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Top five resident complaints about nursing homes (and what to do about them)

September 28, 2010
by Eleanor Feldman Barbera, PhD
| Reprints
Solutions can be as simple as the problems themselves

Editor’s note: The following article originally appeared in separate chunks on Dr. Barbera’s blog, www.mybetternursinghome.blogspot.com.



#1: No one coming when the call bell is pressed

I've worked on units where the moment the call bell goes off, the charge nurse immediately and calmly asks an aide to check on the room. The bell goes off, someone arrives. Simple customer service. This leads to a unit full of residents who feel confident their needs will be addressed in a timely fashion, and they are therefore far less anxious. Staff training is a good way to change the nursing home culture on this issue, but each worker can take it upon themselves to make it their own personal policy even if the nursing home as a whole isn't making it a priority.



#2: The food

Where is the Emeril of nursing home food? It's time to kick things up a notch. There's a huge opportunity for improvement in the quality, number of choices, and presentation of food in nursing homes, and to positively affect resident satisfaction with meals.

A good start is to increase the food rotation schedule to at least a four-week rotation. Residents also appreciate having their hot food hot and their cold food cold. Restaurant-style service, where residents are offered options while sitting at their tables, is as popular as the flowers decorating said tables.

I've heard of facilities stimulating appetites by filling the dining rooms with the aroma of fresh-baked bread. What other meal-enhancing ideas are out there?

#3: The patient lift

The patient lift is a machine used to transfer a resident from their bed to their wheelchair and back. No resident I've met likes using one, and I suspect the reason is the combination of loss of control; the frightening feeling of being suspended, helpless, in midair; and a lack of training that makes the procedure more alarming and uncomfortable than it needs to be.

When I was in grad school, all psychologists-in-training were required to undergo psychotherapy. Similarly, aides could gain perspective from a ride in the lift as part of their orientation or ongoing training. (I'd like to do this and blog about it, so if there's a home in the New York Metro area willing to let me, please contact me.)

A professional approach by staff members with a focus on increasing confidence in the transfer procedure can reassure anxious residents. Techniques that reduce anxiety include:

· letting residents know what's about to occur at each step of the process;

· engaging in a dialogue with residents so they know the focus is on them; and

· listening to feedback about how they're feeling (frightened, uncomfortable, etc.) and responding to their concerns

What techniques do you use to make this procedure more pleasant?

#4: Nighttime disturbances

The main culprits:

· TVs blaring into the wee hours

· agitated neighbors

· loud conversations between workers

Steps toward improved sleep hygiene:

· Implement a TV curfew and require night owl viewers to use headsets past the curfew.

· Encourage nightshift staff to report resident sleeplessness so sleep/wake cycle disturbances can be reversed and medications adjusted if necessary.

· As part of in-service training, address ways in which nightshift staff can communicate with each other to avoid disturbing sleeping residents.

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If you want to be put in a mechanical lift, the vendors that sell these are willing to let you try them out. We have also had "sample" machines brought in for us to from when we have purchased new ones.We have put staff in them at our facility. It is definitely an experience. We have had staff get in one to demonstrate to residents also so its less frightening.

Sue, you're right about it taking work for residents to connect with their peers. It can be especially challenging because of soft voices, hearing impairments, and mobility issues. Getting to activities provides the opportunity for recreation staff to help residents overcome these challenges.

Cathie, thanks for the suggestion about having the vendor give me a ride in the lift. Good idea!

Catherine, I also found it illuminating to get a wheelchair ride. The chair seemed to be moving much faster when I was the pushee than when I was the pusher.

Dr. El,

It can be frustrating, at times, helping residents see that they can be socially active in the nursing home. Meeting others in a nursing home, as in the community, takes work. If you wait for someone to knock on your door to become friends, you will probably be waiting a long time. I would like to reiterate what has already been said, go to activites. Of course, the ones you are interested in, but initially try going to just about everything and go consistently. Establishing relationships takes work. I would also like to suggest attending discussion, trivia, arts and crafts and baking groups and others which tend to be conducive to socialization.

It is beneficial to have staff experience how it feels to use equipment. I took a class about wheelchairs and was expected to drive with different controls. It gave me a new level of respect for those who drive them. Additionally, when I teach classes about eating and drinking for those who lack independence in these areas, I like to have students try all of the techniques to understand how it feels. Let staff experience what residents experience on a regular basis!

Complaint #1 concerning answering call lights really misses the mark. You suggest that the nurse tell the aide to respond to the call light. Why can't the nurse get up and do so? For that matter, no one should pass a ringing call bell. Continually asking aides to do something that everybody can do, drives a wedge between nurses and C.NA's. That's not very good for staff morale. Remember, we're all in this together

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