A Day in the Life ScenariosEnd of life IssuesHuman Interest


“Activities of daily living” (ADL) is a general term that describes all the common actions people do every day. Eating, bathing, dressing, walking, standing, and eliminating are just some of the activities we take for granted. Life is good until something happens that affects our ability to perform those activities, then, maintaining a normal home environment becomes a problem. These life-altering events may cause a temporary change in living arrangements, but more often than not, the changes are permanent. Whether the situation is temporary or permanent, the patient might benefit from short-term, or permanent, placement in a nursing home. 

After major surgery such as heart valve replacement or a total joint, patients are often admitted temporarily to nursing homes for rehabilitative therapy with the hope they will gain strength and  be able to return home. On the other hand, patients who have a stroke, dementia, or other chronically disabling problem find themselves nursing home residents permanently. It’s a patient’s ability to perform ADL’s that determines the extent of care the person needs and how long they will need it. 

It then becomes the responsibility of the family, in concert with health care professionals, to decide the best place for their loved ones to receive the care they need. 

Choosing a place for a loved one to spend their last days is a difficult and very important decision. It’s a decision most often made FOR someone rather than BY someone. By the time many people need full time care in a nursing facility, their judgement is questionable and their decision-making capacity cannot be relied upon. They have become physically or mentally incapacitated and are incapable of taking care of themselves. Although the majority of such cases involve the elderly, younger people who suffer catastrophic accidents or illnesses often need long-term care and have no alternative but a nursing home.

Many nursing homes have a bad reputation and are only as good as the people who work in them. That includes:

  1. Patient care assistants, or nurse’s aides, who work at the bedside and are the patient’s first        contact.  They have direct, minute-to-minute responsibility for the patient’s needs. 

2.   Nursing staff whose responsibility it is to administer medications and assess problems that


3.   Administration who are responsible for providing a care environment pleasing to the family 

       and attentive to the resident’s needs. 

4.   Ownership who have the financial wherewithal to provide the services each patient needs. 

5.   Attending physicians who are responsible for determining the patients needs and

        overseeing care activities.

If any of these elements fail to efficiently perform their duty, the quality of care suffers, patients and families complain, and the facility’s reputation and desirability are affected. 

The five most frequent complaints about nursing home care are:

     Slow response to calls for assistance

     Poor quality of food

     Inadequate amount of employee help

     Frequent disruptions of sleep

     Negative social environment

These are all caregiver/management related issues. If the employees aren’t responsive to a patient’s needs, the perception of the quality of care will suffer. 

In deciding if a facility is suitable to your loved one’s needs, it is important to talk to the families of other patients and get their impression of the care their relative receives. Talk to more than just one or two families to gather a good sampling of opinions.

Watch the nursing staff in action. See how quickly, and in what manner, they respond to patient requests. It is important to know how your loved one will be attended promptly and properly.

Talk with the nursing home administrator to get a sense of staff attitude, commitment, and sense of responsibility. 

Have a meal in the dining room to sample the quality of food your loved one will be served. If you don’t like it, they won’t like it! 

Read online reviews about the facility. Check with the State Board of Health, or whatever state or local agency oversees nursing homes, to learn if complaints have been lodged against the facility. Contact the local council on aging for their recommendation and evaluation of the facility. 

Evaluate the ancillary services offered by the facility to be certain your loved one will get the type of treatment he or she needs. Physical therapy, occupational therapy, speech therapy, cognitive therapy, if they are available, and their success rates with different age group patients. 

Is the facility secure, ie. are there safeguards to prevent your loved one from wandering off, from falling, from other harm that may occur. All of these factors are so important in the decision you reach for nursing home placement. Is there enough help to be sure grandma gets fed, bathed, and dressed? Does therapy work well with grandma and do you see improvement in her status? 

This decision is too important to make on a whim without thoroughly investigating the place. Getting the opinions of other families who have been through the same process makes you more certain of your decision. Don’t take it lightly because it really is a life or death situation. 

Admission to a nursing home is highly probable for elderly or disabled family members, and is one of the more difficult decisions one can make. Knowing in advance what questions to ask and what to look for as potential problems will help to make this highly emotional decision one you won’t regret.

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