Poor Care? Malnutrition, Dehydration, Falling, and Pressure Ulcers


By Pamela D Wilson MS, BS/BA, CSA, NCG

Malnutrition, dehydration, falling, and pressure ulcers are common occurrences in the frail elderly population. When these issues occur in assisted living communities or in nursing homes, responsibility is placed on staff and assumptions are made that the diagnoses or event is the result of poor care.

When these occurrences are identified early, a review of the care plan and steps to address the concerns are implemented by care staff. That being said, questions remain about the level of care provided in assisted living communities and in nursing homes; neither promise or provide one-to-one care which is often the expectation of family members. Most care communities adhere closely to required staffing ratios.

If one-to-one care was unsustainable at home because of the inability of a spouse or family member to provide this level of care (family caregivers do wear out and become exhausted) is it practical to believe that community staff would be able to provide the same level of care? Is it possible to avoid health declines in a frail elderly population diagnosed with multiple chronic diseases, physical frailty, decreased cognitive function and underlying chronic infections?

What responsibility does family bear to ensuring that their loved ones receives the a level of care to avoid malnutrition, dehydration, falling, and pressure ulcers?

No one wants a loved one to suffer or to experience health declines. Yet, as we age this becomes a reality unless extensive one-to-one care can be provided. The best place for one-to-one care to occur is in the home setting provided that family caregivers exist and are available to provide this level of care—which becomes all encompassing—and may not be eternally sustainable or realistic. At the point that care in the home becomes impractical, families look to care communities to provide care and solutions.

The reality is that care communities provide minimum levels of care. Assisted living communities are best suited to individuals who are able to take care of the majority of their daily activities of living. Traditional supports include medication reminding, assistance with personal care, housekeeping and activities. For individuals with severe mobility difficulties or complicated medical conditions; assisted living is not a long term solution.

Nursing homes provide medical care and general oversight with day to day activities. Nursing home staffs are not specialists in meeting the personal and social needs of residents; they are not charged to provide meaningful interaction, mental stimulation, and meaning in life. Care communities provide an alternative for individuals who are unable to remain at home and who may require medical care and oversight; they are not the solution to receiving one-to-one care.

None of us wish to be in a situation where we will not receive the best of care. However this may be the situation in which we will eventually find ourselves if family is unable to personally supplement the care offered by care communities or if finances do not exist for the hiring and retention of additional care staff to provide one-to-one care.

In many situations where family are unable to continue to provide one-to-one care or finances do not exist to retain additional care, the health of the frail elderly continue to decline until death results from a contributing factor of malnutrition, dehydration, falling or a pressure ulcer. Some ask, why preserve life if quality of life does not exist. Others believe that dignity should be preserved at all costs. Both opinions are valid yet the determinant is the feasibility and practicality of providing the additional care to support quality of life.

I personally coordinate additional one-to-one care for clients with the financial means to pay for a higher level of care. These clients clearly benefit and thrive by receiving assistance with mobility, dressing, feeding, and meaningful interaction that cannot be provided by communities with traditional staffing ratios. This is not to say that the lives of my clients will be extended indefinitely if medical conditions exist, however the daily lives of these clients is filled with one-to-one attention, connection, dignity, and attention to all of the small details that make aging just a little more pleasant.

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©2015 Pamela D. Wilson, All Rights Reserved.

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