Some Nursing Homes Stuck in the Unenlightened Past

  • I live in an area of the country where, I believe, most nursing homes are good. Not perfect, mind you, but for the most part they are good. There's a lot of competition, which forces a certain amount of progressive thinking. We have some good training programs for dementia caregivers which is something I've written about on OurAlzheimer's. We also have one home that is part of the forward thinking Eden Alternative.


    I am bringing this up, because a reader related to me a disturbing story about a nursing facility in another part of the country. The person who told me the story was referring to the nursing home where her grandmother, who has Alzheimer's disease, lives.

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    This particular nursing home has two levels of care for Alzheimer's patients - literally. If the patient is "manageable," that is to say "good," the patient is allowed to stay on the top floor, with minimal but good assistance, plus more light and more freedom.


    If the patient is "unmanageable," or "bad," he or she must go to the lower level, and this person's grandmother fears that this is where she is headed. Get that. The key word is fears.  After an incident where the grandmother fell, she insisted she didn't fall, because that could cause her to be demoted to the lower level, so to speak.


    To me this is horrifying. It reminds me of the old days in "insane asylums" where "good" patients got treated well, and "bad" patients got drugged, or worse. I'm amazed that this mentality exists in this supposedly more enlightened time. To run a nursing home in such a way that even someone with a dementia impaired brain understands that they can "mess up and be punished" is simply beyond my comprehension.


    If the Alzheimer's patient were telling his or her family about a situation like this, and it turned out to be a delusion, that would be understandable. Paranoia, fear and misinterpreting circumstances are all part of most dementias. But this is actually how the home operates. The family can see this is true.


    So, this home is taking people with impaired brains - people who are already fearful, as they know, in their hearts they are vulnerable and dependent on their caregivers - and using the fear of worse surroundings to control them.


    The reader's comment about her grandmother's circumstances underscores my mantra that we must check out facilities (and/or in-home caregivers) regularly. If possible, check them out before a loved one is admitted. Drop in often, at different times of the day. And - my personal favorite - see how the upper level staff treats the hands-on staff - the CNAs. I feel that the kind of management that treats everyone on staff with respect is the kind of management that is going to be running a good facility.


    I realize, in many cases, it's hard to find a good home for an Alzheimer's patient. And, often it's not possible to have them stay with family. But I would suggest extra vigilance in a case where the management has a "punishment" mentality for Alzheimer's patients. This makes my skin crawl.


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Published On: September 19, 2007