Nursing Home Care Needs: Dementia and Skilled Nursing

Nursing home care needs for older adults with memory loss or dementia are greater than for the average older adult. Many older adults diagnosed with dementia experience a life event, like a hip fracture, that results in a need for skilled nursing rehabilitation with the goal of returning the individual to the physical state prior to the life event.

The challenge in this situation is that most skilled nursing home staff are not trained to respond appropriately to persons diagnosed with dementia or any type of memory loss. Medical providers in skilled nursing communities operate under a different set of rules and regulations, placing your loved one with dementia at immediate risk.

Persons With Dementia Have Special Nursing Home Care Needs

If you are a family member or a professional working to support persons diagnosed with dementia, how can you ensure that the nursing home care needs of a loved one with dementia are met? How can you ensure that an elderly parent or loved one receives appropriate rehabilitation services?

What can you do to ensure that your family member is not permanently consigned to live in a nursing home the remainder of his or her life due to the familiar statement of a “lack of progress” for not meeting insurance standards?

I guarantee that you will hear from staff that “this is a normal progression of dementia,” which really means “we’re not equipped or trained to care for your loved one with dementia, and we don’t have time to put forth the effort.

” You will hear, “Your loved one is not depressed” and other excuses for beneficial medications being discontinued. There is a long list of reasons why your loved one will not improve and may never leave skilled rehabilitation unless you take the appropriate actions.

Nursing Home Regulations Don’t Always Accommodate the Needs of Persons With Dementia

If you find yourself in this situation, prepare yourself for a battle against a nursing home system that can lack compassion and understanding for persons with dementia who have different nursing home care needs.

This lack of compassion for persons diagnosed with dementia stems from rules and regulations beyond your control. If you are a caregiver for an individual with dementia, be prepared to advocate for a loved one’s nursing home care needs.

If you haven’t yet faced this situation, know someone who is, or want to avoid this situation, read on to learn ways to advocate for your loved one with dementia and to battle against an apathetic system.

The challenges of an individual with dementia placed in a hospital or a rehabilitation community are similar. The person is unable to advocate for needs and has difficulty communicating and understanding information.

Nursing Home Staff Are Not All Trained in Dementia Care

He or she is treated like a normal individual with the cognitive skills to receive, evaluate, and respond to information in a reasonable and thoughtful manner. Nursing home care needs for persons with dementia are not always considered.

Rehabilitation is offered to dementia patients similar to other patients with normal cognitive abilities. The daily activities in rehabilitation communities are tailored to a general population—again, individuals with normal cognitive abilities.

Then we have the issue of “patient rights,” which is perfect for persons who are not cognitively impaired but is detrimental and harmful for persons with dementia. Professionals and knowledgeable family members know that “yes or no” questions are never presented to a person diagnosed with dementia because the answer is usually “no”.

Participation is better gained by saying “it’s time to go to lunch,” “it’s time to visit the activity room (meaning going to physical therapy).”

Persons diagnosed with dementia respond best to a normal daily schedule —not being allowed to lie in bed 24 hours a day because the response to “do you want to get up” is usually “no.” A diagnosis of dementia results in specialized nursing home care needs.

It’s no wonder the person with dementia is experiencing a physical and cognitive decline as a result of interactions, communication, and inappropriate responses of untrained staff.

How to Speak Up for Care Needs of Aging Parents With Dementia in Nursing Homes

How do you challenge the system? Admittedly, if you have abundant time, it is easier to support your loved one than if you are a working caregiver. Engage other family members and friends able to provide support. Depending on the situation, superhuman effort and advocacy may be required to help your loved one.

You know your loved one better than anyone else. You know what motivates them to take action. Provide this motivational information to the skilled nursing staff so that your loved one’s refusals of care will be few and participation will be greater.

• Attend physical therapy sessions to motivate your loved one to participate in the exercises. Remember that statements of “no progress or a plateau” from therapy staff are a deal killer for the health insurance company waiting to end reimbursement for rehabilitation services.
• Ask and know under what conditions your loved one will be “discharged” from insurance and will become a private payor. Don’t be naïve in thinking that insurance will pay forever. Insurance companies want to discharge patients from care as soon as possible.
• Learn the exercises and encourage participation outside of the therapy sessions. The more repetition and activity, the more quickly your loved one will return to the prior state of physical ability. Many therapy rooms will permit you to bring your loved one into the therapy room to use the equipment if staff are present and the equipment is not being used by another patient.
• Participate in cognitive activities of reading and other preferred activities. Cognitive ability supports physical ability.

Talk to all community staff at each visit to obtain updates on participation and the daily routine. Know staff names and make sure they know your name so they know you are holding them accountable.

Set weekly meetings with social services, nursing, and therapy staff to review the progress of your loved one’s special nursing home care needs.

Don’t accept “normal decline” as a reason for the community to discontinue medications or deny services. Don’t allow physicians to change medications without your approval.

Physicians can be too busy to make time to communicate with family members because it’s easier to make a change and ask for forgiveness than to have a discussion that takes time and may be met with disagreement.

Speak up for the care of your loved one.

Looking for 1:1 or family caregiving support? Schedule a 1:1 virtual or family consultation with Pamela D Wilson.

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