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Recently I was in a couple of nursing homes. In both cases it was mid afternoon and it looked like about a dozen residents were arranged in their wheelchairs or other chairs around the nursing station. The residents mostly seemed asleep or dazed. No one was talking.


Is this the normal way they supervise groups of residents in facilities? or is it a bad sign that the staff and residents are not engaged? I didn't expect a party atmosphere, but this looked depressing.

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Ahmjoy, I think that your comparison to a "front porch" is great.  My Mom's roommate was not much of a talker and sat watching TV all day, so Mom would sit in the hall near the dining room or one of the little hallway alcoves where she could see anyone who walked by.  The CNAs/nursing staff would say "Hi" to Mom everytime they walked by and visitors would stop and talk briefly to Mom.  It was much more enjoyable for her to sit in the hallway where she could talk with other people then to sit alone watching a TV that she had trouble seeing and hearing.  And YES, sometimes Mom did close her eyes and nap in the hallway when she was tired or sleepy.  But she woke up easily and was ready to talk to whoever walked by.
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Ahmijoy Oct 27, 2018
This is exactly the point I was trying to make. The staff should not be considered “lazy” simply because they allow the residents to congregate around the hub of activity, the nursing station. That’s not fair to them.
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Another poster compared it to a front porch. Brilliant!

At first we, too, thought this was terrible. Then when Mom asked to sit there “& watch the action” when each of us would leave, we looked at it from her frame of reference. She loved watching all the comings and goings; loved being greeted by people walking by; loved talking with others about her beloved Yankees; loved gossiping with other residents; and overall just loved the quiet companionship of others. A bonus was she could doze off & on when her body told her it needed it.  

We came to realize that initially we were projecting our own expectations & lack of limits on her situation. WE would find it awful if we, who could move freely, were forced to sit there. However, for Mom, who wasn’t mobile, it was the best thing possible. It actually was no different than her & I sitting in the garden or the great room together & watching others. It was certainly preferable to her being isolated in her room. Or being forced to participate in an activity she had no interest in.  

Mom, who was way down the dementia path, was still teaching her middle-age children a thing or two!
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MaryKathleen Oct 30, 2018
I totally agree with you on the projecting our wants and expectations part.
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Normal, although in our case it was in the lounge beside the main entrance, offices and nursing station. I'm always amazed when I read about people enjoying activities and socialization in a nursing home because, although there are programs, the vast majority of people are too far gone physically or mentally to really take part. Isolating people in their rooms is frowned upon, keeping residents together means that eyes are on them more often and since many of the rooms are shared keeping contact between room mates low reduces conflicts.
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It works both ways – the residents watch the staff coming and going, and the staff keep an eye on the residents. It’s a whole lot better than charging private pay for a 24/7 care sitter!
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To me, the nurses station is live theatre for many of the residents. It’s “As The Nursing Home Turns” daily edition. It’s the closest thing to a main plaza or village square and serves to both help oversight by staff and for residents to socialize if they want to.

If a NH is heavily Medicaid residents, it’s going to be extremely tight on staff. Whatever the required minimum needed to be open will be what staff is. For some states, the daily Medicaid room&board reimbursement is at or below the daily operating cost. There simply isn’t the budget for more staffing. Medicaid R&B is set by your state, if you want the situation to be better, you have to vote in elected officials that will put state funds into Medicaid programs and support all Medicaid programs.
Remember this when you vote next week.
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Yes, that can be perfectly normal. There are many different levels of care in a NH that the staff have to determine on an individual and even daily/hourly basis. At Moms, some are engaged, can participate and get to activities on their own. Some will participate with lots of encouragement. Some are brought to activities but don’t participate or sleep through them. For some the activities are too stimulating and cause the resident anxiety. Some who are no longer a fall risk or need medical care stay in their room and sleep or watch their own TV. And of course a resident can fluctuate between these levels on a daily basis. Mom gets too stimulated at some activities, so they know not to bring her to those types. She loves the singalongs, but cannot deal with loud, action TV shows. So they move her away from the TV when it’s loud. They move residents closer to the nursing station if they want to keep a closer eye on them if they are a fall risk from their chair. Those sleeping people eventually wake up! And mid afternoon is usually a sleepy time anyway. I would estimate 80% of Moms floor take a nap in their room from 2-4, or sleep in their chair in the common area. Few stay awake right thru dinner, that’s why there’s fewer activities in the afternoon, most are from 9-12.
So I wouldn’t be concerned if there’s a group of people near the station. I would be worried if there were no residents at any activities. And I would be very worried if residents are left in the hallways away from the eyes of the nursing station. And you might see a different picture if you visited in the morning.
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My father and husband were both in the same nursing home, at different times, and both with dementia. Neither was in a wheelchair. My husband was a fall risk and was moved to a room near the nurses station which I appreciated because he would sometimes get out of bed in the middle of the night. But, if he was not in his room or the living room, he could usually be found standing at the nurses station. He was not expecting anything from them - I think he just liked the nurses and felt comfortable being near them. When my father was there several years earlier, one of the nurses told my brother that Dad would stand at the station and sometimes at night fall asleep while standing there. During the day, I saw many residents in wheelchairs wheeling themselves to the nurses station where they arranged themselves around the others in wheelchairs. The nurses and aides were very alternative to my father and my husband, along with the other residents in the memory care unit. Putting a loved one in a nursing home is difficult and something none of us look forward to. But sometimes that is the only way to keep them safe.
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I don't think I'd like what the layout seems to be saying about what order the NH is putting its priorities in. If one of those residents had felt lively enough to lift her head and look around her, what would she have had to look at? Did they have anywhere else to sit if they'd wanted to?

You're right about the party atmosphere, though; and I have to admit that thinking back to the various views elders I know have had, it's made no real difference to how engaged any one of them was by that stage. Lovely gardens, art works, tropical fish, t.v., souvenirs, photos, other people... I suppose by the time you're that frail and tired, what's inside your head claims most of the attention you can spare.
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cwillie Oct 27, 2018
My mom rarely put more than two words together but when I left I always gave her the option "do you want to stay in your room or go to the lounge" - 99% of the time she said "lounge" because she knew people were coming and going and she was comforted by being among others, so sometimes it's not the view that's important.
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I have seen this too both when my mother had to be in one briefly right after surgery and also when a friend had a period of recovering after a stroke. I think it is a more positive sign than having severely impaired patients wallowing alone in their rooms alone for long periods. In both cases there was relative calm which is certainly a decent sign.
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One of the nicest things I saw was for a cranky, not-with-it woman who shouted for 'help' from her room, but hated being parked along with quiet ones in the hall. She was taken to sit in on activities, which 'worked' for the hour, but days were long. The solution - she was given a seat at the main desk, along with a pad and pencil, where she spent days, happy as a lark.
In time the joy wore off, but it was great while it lasted.
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Paulcar Oct 30, 2018
There is a little lady like that where I visit my Grammy. Lorraine is little and scoots along in her wheelchair all day. She doesn’t stop too often but if she’s not scooting she can be found at the nurses station tapping in a computer screen (it’s off) or taking notes with her pad and paper. She doesn’t talk really but she sure lets you know when to go or when she wants to hold your hand or say hi. She’s one of my favorites even though on some days she’ll wave her hand and motion for me to go lol it makes me chuckle.
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