7 Things That Can... and Do...Go Wrong In Nursing Homes

Photos of nursing homes show happy people getting exceptional care. Unfortunately, there's another side to that picture... one that's best described by Murphy's law. It tells us that "everything that can go wrong will go wrong," and this too often describes the challenges that await trusting residents of nursing homes and their families. Here's a short list of what My Elder Advocate considers to be the top 7 things that can go wrong... and do go wrong... in a nursing home. The consequences to your loved one... and to your family... resulting from any one of these can be devastating, destructive, and disastrous, to say the least.

#1 – Bed Sores. Decubitus ulcers or bedsores are a major killer in nursing homes. Elders who suffer from poor nutrition and Diabetes are especially susceptible. Even a short stay in bed can cause an elder with thin skin to develop stage IV Decubitus Ulcers. These ulcers can grow from a small spot to a major case in a very short period, if a resident is not turned every two hours. In many cases bedsores start in a hospital and follow a patient to a nursing home where they can become exacerbated if not cared for properly. Bedsores are extremely painful. They sap the life out of even the strongest elder. In fact, they pack a double whammy because elders are often prescribed painkillers that cause them to live in a drugged state.

If a resident is in a poor quality facility with poor infection control and the ulcers become infected, death usually isn't far behind. That leads directly into to #2.

#2 – Poor Infection Control. One of the most important aspects of a nursing home is its proper infection control policies and procedures. It goes without saying that inadequate, poor, or bad infection control can lead to frequent hospitalizations, MRSA infections, and death.

#3 – Chemical Restraints and Management. Poor nursing homes use psychotropic drugs to manage or chemically restrain their hard to manage residents. Alzheimer's and Dementia residents are especially at risk of being overmedicated with psychotropic drugs such as Haldol, Risperdal, Adavan, and Seroquel. The prolonged effects of these drugs are harmful and may lead to death. These drugs are also used to chemically restrain other residents, and are prescribed by physicians who have little experience in the effects of these drugs.

#4 – Inadequate Physician Services. Most of the physicians who see residents in nursing homes aren't Geriatric specialists. They are usually local general practitioners who work at nearby hospitals or have offices locally. They usually don't spend much time seeing residents and when they do, they see them very quickly – sometimes at six in the morning or eleven o'clock at night. They communicate mostly with the nursing staff, and in most instances will prescribe drugs based on what the nurse suggests – not based the patient's chart or a visit. If they don't want to deal with an issue, they will just ship them to the hospital. These trips to the hospital can be very dangerous. Nursing home physician do not like to communicate with families, which often results in the family not having input into the care of their loved ones.

#5 – Poor Nutrition and Hydration. Many residents in Nursing Homes suffer from poor nutrition, hydration, and weight loss. This can manifest itself in several ways. Some residents require food preparation (cutting into smaller bites) and feeding. This can be very time consuming and a burden to staff , especially if the nursing home is understaffed. Other residents have to be encouraged to eat. In poor nursing homes, some residents just don't eat. Their trays are just removed. Proper hydration is also a big problem, because residents have to be encouraged to drink plenty of water. In other facilities the food is inedible.

Susan is available to discuss any aspect of family law. To contact her call: 973-315-4408

With nearly 50 percent of all marriages ending in divorce it is critical that anyone going through this traumatic, complex process select the lawyer who can do the best job representing them.  As part of an ongoing video series dealing with various divorce issues Judy Chapman, founder of Garden State Woman, asked Susan Reach Winters to share her thinking on the process people should go through when selecting a lawyer to work with in their divorce. Susan is one of New Jersey's top family law experts and a partner at the Short Hills-based Budd Larner law firm where she chairs their family and matrimonial practice.  In the first video interview hosted in this section of our web site Susan spoke about the importance of developing a fair and equitable prenuptial agreement. Future video interviews with Susan hosted here will focus on custody issues, the team approach to divorce and handling the financial aspects of divorce. We encourage you to refer this and our other video interviews with anyone you may know who is contemplating or going through divorce. We also welcome your feedback on these video interviews. Join Judy’s Circle so you can add your comments. Background information about Susan is available in her profile that appeared in the Leading Women section of our web site.Susan is available to discuss any aspect of family law. To contact her by phone use 973-315-4408, let her know you are calling as a result of her video series with Garden State Woman.

 

New Book, “Wise Words & Witty Expressions,” Helps You Keep Life in Perspective and a Smile on Your Face. First time author, Renee’ Gatz, has burst onto the scene with her first book, “Wise Words & Witty Expressions,” a collection of the expressions she heard repeatedly from her parents while growing up. Gatz’s book provides perspective and laughs by sharing expressions that help her readers more easily navigate life’s ups and downs.

Being raised “old school” in a traditional Irish-Catholic household with a no-nonsense mother and a traditional, old-fashioned father, Renee’ Gatz had a lifetime of hearing their various expressions—profound, funny, and even sarcastic. Without realizing it, these expressions stayed with her and came back to her at the appropriate moments in her life to help her laugh, understand, or survive.

In her early growing years, Gatz did not appreciate the power of the expressions her parents spoke but, as she grew was amazed at how these expressions would come back to her to provide clarity, understanding, or a laugh at just the right moment.

When you are young and your parents trot out some lame expression designed to teach you a life lesson, such as “if you don’t have anything nice to say then don’t say anything at all” or “you can do anything you put your mind to,” you likely roll your eyes and chalk up their “lameness” to the fact that they are old and out of touch. When you grow up and experience a little bit of life, you suddenly realize that maybe those expressions really do have meaning and are helpful to remember when navigating life’s big and little ups and downs.

“Wise Words & Witty Expressions” is not a book you simply read and then put down; you keep it handy to refer to when life presents you with its inevitable challenges, both good and bad, when you need a laugh or are simply looking for some snappy repartee. Gatz has been told by her readers that her book has found a prominent place on their coffee table, office desk and even in their bathroom.

New Book, “Wise Words & Witty Expressions,” Helps You Keep Life in Perspective and a Smile on Your Face. First time author, Renee’ Gatz, has burst onto the scene with her first book, “Wise Words & Witty Expressions,” a collection of the expressions she heard repeatedly from her parents while growing up. Gatz’s book provides perspective and laughs by sharing expressions that help her readers more easily navigate life’s ups and downs. 

 

Being raised “old school” in a traditional Irish-Catholic household with a no-nonsense mother and a traditional, old-fashioned father, Renee’ Gatz had a lifetime of hearing their various expressions—profound, funny, and even sarcastic.  Without realizing it, these expressions stayed with her and came back to her at the appropriate moments in her life to help her laugh, understand, or survive. 

 

In her early growing years, Gatz did not appreciate the power of the expressions her parents spoke but, as she grew was amazed at how these expressions would come back to her to provide clarity, understanding, or a laugh at just the right moment.

Outdoor Exploration and Play: An Essential Part of Children’s’ Health and Wellbeing

Nowadays it seems like fewer and fewer children experience the freeform outdoor exploration that many of us took for granted when we were young. True, there are real and perceived concerns about letting children play outside unsupervised as we did for hours and hours on end. There are also many more distractions for children than there used to be. If I was bored, it always seemed I only had three options – clean my room, do my homework or go outside and play. Rarely did I need to think more than several split seconds to make that decision.

A recent article on child obesity in the popular Parade magazine cites that by the time a child reaches his or her teenage years that child is spending approximately six hours a day glued to some kind of screen – TV, computer, Play Station or other electronic equipment. With the development of new, powerful and often exciting technologies, we are encouraging a whole generation of sedentary beings. Kids aren’t supposed to be sedentary – they are supposed to be exercising those gross motor skills by jumping (over streams), climbing (trees), running (through fields), skipping, playing tag and jumping rope. Some might also say that these indoor, electronic activities limit a child’s social contact thus fostering isolationism. Indeed, teachers see more and more children who do not play well together, are intolerant and inflexible and have a difficult time staying focused. Habits developed in childhood often become the essential fabric of our personalities and the more entrenched they get; the harder it becomes to alter these later in life.

So should we be concerned with this trend that is moving children away from nature? Does it really make that much difference? Richard Louv, author of Last Child in the Woods (2005) notes that “a widening circle of researchers believes that the loss of natural habitat, or the disconnection from nature even when it is available, has enormous implications for human health and child development. They say the quality of exposure to nature affects our health at an almost cellular level.”

Not only could there be significant health implications for a generation of sedentary children, but without chances to discover and explore special spots in nature, there is also concern that children will grow up without a connection to the natural world. So what? Without direct connection to the systems and cycles that underwrite our very existence it will be hard to place meaningful value on it. And, without value…our parks, nature sanctuaries and open space may not have a place in our children’s future.

For practically my whole life, I’ve been struggling to overcome my social anxiety.  Although this battle was certainly not an easy one, I ended up triumphing in the end. In retrospect, the duration of my social struggles could have been reduced had I let my parents intervene.

From personal experience, as well as from observing others with the same predicament, I noticed that children often feel embarrassed about admitting their social problems to their parents. In the fifth grade, I ate lunch alone for an entire year, while my parents were under the impression that I ate lunch with friends.

Jack and the Helmet Diver would be a great Holiday gift for any young boy or girl ages 4-8. Written by Vincent Scarponi, a friend of Garden State Woman, the book is Vincent’s step by step description of helmet diving with great photographs. Kids will love the book because it introduces them to an underwater world they might not otherwise get exposure to.

Come November, parents across the country will be anticipating the return of the college freshmen they dropped off at the dorms just a few short months ago. For many, Thanksgiving or winter break will be the first real chance they’ll get to see how their children are faring away from home. How much partying kids are doing as opposed to studying will surely top their list of concerns. It’s important for parents to understand the facts about college-age drinking and know what to do if it becomes a problem.

According to a 2002 study based on self-reports about drinking, 31 percent of college students met criteria for a diagnosis of alcohol abuse and 6 percent for a diagnosis of alcohol dependence in the past 12 months*. While most of them stop after they graduate, the near-and long-term consequences can be devastating.

Counselor John Wanner of Father Martin’s Ashley, an addiction treatment facility based in Havre de Grace, MD offers the following tips for parents:

Stop the problem before it starts

• Stay involved in your child’s life: Meet their friends and ask what they’re doing
• Be honest if they ask about your drug and alcohol experimentation: Resist the temptation to soften your stance because you feel guilty about your past behavior. Follow your candid response with lessons you learned
• Set boundaries: Tell them where you stand and what you expect from their behavior

Handle suspicions

• Look for signs: Indicators include isolation and secrecy, missing curfews and family functions, new circles of friends and acquisition of gadgets (kids don’t sell drugs for money; they do it to support their own habit)
• Confront them if you’re suspicious: Be the parent and let the counselor be empathetic
• Set a behavioral contract: Make the consequences tangible. For example, drinking and driving results in losing the car or the elimination of an allowance

Manage the road to recovery

• Give them ownership: Don’t force them into treatment. If “their way” doesn’t work, then put your foot down
• Consider your history: Alcoholism is hereditary. If there’s a history, be aggressive about pushing treatment
• Let them suffer consequences: If they get in trouble, let them find and pay for an attorney, for example
• Institute a zero tolerance policy: If you’ve caught them once, conduct random drug tests (be aware: there are supplements sold at stores like GNC kids will take to pass a drug test)

*Knight JR, Wechsler H, Kuo M, Seibring M, Weitzman ER, Schuckit M. Alcohol abuse and dependence among U.S. college students. Journal of Studies on Alcohol, 2002.

Our society has become very challenging and within those challenges a trend has begun to take hold – too many of our young children are being placed on medication. According to Dr. Peter Breggin, M.D., psychiatrist and medical expert, writing for the Huffington Post states that America is using Ritalin more than five times the usage of the world combined. Ten percent of our nation’s children have been diagnosed as having ADD/ADHD, and for treatment more than 5 million children are using Ritalin or other stimulants such as Adderall, Dexadrine, Concerta and Focalin. There have been yearly reports of children taking more than the recommended dose of Ritalin and other stimulants resulting in overdose, and children aged 6 through 9 are at the greatest risk of overdose.

These statistics scare me and the fact that we are giving drugs known to be amphetamines to our children with growing minds and bodies is unthinkable. In Chapter ten of Dr. Breggin’s book The Ritalin Fact Book states, “no antidepressants are approved for treatment of depression in children because they don’t work and because they cause mental and physical problems in children.” But yet, we are giving this medication to children like we give them vitamins. How can we, as a society, allow this to happen to our greatest asset – our children?

 When parents come to my office in search of answers they have either been pressured by their child’s school to place their child on medication for ADD or their child has already been on some form of medication and they have been witnessing the side effects in their child, such as agitation, hostility, and depression, lack of sleep, not eating, and weight loss. Imagine what can happen to these children when they are on such medication for an extended period of time?

Parents are at a loss as schools have pushed medication as the answer, neurologists have recommended it and pediatricians are writing prescriptions for it. The Pharmaceutical industry has been very effective at promoting the story that medication will solve any attention deficit problem and our society has been buying into it. 

 In this column I want to share a belief that I feel strongly about – to be an Evolved Parent requires you to Educate before you Medicate your child, and sometimes that is very difficult to do. We tend to use the internet as our sole source of information to educate ourselves, but most of the information on the internet is produced by the pharmaceutical manufacturers themselves.

The summer before entering 7^th grade, my parents gave me the choice of attending Junior High School in my district or being bussed to school on the other side of town. The advantage to the former: the security and familiarity of my best girlfriends. The advantage to the latter: my father was not the principal of the school. I chose the path that felt right at the time and settled for middle school alongside my peers. How bad could Dad be?

Webster’s defines adolescence as a transitional period between youth and maturity; a time of conflict. Experts write about that cycle; likening it to an emotional rollercoaster. Having attended middle school under the tutelage of my father, I’d have to agree. Awkward physical changes and psychological highs and lows were tough enough. But standing on the sidelines while Dad reprimanded kids daily for running in the halls, passing notes in class and starting food fights in the cafeteria was nothing short of traumatic. I wanted to evaporate when I heard his voice on the PA system. When I saw him in the hallway, I looked away; hoping to fade into a locker. In the car, I took it as a personal affront when he glanced in the rear view mirror. “Why is he looking at me? What did I do?” 

Amidst the inner turbulence, I was loyal to my favorite TV show: Father Knows Best. Often regarded as an example of the conservative nature of American family life in the 1950s, critics saw it as an overly rosy portrayal. Each evening, I got lost in the predictable, thirty-minute segments. Recapping the show in my mind, I considered alternate endings or future plots. While the situations in the Anderson family changed from day to day, the rules of the household and the roles that each family member played within remained the same. Children spoke courteously, elders were respected, conflicts were resolved, and for the most part, the members of the cast were inspired by faith, love and the Golden Rule.

Enamored with Lauren Chapin’s character, Kathy, (pet name: “Kitten”), I never missed an episode. Kathy was sweet, innocent and protected by her older brother, Bud and teenage sister, Betty. And, of course, she could rely on Mother and Father. No matter what emotional upset she encountered, Father made it all better – simply, gently and kindly. His years of life experience affirmed that frustration, disappointment and bumps in the road were all a normal part of growing up.

A key to successful parenting is the Art of Listening. Kids know when adults are paying attention to them and when they aren’t. Half hearted listening gets picked up automatically and causes them to feel as if what they are saying doesn’t matter. As a parent you have to be present in the moment. Give them your attention and your time. Those are the most important gifts you can share with your children and often the hardest.

When you are really listening, you can pick up on what is going on with your child, because sometimes it is not what your kids are saying, but how they are saying it, or what they are trying “not to say,” that is important. When you are only partially paying attention you may miss something valuable that your child is trying to communicate to you! And when you miss it, in most cases that chance is lost forever.

 1. Being in the Moment

The Art of Listening is about really being in the moment and being present. Letting go of what you didn’t do yet today, what you need to do later, or what needs to be done tomorrow. All of those things will get taken care of in due time – but being there, listening and really communicating with your child is more important than the small details of life.

2. Listening Fully

Listening requires not only the use of your ears to hear, but your eyes to see, your mind to interpret what is really being said, or not being said, and most importantly your heart, to feel what your child is trying to share with you. Children can sense your interest, respect and compassion coming through. They want to feel more valuable than the phone you have to answer, the work that you have to do, and the other people that are demanding your time.

This is one of the main reasons children open up to me when they come to see me at my office. They share their most intimate thoughts and feelings because they sense I am interested, I am genuinely paying attention to them, and I won’t interrupt them. It is amazing what I can find out that many times parents aren’t even aware of. That’s because the right environment hasn’t been provided to let their child open up, or they have allowed a breakdown in communication to occur.