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Senior care: Our heads are in the sand

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Elizabeth Stewart, founder and president of the Action on Alzheimer’s and Dementia charity

The decision to move someone from their own home into a rest home or nursing home is one that should not be taken lightly.

Studies show that once a person enters a nursing home, their life expectancy is greatly reduced and this alone should prompt us all to ensure that such a decision is taken with a great amount of thought, research and consideration.

For those of us who have ever moved house, school or country, we know how unsettling, difficult and possibly depressing it might have been.

Now imagine you have lived in your house, in some cases for all your life, surrounded by your memories, history, belongings, pets, and all of a sudden you are expected to go and live somewhere that you have never been to; where you will share everything with strangers and be looked after by people you have never met.

Some are aware that this is essentially the end of the line, that they will never go back home. Others who may have dementia will be confused, upset and unable to figure out what is going on. How would you feel?

Unfortunately, not many people choose to “walk around in the shoes” of the person who will be subjected to care outside their own home. In their mind, this is what needs to happen, the next stage that should be accepted — often the misconception that they are going somewhere with “expert care”.

Care homes or nursing homes should be a home away from home, but unfortunately, today, care homes more often than not resemble miniature hospital wards as opposed to a person’s home.

Some remain stark and impersonal with staff dressed in uniforms, service users often armchair-bound around the day room, sharing rooms with a stranger, all the while at the whim of a strict schedule of meal times, bathing times and bedtimes that tend to cater for staff rotas versus the individual preferences of the “paying customer”.

So what should we expect and what questions should we ask or look for when considering a care home? The following are some suggestions:

• Are individuals encouraged to bring their own possessions, such as furniture, pictures, etc?

• Does the home allow pets or have its own pets?

• Are rooms private or shared?

• Is there a “go with the flow” approach to the day, with no sense of routine, with individual preferences catered for, for example, when to go to bed and get up, according to the individual’s routine, eating at times that suit the person, etc.

• Are people freely able to go outside into a safe, enclosed area without needing locks to be unlocked or without having to be accompanied?

• Do the staff “know” the people they are looking after? Do they know the person’s life history, their preferences, their likes and dislikes?

• For persons with dementia (one out of every five people over the age of 80), are staff knowledgeable and have they had dementia-specific training?

All of these seem like obvious points. However, I have been in homes in Bermuda where none of the points are present. In one particular home, the staff did not even know the names of the people they were supposedly caring for.

Questions about staffing are another important issue. According to the Residential Care Homes and Nursing Homes Regulations 2001, the minimum staff level is one staff member to every ten residents.

However, this is only where all “residents are ambulatory and oriented as to time and place”. Family members should do a deep dive into who the staff are at the home.

How many full-time staff, how many part-time, how many staff are working at one time, how many hours are they restricted to working, etc? Do your own background checks on any complaints at the NOSPC (National Office for Seniors and the Physically Challenged) and ask for résumés if you feel necessary.

Red flags include:

• Restricted visiting times;

• High staff turnover;

• Lack of activities and sedentary life for service users;

• Use of physical restraints (a topic I could go on for days about);

• Requests to have your GP or the home’s GP prescribe medications such as antipsychotics, sedatives or anxiety drugs;

• Being told that you need to supplement food and toiletries at the care home; and

• Poor meals (the 2001 regulations require that “at least three meals be provided that are nutritious and suited to the special needs of residents”).

Ultimately, families (and friends) should be intricately involved in not only the selection process but the continuing care of that person. Be present, ask questions and be engaged in all areas of care.

The conversation around care homes and standards is one we need to all start having.

Bermuda, like most other countries in the world, has an ageing population. What this means is that people are living longer and the over-65 population is rapidly expanding.

This ultimately means that there will be more elderly to support in society, with the financial burden falling on those in the younger spectrum. We are all so focused on how we can live longer and extend our life.

However, what is the point of extending our life if that life is going to be one not worth living. If we are going to have a longer life, we have to ensure that it has value and gives us a sense of being.

As president of Action on Alzheimer’s and Dementia, I am always coming into contact with families who ask about care homes in Bermuda and where we would recommend a family member be placed.

Unfortunately, my conscience will allow me to support placement only as a last resort. Until standards are raised and our existing regulations enforced, we are firm advocates of at-home care, where possible.

The public need to demand improvement in the standard of care being received by loved ones and regulatory enforcement must happen if anything is going to change.

Our “head in the sand approach” as a society, and complacency around the topic of senior care, will come to bite us where it hurts if we do nothing now. Do we want to wait until it is our turn to enter a home to clamour for better care?

Elizabeth Stewart is the founder and president of the registered charity Action on Alzheimer’s and Dementia.

Pain: Joe Williams, 69, told The Royal Gazette he had a leg amputated after an infection developed in his foot while at a rest home he described as a "madhouse" (Photo by Akil Simmons)