The realities of long term care homes, the way I see it anyway. Can you show me I'm wrong?

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I just finished reading two threads about problems in assisted living/nursing homes. In one the poster's mother had a room mate whose husband visits all day every day, basically forcing her from her room in search of some privacy. Unfortunately she ends up in the lobby, no privacy there either.
In the second dad wants to move mom and himself into a rental unit because he is going bonkers staring at the walls all day in assisted living, refusing to participate in activities, while at night having to endure the noise from the adjacent laundry room.

Many of you mention moving to retirement homes that are like moving into the Ritz. Those places exist for those who can afford them,(and they seem to be geared toward younger, higher functioning residents) but the reality, at least where I live, is that most facilities have changed very little over the past 30 or so years. One nursing home nearby has been upgraded recently and is held up as the new standard of care in the province. I haven't toured it since the renovations but checking it out online I can tell it's still not the Ritz, lurking in the background is the (necessary) institutional flavour common to all of them. The menus seem to offer tasty items, but I wouldn't want to live on the endless repetition of cafeteria style choices. Older buildings were not built with privacy in mind, so sitting in the lobby is still commonplace. Indeed, staff like to congregate immobile residents in one place so they can keep an eye on them more easily. And the activities list always looks impressive until you understand that it is mostly boring repetition and spin (eg, brain games is really just a printout of a word search found on the internet). Bingo anyone?

The unfortunate truth is that even in the best places somebody has to be stuck in those less than desirable rooms, and that unless you can afford a private room your roommate can make life h*ll. JessieBelle stated it so well, "So many of the assisted living facilities are like college dorms or hotels. Unless you engage in the activities or watch TV, there's not really a lot to do except to sit around and wait for God."

31 Comments

How depressing.. I hope someone can prove you wrong. I can't imagine not having any privacy in your room for the prices they charge...my god. There should be now substandard rooms...and they should look like exclusive resort vacation cottages for that price! Where does all the money go that these poor people pay to live in these places?
Most places, fortunately, don't have to be shared. Each person or couple can have their own apartments. The greatest problem I see is trying to maximize the use of the land by having more than one floor and providing shared resources, e.g. walking paths, to be used by everyone. People can't just go out onto their own patios and yards to sip a cup of coffee in the morning.

I think a wonderful model for an assisted living community would be small single-story clusters, maybe with 4-6 apartments per cluster. The apartments would be built on slabs, so that wheelchair access is easy. Each apartment would have a patio and a little bit of lawn. The problem with such a design is they would take a lot of land, so probably wouldn't be practical within a city where land is so expensive. There's nothing wrong with putting them outside the city, though. These developments would be perfect for someone who still wants to feel they have a little home of their own. They are probably available. We have some communities that come close here in the Birmingham area. Texas has several IL communities that follow this model.

So often we house elders in a way that is convenient for workers and families. We don't consider what their individual needs are. Some people are probably fine with a roommate. Other people may want to live alone, but not care if they have access to a patio and yard. Multi-level housing is fine in this case. But to take an outdoors type person and put them in two rooms on a top floor of a building just doesn't seem right. We need more options that are affordable.

One reason I hope my mother can stay at home as long as possible is that she would have a very hard time adjusting to AL life. She likes to sleep as long as she wants, stay in her pajamas all day, eat when she wants to eat, and avoid being around people most of the time. I don't see any AL communities around that would fit her life. It's not a neat, orderly life, but it is the one she prefers.
I'll try again. Many valid points here, but I have to wonder, is it almost a question of which is the lesser evil? Elders in danger at home or elders supervised, fed and housed in a not so nice facility.

In my parents case, the NH would have to be pretty damn bad to be worse than their nasty little house.
Windyridge, I fully understand about choosing the lesser of two evils, at least they are warm, fed, clothed and supervised. I just have been mentally placing myself in one of these places and find myself having to look at it out of the corner of my eye, so to speak, or else I would descend into soul sucking despair. Life sucks and then you die.
Being at the tail end of the baby boom maybe things will have improved greatly by the time I reach the time for extra care, on the other hand maybe those ahead of me will have sucked the system totally dry and I will be left with whatever remains.
Ugghhhh. I'm having just a bad day.
cwillie, I think we are looking at nursing home through our own clear mind and physical ability to get up and move about. Yes, we wouldn't want any part of it ourselves at our current stage of life.

For me, I can't wait to have someone else do the cooking as I hated cooking all my life, science experiments that went terribly wrong. I wouldn't care if it was fried fish on Friday, and hot dogs on Sunday each and every week. And Bingo is fun to me, but I know not to others.... where playing cards might be fun for them, but not for me. Ok, I will do a 1000 piece puzzle but by myself, thank you.

I think once our minds are a bit more clouded, and we become immobile, nursing homes at least offer other people to talk to from my generation.

Living with an elder or someone from a younger generation doesn't help change our like of music from our own generation... I find myself saying "is that music?" when I hear rap.... on my gosh, I am sounding like my parents when I use to listen to the Beatles. Would I want to hear rap all day long?

Same with taste in TV shows.... I remember my parents saying "there's nothing good to watch"... well, now I am saying the same thing and here I have 500 channels to choose from instead of 3 or 4. If the family is watching "Big Brother", sorry that doesn't interest me... anyone interested in PBS?
No-one can care give alone 24/7/365. I cared for my mother in her home for four years and bought her a rollator but she wouldn't use it in the house. Instead she got about hanging onto the walls and furniture and was forever falling. With physical issues of my own I couldn't lift her unless she co-operated. At 2 a.m. one morning ... and thankfully I was awake - I lived in the basement - there was a huge thud and I found her out of it on the floor in a pool of blood. She was taken to hospital and I realized that I could no longer do this. For her sake and mine she went into a NH 2.5 years ago where she's clean, fed and safe.

She would never engage in any of the activities as the rest of the residents were beneath her in her view - A1 narcissist life long. Currently she's bed ridden, barely able to speak, sleeps all the time and weighs less than my dog. Her time on this earth is coming to an end. I did the very best I could for her and have no regrets. When it comes down to it she's far better off with nursing staff around the clock. No one person can do around the clock care.
Cwillie, life sucks, you suffer, then you die. Fell any better now? I try to help.

Flyer made a good point about how we see care facilities now and how we see them when we old and senile. I helping my folks hang on in their home, dangling by the last thread of safety and common sense. This is what they want but if they were in assited living, even a crummy one, we could probably avoid the next insuline coma er trip, broken arm or broken hip.

So I'm just waiting them out and guessing what the next big catastrophe is going to be.
I think we forget that these NH or AL facilities are for profit. Stockholders
expect returns... Frontline did an episode on AL-- http://video.pbssocal.org/video/2365054620/ -- If you watch this, you will understand that these facilities are filling a need that they are not prepared to really fill nor are they regulated consistently. Many elderly really need skilled nursing care ( not AL) which is very expensive and again good care is not always provided. Sometimes the elderly patient is not generally happy with any of his/her options. Sometimes they long for the life they had. Sometimes they become bitter. It's not an easy thing for anyone. It's sometimes a blessing when they forget.
We like to believe that somehow if we do the right things it will make it better for them, but mostly I think not. You just do the best you can to keep them safe and comfortable. You do it because it's the right thing to do. I think many are not prepared to go down that road with their elderly relation. I can't really fault anyone because it is a huge undertaking. I have left my role as daughter behind and have been the caregiver for my 92 year old father for 6 years. I have in home help which makes it manageable. I have the right equipment to take care of him. My dad went to his lawyer and took care of the
details before he went into this decline so I'm able to keep him with me and make decisions. His doctor of 26 years and I are on the same page when it comes to his care. We both understand what my dad wishes are... We have good and bad days. I feel that we have a good chance of getting through this with some dignity. I hope so.
I think the concerns are valid, but I agree with Fregflier for the most part. We see the shortcomings from out point of view. How would we feel living that way? I know now, but what about when I"m 80. I think I may see things differently then.

When I visit my loved ones in assisted living, I often consider how is this compared to being at home. Before my loved one went to Secure Memory Care, she was in a regular AL facility. It was clean as a pin, so no complaints there. They had an activity director and she worked hard to get all residents involved. They had live music performed by some group or person at least once per week. The food was delicious. They had several sitting rooms and two outdoor areas. Some of the more independent apts had private balconies. They took the residents shopping at least once a week. And held church service every Sunday. There were regular visitors who came in all during the week.

I was very pleased to have my loved one there, because she got none of that at her home. She had hardly any visitors and could or would not cook. it was the best environment she had been in in many years.

Oh, and if you are not happy with a roommate, the places I know of are happy to move you elsewhere to find a better match. It's not perfect, but for many seniors or those with disabilities, it's much better than the alternative.

Oh, I smiled when I saw this thread, because I have been daydreaming lately about building the most beautiful, helpful and expertly designed Assisted Living facility in North America! I'm serious. I have no idea I would fund it, but I have a dream.........
I also think FF's points on seeing the facilities through our own eyes, at our ages now, is a really critical issue on how we view long term care.

I have experience primarily with SNFs and only a brief approximate one week experience with a memory care unit on a long term basis so my observations are more generally limited to shorter term care facilities.

One SNF was bad; we had to intervene and document, but eventually sufficient healing took place that return to home was possible. The longer term care facility was part of the same prominent chain, the facility was lovely, but the care was minimal. The staff to patient ratio wasn't sufficient - at dinner time the staff was overloaded. The tony decor belied the actual care.

I still have negative thoughts about having to even use any kind of facility at that time and wish that we could have found better alternatives. But I know more about them now than I did then.

Yet another facility in the same chain was outstanding. It was in an area known for high medical standards, however. Perhaps the location made the difference, perhaps the administration was the dominant factor.

I do know that I will not spend my own years in a facility. If/when the time arrives that I can't live where I want, with my own hired help, I definitely will not sacrifice just to mentally vegetate in a situation that I find less than tolerable.

Keep the conversation going (or start a new one)

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