|ADvancing Care Newsletter|
While most people can imagine how difficult it may be for someone to move into a nursing home for the first time, less understood is how hard it can be for someone to relocate from one unit to another in the same nursing home..
Room changes have become much more common over the past few years due to several factors. For instance, there are always a number of people who come to a nursing home for short-term rehab (as “patients”), and then for a variety of reasons must move to long-term beds on other units (as “residents”). Such a move can be particularly upsetting (for both patients and their families) because this usually means having to accept that they will never return home.
In addition, more recently in New York State, there have been changes to the bed-hold requirements in nursing homes. In the past, Medicaid would often cover the cost of holding a room for someone who had to be hospitalized. However, the new changes mean that many residents will no longer have their beds held for them, and when they return to the facility they will be transferred to another room or even another unit.
Other situations that may necessitate movement from one room or one unit to another can include incompatibility with a roommate, changes in care needs, or facility priorities.
Regardless of the reason for the move, it is extremely important to examine the impact of any move on the resident. These changes can obviously be very distressing to residents and to their families, and challenging for staff. Moving to a new unit may seem simple, but in fact it usually means an entirely new set of caregivers, including nursing assistants on three shifts, nurses and nursing supervisors, social workers, recreation workers, dietitians, physicians and housekeepers. It means a new roommate. It means leaving roommates, their family members, and staff on the old unit to whom the patient may have become attached. Routines from one unit to another vary (meal times, bathing times, recreation schedules).
For residents with dementia, and for their families, these adjustments can be even more difficult. Changes in staff and in routine can be upsetting and even frightening for the resident, thus also adding to the distress for family members. Because these residents are often not able to say what is troubling them, it can be especially hard for staff to respond to their needs and to make them comfortable.
A family member of a resident at Jewish Home Lifecare talked about the difficulties her relative faced when moving from one unit to another:
It was a huge change, very difficult. The Rehab floor had a different look, and on the new long term unit there were uncomfortable things to get used to. We tried to ease things by finding someone from the new unit who could get to know her before the move, so she’d have someone she knew and recognized when she arrived, so she wouldn’t feel alienated. It meant so much when one of the new Nursing Assistants knew she liked oatmeal, and made sure she got it. They (Nursing Assistants) are so crucial, and the littlest things can make such a big difference in helping to build a relationship.””
The Jewish Home, at their campus on 106th Street in Manhattan, has been seeking to find ways to ease these transitions for residents, family members and staff. Working with other New York City health care providers as part of the United Hospital Fund’s Transitions in Care Quality Improvement Collaborative (TC-QulC), Jewish Home made a number of improvements in how they approach moves for residents within the facility. TC-QulC is a major activity of the Fund’s Next Step in Care campaign.
One of the first steps they took was to institute the practice of calling family members before the move, not just to inform them of the move, but to give them information about what to expect on the day of the move, and to answer questions about the move and the new unit. Family members have reported finding this information very helpful. The Home also developed a new brochure for family members, explaining what to expect when a move is planned, and who to contact for help. Family members are in a better position to provide support to residents when they themselves know what to expect, and can be available to help orient staff to their relative’s needs and preferences, especially important with dementia. Within a week of the move, Jewish Home is now calling family members to see how well the transition went from their perspective.
Recognizing that some of the toughest transitions were for those moving from “patient” to “resident” status, two support groups for residents were formed. These have been very successful, with residents reporting back that “I feel alive” and “connected” and “like I am with friends,” and “someone understands.” Staff report that as a result of these groups there has been more interaction on the units, with less isolation and loneliness. In addition, nearly 40% of residents involved in a move have been referred for one-on-one counseling because staff observed they were having a tough time, and were withdrawn or depressed. Plans are also underway to use the MDS 3.0 depression scale to monitor any changes in the resident following a move.
To help staff prepare more effectively, moves are now discussed in the “Morning Report” held at the beginning of each weekday, with representatives from Housekeeping and Medicine now participating, in addition to Nursing and the other disciplines. This has expedited decision-making as to who will be transferred, and has reduced miscommunication. Housekeeping staff have all been trained on how stressful these moves can be for residents and families, and how to help the process go more smoothly for them. Some staff have also changed their working hours to better meet the needs of residents, providing later hours and weekend coverage. In addition, a case presentation was made about a resident’s experience in moving, to increase awareness about the importance of easing transitions. For more information, contact Deirdre Downes, Director of Social Work, at firstname.lastname@example.org.
Next Step in Care, created by United Hospital Fund, is a campaign to support family caregivers and health care providers in improving transitions for patients between hospitals, rehabilitations facilities, nursing homes, and home. The related website, www.nextstepincare.org, provides free practical advice and easy-to-use guides for both providers and family caregivers, available in English, Spanish, Russian, and Chinese.