competent people, it still feels like a hospital and I get the feeling that she's a little uncomfortable there (but of course she doesn't want to worry me and insists that she doesn't need anything). So what are you're favorite nursing home hacks- things that would make her life just a little bit easier or provide a degree of comfort that's hard to come by in a hospital setting?

A little more about her- she's in her 90s and uses a wheelchair most of the time. She has some trouble with her memory, but is "with it" for the most part (she has reading material, but probably wouldn't be interested in puzzles or games). She has a roommate (who she seems to like) and her room is laid out much like a typical hospital room- the beds side-by-side with a divider between them and a private bathroom.

posted by Thin Lizzy to health & fitness (21 comments total)

For my grandfather it was helpful to have a way to keep track of his clothes (we used some labels) because of the way laundry was done at his place. Think about what systems are set up to help you/your grandmother keep track of the things that matter to her. It can feel dehumanizing to suddenly be in a place where there isn't anything that's yours anymore - both stuff-wise and space-wise. My grandpa had a roommate who was frequently annoying (though likeable), and not too much space to just do his thing. Can you set up your grandma with a garden plot outside, or her own special comfy chair, or something that can just be hers?

Short of visiting lots and lots: laptop for video conferences? mini dvd player/vcr where you can send video messages? What's sad about those places is feeling disconnected from your life.

Also, ask to meet/hear about her new friends at the home. Validate that this a real phase of life, and that the people around her are really part of it now.
posted by cubby at 10:52 AM on November 5

After we had to move my father to a new place, I sort of snuck in at 6 am and sat in a chair in his room reading. I was positioned out of sight around the corner of his room. Two days that week they didn't bring him lunch. We moved to another place the next week.
posted by StickyCarpet at 10:53 AM on November 5 [4 favorites has favorites]

Seeing she has a roommate, she might want games/cards that are simple. Did you meet the roommate? Do they get along?

If she can (and likes) perhaps getting her out of that room more might help. That does sound like a very small room. She is probably uncomfortable because it's the next stage in her life. Is there any way you can ste up a laptop where perhaps a slideshow of things she loves (family, maybe the old home if it's not depressing) is part of her screensaver?

Sorry about your situation.
posted by stormpooper at 10:56 AM on November 5

Thank you so much for the suggestions so far. I probably should have included the following details: I live very far away, but she and I have always been very close. My mother and stepfather live in the same city and are her primary care-givers, so ways I could help them help her (or save them time, money, and/or hassle) would also be appreciated.
posted by Thin Lizzy at 11:02 AM on November 5

The main thing, I think, that gets people good treatment from nursing home staff is giving the staff a strong impression that the family/friends are actively interested in the resident and doing their best to ensure (ideally in a collaborative rather than an adversarial way) that the resident gets good care. It makes a huge difference.

If your grandmother has a religious or spiritual affiliation of any kind--even if she's pretty lapsed--getting her connected with visitors from that group might be a good thing to do. Many younger retirees are part of outreach efforts to folks in nursing homes through their religious groups.

Make connections with the activities director, and with the social worker who's in charge of your grandmother's case. Sometimes there are local businesses who cater to the nursing home with things like food deliveries, etc., and it's good to know about that.

A subscription to the local paper from where she was living, and one to the local paper in the community where the nursing home is located, might be good--that way, she can keep up with her old hometown news and also get to know a bit about the new hometown.

Quick calls are really welcomed by folks in nursing homes or hospitals. If you're like me, you don't make phone calls when you don't have a lot of time to spare, because most of my friends like to chat for a half-hour or more. But several people have reminded me that when someone's in a facility, a quick five-minute call is great--they might not have the energy for a long chat, but a quick check-in brightens their day. So if you can get in the habit of a quick "Hi, Grandma! I only have five minutes, but I wanted to let you know about {cute thing your dog did, or whatever}" it's definitely worth it.
posted by Sidhedevil at 11:07 AM on November 5 [1 favorite has favorites]

There is an awesome article somewhere on the web (that I have lost the link to; I think it was on the blue) about a guy who simply has a webcam at work so that his aged mom can see him... typing, and working during the day. I thought it was a neat idea, if both parties are interested.
posted by gensubuser at 11:11 AM on November 5

I don't have direct experience with nursing homes, but have often heard that it can be very helpful to have a variety of aromas available, especially food. The rationale being that food is often prepared away from the person's room and without the aroma, the appetite is not stimulated. The urge to eat when the food is delivered is decreased, food intake is decreased, mood is dampened, the cycle continues.

You should check with the staff, since candles might be discouraged in the facility. Yankee Candle often has very true-to-scent fruits and baked goods candles. An electric tart warmer might work quite well.

But frankly, anything that keeps the smell of hospital/nursing home to a minimum is bound to be appreciated.
posted by wg at 11:15 AM on November 5 [1 favorite has favorites]

Get to know the head administrator. Be nice to her/him. They can be your greatest ally or worst foe in the everyday dealings.

YMMV with this, but we sneak extra tips to the maids and assistants who are personally in charge of our grandmother's room or floor. Find out which ones they are, learn their names, be friendly to them. Ask about their families. If you treat them like human being instead of servants, they will be naturally more inclined to be nice to your relative.

Make sure you ask your grandmother how she is being treated, if she ate that day, etc.

I know it sounds paranoid, but if she has any small valuables in the room with her, make sure you count them every time you visit. If anything's missing, don't immediately blame the staff-- conduct a thorough search of her pockets, purse, under the bed, etc before talking to the staff.

Water the houseplants when you are visiting, since your grandmother may forget.

I know this sounds random, but once a month look at your grandmother's feet. My grandmother's toenails are real issues for her-- she can't really see them, certainly isn't flexible enough to clip them, and they grow into painful talons if we don't make sure she has someone take care of them. (For some reason, her podiatrist won't clip them for her-- he says it's standard protocol.) Fortunately there's a lady who does manicures in the nursing home-- we pay her 5 bucks once a month to clip her toenails.

Make sure she knows how to use the thermostat. Sometimes we would visit my grandmother and it would be 90 degrees because she'd accidentally turned it to "heat" instead of cool.

My grandmother hates being given gifts, but loves to give them, or feel she can still "take care of" her family. So we slip bingo money into her purse when she isn't looking, and then when she wins a ton of nickels or whatever, and insists on giving us a handful of coins, we never say "we don't need it." We accept it, graciously, because it makes her really happy to still be able to contribute, even if it's just for parking meter money.

I don't know how it is for your relative, but my grandmother loves looking at photos. So try to bring photos when you visit, even if she's seen them a few months ago. If her memory isn't great, she probably will enjoy them just as much as she did the first time she saw them.

Lastly, visit her as often as you possibly can. When you can't visit, call.
posted by np312 at 11:19 AM on November 5 [1 favorite has favorites]

Yes, labeling clothes with her name will be very helpful, so will giving some thought to clothes that she can put on herself (if that's still at all possible for her) and that she feels good in. The difference between something with a bit of stretch that fastens with large buttons up the front and something that has to be put on over the head could be the difference between being able to dress herself and having to wait for a rushed staff member to come dress her. And your Grandmother's mileage may vary, but I have seen lots of older women in nursing facilities get a lot of pride and pleasure from putting together an outfit and putting some jewelry on every day.

In many facilities she may also be able to have blankets and furniture from home too, which can make a big difference to how familiar and comfortable her room is to her. If you learn how she spends her time, you will be able to see ways things can be made better for her - if she's bored in a chair, find things she'll enjoy doing, if she's stuck in bed help make it more comfortable and bring pictures she can see when she's lying down. So many times people in facilities are frustrated and made miserable by the cup they can't quite reach, or the light shining directly in their eyes - it's tough not to be able to fix the little irritations you used to be able to just deal with, and few nursing home workers can or will go to a resident's room repeatedly to hand them a cup or tweak a blind. The more self sufficient you can help her stay the better it will be for her.

Aside from that, I can't emphasize enough how important it is just to be around and get to know the staff and the rhythms of the day. Very, very few residents get regular visits, but if they get to know you (or your mother, or stepfather) and you are pleasant to them, the nursing staff will almost certainly treat your Grandmother better and see her more as an individual, and as others have pointed out, you will get to see if things are run well and your Grandmother is getting what she needs. The staff shouldn't have any problem with you taking her lunch or a cup of tea, if they do it's a big red flag. Advocate for her and don't accept poor care, but be respectful to care-giving staff, they are often in an impossible position where they want to provide more personal care but are exploited and stretched beyond capacity, bring them some cookies and learn their names. Don't be scared to be pushy with the managers of the home though, they're the ones who can really do something about resources.

All the best to you and your Grandmother!
posted by crabintheocean at 11:28 AM on November 5

Mr Bewildered's grandma is in a home. She has a small supply of coffee mugs and teaspoons of her own, plus containers of her favourite teas and fluffy coffee mixes and cookies. This way she can still be a hostess to her visitors - even if they have to go down the corridor themselves to make the hot drink.

Her room opens onto an enclosed courtyard with a garden, and different family members have given her plant cuttings which she tends with great care.

She has a dvd player and the family keep up her supply of old tv series which they ebay when she's done. Remote headphones might be an idea with a roommate.

She has a big noticeboard for photos above her bed as well.
posted by slightlybewildered at 11:30 AM on November 5

And what np312 said x 1,000, especially regarding feet (although I have never been anywhere tipping would be ok, and I'd suggest that friendliness and gifts that can be shared among staff are a better idea).
posted by crabintheocean at 11:32 AM on November 5

Yes, I don't think the "tipping" thing would be at all advisable in the US or Canada (the only two countries where I have experience with nursing homes and rehab hospitals).

Gifts of fruit baskets, fancy coffee and tea, mini-muffin baskets, etc. do seem to be welcome with US/CN nursing home staff members.
posted by Sidhedevil at 11:37 AM on November 5

Have someone visit during every shift (not every day, but occasionally). Lots of families only visit during the day or evening. You need to know the overnight crew also.

She probably also cooked for herself for 50 years and may not be fond of institution food. Bring some small jars of spices that she can add. A little cinnamon to add to those sweet potatoes and rice pudding can make it taste a bit more familiar. Also, if your parents can bring fresh fruit that's great because nursing home food generally uses canned ingredients over fresh. Keep an eye on her weight - it can go down if she's not eating or up if the food is generally less healthy than what she ate on her own.

Other than that, it's phone calls, cards and letters. You can't overestimate how much this means to someone when they've lost their connection to home.
posted by 26.2 at 11:42 AM on November 5 [1 favorite has favorites]

From the perspective of someone currently doing clinical rotations for a nurse practitioner program, including one in a nursing home (with a clinical instructor who is a well-know geriatric clinician).

*mobility, mobility, mobility She needs to be, even if she's in a chair, using her upper body each day, taking deep breaths each hour, and out of bed as much as possible. Her biggest enemies are immobility-related pressure ulcers, electrolyte imbalances, gut troubles, and pneumonia. The folks that stay healthy in the long term care facility setting are the ones that move and breathe. I cannot underscore this enough. Nursing home staff, if care gets dropped, drop this first and leave residents in bed too long, don't encourage those in a chair to do upper body exercises, and don't do their deep breathing with them.

*Take advantage of whatever the scheduled care rotation is. If staff are giving showers twice a week, don't skip--it's a good chance to get skin assessed for breakdown, move around, and feel better. Make sure the monthly doctor or nurse practitioner sees her and checks her meds and does a full check up. Go to the weekly beauty salon appointment and the senior exercise class. Whatever they offer that gets her seen by people and moving about, she should do. Those that stay in their rooms, refuse services "because they're fine," or sleep a lot are those with health problems.

*Stay on top of nutrition. Don't skip meals, and try not to resort to meal-replacement formulas (like Ensure). More, eat in the dining room. Again, it gets her seen by people in case there is some change in her status (so it won't get overlooked), and it gets her moving from one thing to another. Even a bit of real food with protein and fiber is better than lots of meal-replacement formula that doesn't get the gut moving. As many high-quality calories and water as possible is preventative.

*Stay on top of little things like mouth care, skin health, and foot and hand care. This is where small problems send older adults to the hospital.

*Mobility!

And yes, calls, letters, social engagements and visits keep her active with a regular social network to depend on.

My best luck to your family!
posted by rumposinc at 11:45 AM on November 5 [4 favorites has favorites]

My grandmother enjoyed having a dorm sized fridge in her room. She could keep snacks, ice cream cups, cans of soda etc in it. Not things that would replace a meal, but made it convenient for her to have something available and something that was under her control. It also made her feel more at home to be able to offer visitors something while they were there. My kids also thought it was the coolest thing when they visited to see what treats she might have.
posted by maxg94 at 12:24 PM on November 5

I would be careful about buying expensive electronics. My wife's grandfather was in a home for a while and a bunch of his stuff "went missing".
posted by reddot at 12:41 PM on November 5

Take nice fruit, good coffee, tea, etc., to the caregivers. Take some to the night staff, as well. Their pay is wretched, yet most of them provide really good care.

Music. My Mom had a cd of music from WWII, when she was early 20s, and hearing the music from those years really touched her. Get her a small boombox, and send her cds.

My Mom's independent living apartment, then nursing home room, had a hook for a name tag. All the residents had seasonal door decorations, so I often sent inexpensive seasonal decorations; she loved saying "My daughter sent it"

Flowers once in a while. Flowers just make people smile.

Who has the family photos? Scan them, and send her old pictures. Better to send a few pictures weekly than all of them at once.

Make sure she has stamps, address book and cards to send.

Crossword puzzle books or whatever games she might enjoy. Games are good brain exercise. and fun.
posted by theora55 at 2:10 PM on November 5

Labels
This. My mother has been in assisted living/Alzheimer's care for five years, and it took me a couple of years (I'm slow, okay?) to figure out that I needed some iron-on labels with her name. They tell you to put the resident's name in their clothing with permanent marker, but if her clothes are dark colored, the name is hard to read. White labels with her last name really made a difference.
Also, whoever is buying clothes for her - it's nice to have things that feel good, and look nice, but if her laundry is being done there, it's industrial and absolute murder on clothing. I've found that I can find nice, appropriate (washable) clothing at Goodwill, St Vinnie's etc, and it doesn't cost a fortune. It'll all be destroyed within 6 months or so, so this is not as heartless/cheap as it sounds.
These are the labels I used - cheap and sturdy.

Also, (and I know you can't visit, but share with those who can) we always bring a balloon, would blow it up and 'toss' it from one to another. It's actually a lot of fun, and gets her moving/stretching.

Best wishes to you.
posted by dbmcd at 2:26 PM on November 5

I think good old fashioned snail mail would be great for her. You don't have to write long letters, just a postcard or a small note would be great. There is just something about getting real mail that makes a person feel so special. If you sent her a letter on the same day every week it would be something for her to look forward to with some regularity.

If you have kids, have them draw colorful pictures to send to her. My grandma loves these! Hey, if you don't have kids she might still like pictures from you! Buy yourself some crayons and send her some of your own art. She might get a kick out of that.

Make sure you send her hard copies of pictures too. Even if she has internet access, she'll want to show off her beautiful grandchild. So send her lots of pictures of yourself.

I have to second all the comments about smelly things. Nursing homes are notorious for the smell. If they don't allow candles you might want to look into Scentsy, they don't have an open flame so they might be allowed. If those aren't good then maybe some of those reed scent diffusers. Just remember to send replacements regularly, the smell wears out. I'd recommend sending a few different scents for her and her roommate to choose from, different people like different smells. (I personally like Scentsy, but the diffuser link is just a random store from Google so you know what I'm talking about.)

Does she have any hobbies that she might miss by being in the home? Did she garden? Maybe you could send her a small herb garden to take care of. Does she knit or crochet? Maybe you could keep her supplied with new kinds of yarn. Does she like art? Maybe you could send her paint-by-number kits. I think anything that helps her feel like she is still herself would be nice. (Again, I have no experience with these links, they are just to illustrate what I mean.)

She might also like a subscription to a magazine that publishes a large print edition if she has problems with her eyes. Readers Digest puts out an easy to read version, I'm sure others do too. Again, a subscription is something she can look forward to getting in the mail.
posted by TooFewShoes at 3:40 PM on November 5

Also, you might want to get Christmas cards for her (if she does that kind of thing.) If you get ones that have a preprinted sentiment inside and have all the envelopes addressed and stamped, all she'd have to do is sign them. It might help her feel like she's not missing out on life.
posted by TooFewShoes at 3:47 PM on November 5

For my mother we had a cellphone tethered to her wrist with a string so that she could easily find it and call me or a friend.

Sometimes her call was to complain (justified or not) about a lack of attention or other problem, so I would then call the nurses station, usually getting relatively quick results (non-accusatory best practices followed of course). This was a "ruggedized" Casio model that, incidentally, survived a trip through the institutional washer and dryer when it got swept up with the linens. Obviously, depending on the mental state, there is a risk of getting a call every 3 minutes.

Also, since my mother would have trouble with the various cell phone featues such as speed dial, we had her important phone numbers in large print on an index card taped to a small section of 2 x 4 kept on the side table.

A big hit with my mother (and the staff) was an electronic photo display gadget that would hold a zillion picts and automatically cycle through them.
posted by Kevin S at 5:47 AM on November 6