For the elderly, quality of care in a nursing home often hinges on the sometimes difficult relationship between staff and family.

February 03, 2002|By Peter Jensen | Peter Jensen,Sun Staff

Her family knew Sophie Bernstein could be demanding, but they were stunned when told she was about to be evicted from her nursing home.

Too difficult, a nursing home official told them, after she'd been living there three weeks. She wouldn't sleep in her bed. She refused to cooperate with staff. Sometimes, she'd wander into other people's rooms.

Dena and Hillel Soclof, her daughter and son-in-law, were at their wit's end -- until they found the one employee at Levindale Hebrew Geriatric Center and Hospital in Northwest Baltimore who could come to their aid.

They asked for help from Heather Allen, the nursing home's patient advocate. She, in turn, persuaded top administrators to assign one more nurse to the dementia ward at night to look after Sophie. They also brought in a bed that was lower to the floor -- she'd been scared of falling out.

The problems were solved. The Soclofs were delighted. Within a matter of weeks, Sophie no longer needed the extra attention.

"She's still difficult," Dena Soclof says of her 90-year-old mother. "But she's like everyone else."

Ask anyone who has ever had to put an elderly relative in a nursing home: Families of patients and nursing home staff are going to have their conflicts.

Sometimes, the disagreements are over matters of basic care: Is the patient getting the kinds of food he or she likes? The appropriate forms of therapy? Is she being dressed in the clothes she likes to wear? Are his teeth brushed after meals?

Or it might be something less obvious: Are there opportunities to socialize? Will someone help him read -- or find his favorite show on TV? Does the staff understand her preferences, her memories, her background, or even bother to engage her in conversation?

When something is not going right, a patient's relatives can complain to the first person they see, but that may not get them far. There are no guarantees their complaint will get passed along to the proper person -- or even the next shift.

"Despite people's best efforts, things slip through the cracks," says Ronald Rothstein, president of Levindale. "Health-care systems are notoriously complex. There are a lot of points where things can break down."

Rothstein's solution was to create Allen's job as manager of guest relations and patient advocate two years ago. She serves as a kind of "fixer" for families, sometimes just pointing out who is in charge of what, or passing along a concern to the right person.

"The overwhelming majority just want someone to talk to -- someone who will give them a response," says Allen. "It isn't just complaints. It's often [about] needing someone to assist them."

Relatively few nursing homes have a patient advocate like Allen, but that doesn't mean families don't have other remedies at their disposal.

One of the best ways to avoid or resolve conflicts with nursing homes, industry observers say, is for families to learn in advance as much as they can about how the nursing home operates.

"You have to pay attention to orientation and make an effort to meet people," says Allen, who formerly worked as admissions director at another nursing home. "Families have to learn what's a realistic expectation from a facility."

A typical nursing home is a conglomeration of specialists: physicians who supervise a patient's medical needs, nurses and nursing assistants who attend to patient care, social workers who counsel families, and dieticians who plan the meals.

The most common concerns voiced by family members tend to center on nursing care and particularly the work of the nursing assistants who must do everything from change linens to feed and clean up after patients.

"The nursing assistant is the little hinge that swings the big door," said Bob Harris, administrator of Franklin Woods Center, a nursing home in Rosedale. "That's where most of the care comes from."

Unfortunately, the job is not well paid, and turnover rates in nursing homes tend to be high. Yet the smart families get to know their relative's nursing assistants -- and learn to recognize and praise the assistants who perform their duties well.

"There's a severe labor shortage in the nursing home industry, worse than in hospitals in general," says Bruce Rosenthal, a spokesman for the American Association of Homes and Services for the Aging, a coalition of 5,600 nonprofit facilities nationwide. "The nurse who works for your mom or dad today may find a better job in six months. That's the reality."

Families who have a concern over care and voice it to the first person they see in a white uniform shouldn't expect to get results. It's better, experts say, to talk to the ward's supervising or charge nurse, a person whom they should get to know right away.

"You have to be willing to do constant follow-up," says Gail MacInnes, family liaison for the National Citizens' Coalition for Nursing Home Reform, a Washington-based nonprofit advocacy group. "When you do voice concerns, you have to be ready with specific examples."

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