The Human Factor in Nursing Home Care

David Oliver, Sally Tureman

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136552830
• Edition: 1
• Topic: Medizin
• Subtopic: Medizinische Theorie, Praxis & Referenz

In an attempt to challenge the prevailing attitudes and images of nursing homes in America, the authors have written a touching book about the people and the relationships that are a part of nursing home care. Their extensive study of and experience with nursing home residents and caregivers reveal that our negative and often painful thoughts about nursing homes are not always well-founded. The authors effectively use monologue and dialogue to take the reader into the world of the nursing home to observe the work of the nursing home staffs, from administrators to housekeepers, as they become surrogate families and friends of the patients. Most moving are the thoughts and words of the residents themselves, especially as they describe their initial horror and anger at being in the nursing home, and their feelings of abandonment and loss of self-esteem. Valuable for both undergraduate and graduate courses in nursing, social work, psychology, death and dying, pastoral care and counseling, this comprehensive volume is useful as a primary or supplementary text.BACKCOVER COPY
In an attempt to challenge the prevailing attitudes and images of nursing homes in America, David Oliver and Sally Tureman have written a touching book about the people and the relationships that are a part of nursing home care. Their extensive study of and experience with nursing home residents and caregivers reveal that our negative and often painful thoughts about nursing homes are not always well-founded. The authors effectively use monologue and dialogue to take the reader into the world of the nursing home to observe the work of the nursing home staffs, from administrators to housekeepers, as they become surrogate families and friends of the patients. Most moving are the thoughts and words of the residents themselves, especially as they describe their initial horror and anger at being in the nursing home, and their feelings of abandonment and loss of self-esteem. The Human Factor in Nursing Home Care provides a new and refreshing perspective of those who provide care in nursing homes and those who receive it. And, in the end, it challenges the reader to consider his or her own images of aging and of dying.

PART I: ENGAGEMENT

Chapter One

The Encounter

The images described in this chapter are real. They have been shared with us by family members, friends, volunteers, students, ministers, nurses, and even doctors. More importantly, we ourselves have experienced them. We know how they can set in motion a series of expectations which can make it very difficult to enter the nursing home.

We have written this chapter as a “first person” experience and will continue this style in other parts of the book. We feel the reader can follow our discussion and line of thought more easily if we make an effort to personalize the dramas played out in the nursing home. It will also facilitate the reader's identification with the themes and experiences in the book.

THE APPROACH

I am not alone in my car going to make my nursing home visit. Crowded in beside me are duty, fear, and anxiety. Reluctance grips the steering wheel. Like a child in a wagon going down a steep hill, I feel the car is going too fast for me and I long to drag my feet. Almost any excuse to turn back would do. The finality of driving into the parking lot is physically oppressive. I feel my heart constrict. Yes, constrict is the right word; my heart is not going to be big enough to hold the sights and emotions of the next hour. The next hour? Maybe my friend will be asleep so that I may leave a note or a word with the nurse and go quickly. Anything to get away and back into the normal world where I do not feel threatened by old age and deterioration.

The parking lot is filled with cars, but there is only one other besides me in the section marked “Visitors Only.” I envy all those who are not here. And how disturbing it is that so many, many people are required to take care of those inside! I feel the oldness, frailness, the illness, and the boredom that require so much attention to survive and cope. Only duty and affection for my friend, Mary, propel my leaden feet toward the entrance. In my imagination it is not the name of the nursing home I see on the building, but the words, “Abandon hope all ye who enter here.” This is the point of no return.

THE LOBBY

As I enter the door I realize that I can't turn back—they've seen me. Why does the entrance need to be cluttered with all this decaying humanity? If I were an architect I would never put the lobby here! Why don't they congregate in the lounge where they can watch television or look out the window? The chairs are even more comfortable there. I guess they all gather here because this is where the action is. Perhaps that's why the lounges are always empty. The natural sunlight, the televisions, and the artificial plants are pleasant, but nobody ever walks by. Nothing to watch. No one to touch. The lobby is the place to be. Here the world comes in every now and then.

I wish there were a back door. If I ever have to put my mother or father in a nursing home, I will ask the Administrator to remove all these bodies from the lobby when we come through. My dad would die if he had to see these lifeless forms in various stages of consciousness and unconsciousness. And Mom, what a scene she would make! She would demand all the way to her room that I take her back home. Maybe my brother will be stuck with that job.

Oh, no! Is that my friend Mary sitting over there with the others peering at me? I force myself to approach her and discover to my relief that it is someone else. Before I can turn away, the peering becomes a stare and holds me in stunned silence. Why does she look so desperately into my eyes? “Let me go!” I want to yell at her. Yet, my captor is not even touching me. Why did I stop? Now there are others looking my way with expectations, begging for attention. But I have learned my lesson. I adopt that “I'm in a hurry” look and continue my 100-yard dash through the lobby.

I have underestimated the power of these frail people. There is no way to avoid them. It is as if they have become a giant octopus with tentacles slapping and grasping at my body as I rush by. I turn toward faces shouting silently at me to come closer. Oh, God help me, I cannot bare to touch this slimy creature, this octopus.

Latching on, one lady stares at me through her wrinkles as if I belong to her. For a moment I see my own mother. Horrified, I realize I have nothing to say. My stomach is turning upside down as I reach across to pry her hand off my arm. Her smile disappears as I detach myself.

Even as I escape into the empty corridor, I can hear their silent cries, “Please stop … how about me? … won't you visit me? … I count … I'm somebody … Pl..ea..se … listen to my story.” I walk fast and look straight ahead.

This latching-on wouldn't be so bad if these people were like my friend, Mary. She's so lovable. I now hope that she is awake. I may even stay longer if she doesn't have anything else to do. It will be good to see Mary again; she must be nearly 84 years old now. I think she is the “floor favorite”; the staff really make over her.

THE CORRIDORS

Now, past the lobby, I move quickly and purposefully to Mary's room. Corridors are strictly places of passage, aren't they? Alas, not here. Right in front of me is a human whirligig, an occupied wheelchair going round and round in slow motion. I cannot get past it. I must stop it—her. With my hand on the chair arm, I bring the circling to a halt and say, sensibly, “Maybe I could help you get where you're going.”

“I'm here,” she mutters, looking not at me, but at some loathed invisible object oyer my shoulder. “She just dumped me here. Retired, sold her house, and moved to Arizona. Put me here. Left me without anybody. Moved to Arizona.” Now she is crying, her face contorted like an angry baby's, her voice filled with adult bitterness.

I squeeze past her, moving away as quickly as my cowardice will take me. What can one say to a living nightmare of hurt, rejection, and total loss of choice over where one lives? God help me, that is my own nightmare!

Two men, wheelchairs placed side-by-side. The one, attractive, smiling. Relieved at the sight, I speak. “Things are looking up,” I say, “The snow is almost melted.”

His eyes are intelligent and interested. He speaks eagerly. “Badda do, badda do.” His good arm gestures to the outdoors. “Badda do! Badda do, badda do, badda do?” He laughs.

Oh, God, a still good mind trapped by a tongue that can utter only a nonsensical incantation instead of real words. I am horrified; he is still smiling.

The other man has been trying all the while to move, painfully scraping his one good foot on the floor and attempting, with ineffectual body thrusts, to push forward. I do not even pretend to help. Escape is my only goal.

“Badda do. Bye.” Smiling and waving, the first leper calls to my back.

Only one sight in the corridor now. A woman walking slowly, using the wall rail for support. At each door she hesitates, then starts to go in. As I come close to her, I hear a furious voice from deep inside the room the confused woman has started to enter. “Get out! Get out! This is not your room! Go away! Nurse! Nurse!”

The nurse appears and takes the offender by the arm. “Mrs. Gore, this is not your room. Come with me.” Together they arrive at the appointed doorway. “Look,” says the nurse/teacher/parent, “I put this sign up for you yesterday. This is your room.” The sign is a large paper sheet with giant magic marker printing which proclaims, “Room 106. Martha Gore's Room.” The whole announcement is heavily underlined and decorated with flowers and smiley faces. Mrs. Gore's bewildered look grips my heart. Even children who do not know how to read can find their own rooms. Second childhood? Nothing so sanguine. Here the words are read, but no information is received.

Undistracted by corridor crises for a moment, I glance into rooms. In a hospital I would do this furtively, aware of the possible violation of another adult's privacy. Somehow, in this place, between the lobby and these rooms, there has been a complete loss of the sense of adulthood and privacy as realities. I look into rooms unabashedly, even with morbid eagerness. Tubes dripping life into the lifeless. A bedridden specter so ancient and frail that the sight arouses a primeval fear in my heart. Nothing could make me go into that room or approach that bed.

Onward to the nurses’ station up ahead. But what is this around the desk? Wheelchairs in a row. One, two, three, four, five, six, seven of them! A lineup! The non-movers, the watchers! Next to the lobby, this must be the best place to be.

The first in line is a young man, surely no more than twenty-one. Why is one who is beginning life here with those for whom it is ending? The reason is soon obvious. His body, whether by an accident or an illness, is totally lost to use. The head lolls. He is held in the chair by elaborate strapping. Strategically placed pillows prop up rag doll arms. I cringe, unprepared for this kind of misery here. But, where else could he be cared for but in a leper colony?

Next to him is a small lady reading a paperback — a Gothic Romance. She is friendly and tells me her name is Louise. Her hands are rigid and deformed with arthritis, the turning of pages a laborious task which she has mastered — most of the time. She has hundreds of these romances and reads nothing else. “It passes the time,” she tells me. But, it doesn't fill it, I think grimly.

We are interrupted by someone pulling on my coat. “Louise is in my place,” the newcomer says, speaking ex cathedra. “I always sit between Jimmy and Ruth! You must move her.”

Louise shrugs her shoulders and asks me to place her on Jimmy's other side. “That,” I say, determined to redeem my earlier cowardly retreats, “will make you first in line!” We move. Later a nurse tells me Louise cannot straighten out anymore and must be laid in bed in the same position as she sits. Are Gothic Romances sufficient escape from that?

I'm doing better, I think, and approach Number Four boldly, grasping her wrist in order to read her name on the identification band. “Hello, Ruth.”

The unfocused eyes roll toward my face. The jaw line, all bone and tautly stretched skin, juts out. “Go to hell, you goddamn Son of a Bitch,” she says matter-of-factly. The words hit me like a slap and I stagger back. Totally demoralized, I move toward the nurses’ station and sanctuary.

Sanctuary? In the midst of the suffering of this place, the nurses are laughing! In my own despairing mood, I feel deeply offended by their levity. How can they laugh when these poor pathetic souls surround their island desk like some treacherous sea about to engulf us all with its waves of misery? Is the indifference of laughter the only defense? As wasted as I feel, I am not really surprised that they do not notice me. Perhaps I have become invisible.

I know Mary's room number anyway. One reasonably happy encounter before I see her would surely improve our visit. I look into rooms for someone likely. Here. A lovely room showing personal touches of love and reason. A handmade bedspread. Plants on the window sill. Family pictures everywhere. The woman is seated in a wing chair obviously brought from home, a colorful throw over her legs. I enter and we smile delightedly at each other. I talk and she coos and chuckles at all of my comments. Success at last! I feel my spirits rising. From the picture laden table by her chair, I select one of a smiling young man. “And who is this?” I ask, handing the framed photo to her. “Your grandson?”

She frowns. “I was just going to ask you if you knew. Someone put all these pictures here, but I don't know any of the people in them.”

The roommate lying on the other bed says, “Her memory is gone, you know. Some of her people come to see her regularly, but she doesn't know who any of them are anymore. That's her grandson Bill by the way.” Sorrowfully, I replace the photograph and kiss the soft, smooth cheek of Bill’s grandmother. She is a prisoner and so am I. I leave her cell.

THE ROOM

There it is, finally, only two more doors to go. No longer looking into the other cells, I can't wait to see Mary's pleasant, often radiant face. Thank God she is not like Bill's grandmother. Pictures on the dresser, quilt on the bed, dolls in the chair, but most important, wits still sharp. It will be a good visit. Yes, I'm glad I came.

Not bothering to knock, I barge into the room with new energy and even anticipation. Oh, my God, is it Mary? I can't move. There she stands gripping the steel post of her bed as urine dribbles to the floor from beneath her soiled gown. I freeze. What should I do? Can I get out before she sees me? Oh, my God, she's crying.

“Nurse! Nurse!” I shout down the hall. When I return to Mary she is climbing into bed, wet clothes and all. Stepping carefully around the mess on the floor and holding my breath, I lean over and kiss her on the cheek. The tears stream down her face; she says nothing.

The aide comes quickly into the room, strips the bed (Mary hardly moves), grabs a cloth and wipes her clean. I stand like a petrified tree as Mary lays there naked, waiting for a new garment.

“I'll be right back,” says the aide.

“But wait, you're not finished …” The words fail to convey the utter despair and embarrassment I feel for both Mary and myself. I realize I am far more concerned about my own embarrassment than Mary's. I feel helpless. I can't handle it. I want out.

A few steps further into the room and I find myself in the world of Mary's roommate. ...

Table of contents

• Front Cover
• Half Title
• About the Author
• Title Page
• Copyright
• Dedication
• Content
• About the Author
• Preface
• Acknowledgements
• Introduction
• Part I: Engagement
• Part II: Players
• Part III: Transformation
• Appendix