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For the growing number of people who live in conventional nursing homes, opportunities for spontaneity are almost nonexistent. Institutional care does not typically invite fun or inspire memorable moments. Rigid schedules and nursing shifts are too demanding for this when basic medical care is the focus. Sure, there might be opportunities for fun during activities and family visits. But even recreational activities can become predictable and boring day in and day out. As for family visits, they are usually infrequent or short and strained.
Assuring families that their loved ones will receive excellent medical care should remain a priority, but there is no reason to stop there. At Levindale Hebrew Geriatric Center and Hospital in Baltimore, we have discovered the secret to a happier, richer life: fun.
Since it opened 110 years ago, Levindale has endured countless changes, but it has always tried to create the best possible quality of life for its residents. Not long ago, though, we realized something was missing. We were looking for something that transcended the physical needs of the residents. We wanted the culture to more closely resemble how we ideally envisioned our own last years at home. As a first step, we decided to adopt the Eden Alternative.
We hired a horticultural therapist who leads gardening clubs and works with residents in wheelchair-accessible gardens. Residents who were once avid gardeners look forward to these meetings. Meanwhile, a greenhouse is under construction, and residents will soon grow vegetables and herbs and then cook with them. Also outside are two beautiful playgrounds for children of all ages, as well as a gazebo area to foster interaction between the growing numbers of visiting children and elders. At the same time, the Therapeutic Recreation department was expanded to include music therapy, dance therapy, drama and individual recreational outlets to suit each resident, whether one prefers computers or golf.
Then there are the animals. Dogs, cats and birds provide spontaneous moments of pleasure because they are totally unpredictable. They also provide companionship, relax the residents and even help with rehabilitation. Immediately before rehab begins, residents are encouraged to brush the hair of a dog brought in by one of the physical therapists. The residents don’t even realize their therapy has actually begun with the stroking of the animal; they just know they enjoy it.
Still another component in improving the quality of life, as outlined in the Eden Alternative guidelines, is the formation of “family” groups. At Levindale, to complement our Jewish mission, we call them “kibbutzim.” Like the kibbutz movement in Israel, each kibbutz is a little community that decides together “How life is lived.” Each group votes on its name—names include Forest Park, Sunshine over Pimlico and Hatikvah, for example—as well as what kind of animal to own, when to schedule a party or what time of day is best for bathing. More cognitively impaired residents are accommodated as best as possible.
Kibbutz members have reported some wonderfully spontaneous occurrences, such as the following:
• Ron Rothstein, Levindale’s president and COO, was “in training” for a United Way kickoff and decided to ride his tricycle through the halls of Levindale. The residents shrieked with delight as he surprised them. He also set an example for staff to act silly sometimes to bring joy to the residents.
• Nat, a member of the Dietary staff who loves to play the piano, decided to hit the keys in his free time and play songs for the residents, including requests.
• When Andy, our music therapist, is on the halls conducting one of his programs, residents pick up instruments to play, while other residents, visitors and staff join the fun and start singing and dancing. Spirits are automatically lifted for both residents and staff.
• A group of nurses and other staff decided, on a whim, to surprise one of the patients in our Specialty Hospital by buying him a guitar. He always loved playing guitar and would borrow Andy’s whenever he could. Needless to say, this patient was bowled over by the spontaneous gesture and now spends hours playing his new instrument.
• Staff on one of the units purchased a radio and clothes for a young resident whose family lives out of state. They decorated her room for her, too. She was thrilled and extremely touched.
• One kibbutz decided to buy beautiful sun hats with scarves for the residents, who were naturally delighted by the generosity.
Whether it’s a random act of kindness or an outburst of fun, like singing an old song in harmony with a resident, the possibilities for spontaneity are endless. For our nursing home residents, a spontaneous gesture can make the difference between a depressing day and an uplifting one, between a day when pain medication is needed every three hours and one in which human interaction succeeds in taking the resident’s mind off his or her pain. Spontaneity is, by definition, a welcome change from the routine. It is also contagious, and you’ll find smiling faces spreading throughout the facility.
Thanks to skillful medical care, improved drugs and more knowledge about healthy lifestyles, people are living an average of 30 years longer than they were 100 years ago. This means elder care isn’t just for aging parents; the children of the very elderly are often more than 65 years old themselves, and may need care.
With so many people affected, Levindale has commissioned author
Jill Yesko to write a book for caregivers who are beginning this complicated, often overwhelming journey. The book will encompass everything from how to talk to parents about their changing conditions to dealing with crisis situations to having the necessary legal documents.
Here is an excerpt of the guide to elder care:
When It’s a Crisis
Not everyone involved in elder care has the luxury of time. Accidents happen, situations arise and, before you know where to turn, someone is asking you to make a decision about something you’ve never thought about or wanted to consider. When “elder care” becomes “elder crisis,” tough decisions have to be made quickly. Letting go of perfection and self-criticism or self-doubt will help you make the best decisions possible. Care giving is an art, not a science. As difficult as it may seem, try not to let guilt influence your decisions.
Make sure you know your loved one’s blood type, allergies, chronic conditions and medications, and take all medications to the hospital or as soon as possible after admission. That may be the only way to protect against negative drug interactions, especially if your loved one is not fully coherent.
Most elders who are admitted to the hospital will need further care once the immediate crisis is resolved. If a loved one is hospitalized, don’t wait until the day of discharge to begin planning for continued care. Hospitals employ professionals who specialize in discharge planning. Start talking to them as soon as possible about what type of care will be needed once the elder leaves the hospital.
Talk to doctors (don’t forget to write down their names and the date of every conversation) about what type of continuing care, if any, elders may need. Ask frank questions such as, “Is it possible my loved one may need to go into a nursing home?” Many nursing homes offer short-term and rehabilitation care. Ask doctors what situation would be best. Ask specific questions about elder care, especially practical matters such as toilet use and bathing, medical equipment, insurance, and how to hire home health care workers.
“People need support during the transition to a nursing home or other facility,” notes Doris Randall, LCSW-C, director of Social Work at Levindale. “Usually, older people have experienced trauma that has taken them from their homes, and they’re not sure if they’ll be able to go back to their independent living.” That uncertainty can create fear and stubbornness or a reluctance to face reality so treat them carefully and lovingly.
This as yet untitled book is scheduled to be published in January 2004.
This article originally appeared in Nursing Homes—Long Term Care Management, October 2001.
Related Links
Levindale Hebrew Geriatric Center and Hospital
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