Academic journal article Online Journal of Issues in Nursing

They Know Me Here: Patients' Perspectives on Their Nursing Home Experiences

Academic journal article Online Journal of Issues in Nursing

They Know Me Here: Patients' Perspectives on Their Nursing Home Experiences

Article excerpt

In response to increasingly rapid discharges from hospitals before many patients are ready to return home, nursing homes (NHs) have evolved into multilevel care facilities. They may offer subacute, rehabilitation, hospice, and other services in addition to traditional residential (long-term) care. This evolution into facilities that provide multiple levels of care has attracted regulatory attention and pressure to keep costs under control while maintaining or improving the quality of care.

Of recent interest particularly are the number of hospital réadmissions from NHs which generate costs of as much as 14.3 billion dollars a year (Levinson, 2013) and put the admitted resident at increased risk for nosocomial infections, falls, skin breakdown, and other untoward effects (Ouslander, et al., 2010T Interest in this area was the impetus for a study of NH resident, family member, and provider perspectives about these réadmissions (Tappen et al., 20141. This study unexpectedly generated a wealth of information from residents regarding their experiences in the NH, many comparing it with their hospital stay. This article offers background information about nursing home reform and standards, and contemporary reports on the patient experience in nursing homes. Methods, results, and discussion of the study findings will inform readers specifically about the analysis of narrative data as it relates to the patient experience, with hope to inform strategies to remedy the concerns expressed.

Background Information

A Look Back

In the 1970s, there was a series of scandals about nursing home care in the United States (US), exemplified by Mary Adelaide Mendelson's book, Tender Loving Greed (1974). In her book, Mendelson described poor care, emaciated patients, kickbacks to doctors, and financial manipulation by the owners of these "dank institutions" (p. 205). Robert Butler (1975) did not mince words either, calling NHs "houses of death" but "lively" businesses (p. 260) with few or no nurses and hardly qualifying as a home. This was a time of doctors making "gang visits" of 30 or 40 people at a time, the use of chemical strait-jackets and few or no nurses (Butler, 1975: Mendelson, 1974). Although there were some excellent NHs, the vast majority were at best mediocre, at worst dreadful (Mendelson, 1974).

For a closer look at what happened day after day within the walls of a NH, Jaber Gubrium (1975) spent several months at a NH he called "Murray Manor." As a participant-observer, he engaged in a wide variety of tasks from helping with toileting to sitting in on staff meetings. He found the instances of anger, humiliation, and despair decried by others. An example he gave was the aides' habit of putting residents still wet and soiled into their wheelchairs when they were in a rush to get everyone to the dining room on time. He also found moments of love and hope. While the more functional residents were able to socialize and form close relationships with each other, those who were entirely dependent upon the aides for carrying out the basic tasks of dressing, eating, and grooming (ADLs) were described as appearing uncombed, "tastelessly dressed, wan, gray, and toothless" (Gubrium, 1975, p. 140).

_ These scandals energized efforts to reform NH care. The Institute of Medicine's Committee on Nursing Home Regulation issued a set of recommendations to improve nursing home care and sustain residents' rights and quality of life (Noelker & Browdie, 2014) that, along with General Accounting Office (GAO) recommendations, were eventually incorporated into the Nursing Home Reform Act known as OBRA '87 (Omnibus Budget Reconciliation Act of 1987). Among the sweeping changes called for was a change from paper compliance with nursing home standards to actual observation of the care NH residents received during onsite surveys and real enforcement of these standards (Grasslev, 1999; Noelker 8c Browdie. 2014). Data from over 5,000 NHs showed a significant increase in staffing levels from 1987 (the year OBRA '87 was enacted) to 1993 as well as a decrease in pressure ulcers, use of restraints, and use of urinary catheters. …

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