Annals of Long Term Care

Nursing homes have long been thought of as dingy places where older adults go to die, and many in the twilight of middle age fear winding up at one of these “dead-end” places. As recently as a decade or two earlier, that negative view of long-term care (LTC) facilities might not have been too far off the mark. It used to be that when you entered a nursing home, you bid your old life goodbye, including the activities you enjoyed, the meals you liked to eat, and the ability to choose how to spend your time.

Although this gloomy situation remains at a handful of nursing homes, a growing number of facilities are embracing the LTC culture change that puts patients at the center of care. This shift has come in part as a response to regulatory changes and demands from residents and families for better care, but it also reflects the desire of many dedicated LTC professionals to protect the dignity of their elderly charges and preserve their enjoyment of life.

We are all familiar with the culture changes taking place in the dining room, and they represent a great start to adopting a person-centered platform of care, but residents typically eat just a few meals each day. What about the rest of the day? Alexander Port and colleagues discuss the importance of keeping residents mentally and physically active in “Engaging Nursing Home Residents in Meaningful Activities." The authors designed a tool that LTC facilities can use to identify residents’ interests and any barriers to pursuing them. A pilot study testing the instrument and implementing various interventions had good results at one facility. In cases where barriers to the residents’ activity goals seemed insurmountable—such as an elderly resident in a wheelchair who expressed a desire to travel abroad—the nursing home staff and researchers came up with substitutions that brought residents a little closer to their destination. In the would-be traveler’s case, they organized a weekly meeting among other interested residents who watched travelogues together and discussed exciting locations. It proved to be an inexpensive yet effective solution.

Preserving functional ability is an important goal in LTC and one that benefits residents, staff, and the bottom line. The AGS Viewpoint discusses a study led by Barbara Resnick, PhD, CRNP, that demonstrates how making it easier for nursing home residents to attend to more of their own personal care needs helped them preserve function. When direct-care workers were instructed to encourage residents to be more active and give residents only as much help as was needed to complete a task (eg, bathing or feeding), residents maintained more functional ability and suffered no more falls or injuries than residents whose tasks were completed for them.

The culture change movement at nursing homes is gradually influencing how these institutions are perceived. Eventually the outdated image of nursing homes as places where older or infirm adults are shuttled off to die will be supplanted by an image of a place where residents can spend their final years safely, with dignity, and without having to let go of everything they embraced about life before they got there.