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Productive Visitations At Nursing Facilities


by Theodore Hardgrove, M.S.W. L.I.C.S.W.

Dreading your next visit to the nursing home to see Mom or Dad? Do you feel frustrated and exhausted after every visit to the nursing home? You're not alone.

Visiting a nursing facility, (or nursing home), can be a daunting experience for family members. Once the admission process is over, a family member must face trying to help Mom or Dad feel comfortable in their new environment. But how can a family member help their loved one feel comfortable, when the family member themself is experiencing a high degree of discomfort as well? The nursing home resident will openly express their discomfort to those who visit, but the visitor rarely has that same opportunity. This can be frustrating, especially since family members are often reluctant to admit their own uneasiness. Family members frequently give, without recognizing their own needs. They walk through those nursing home doors full of vigor, find the person they came to visit, and leave looking virtually exhausted.

Here are some pointers for friends and family members. They may help make your visit more productive and, hence, more meaningful.

1. What to Talk About??

Many family members never had the experience of spending a full hour, in any capacity, sitting face to face with their Mom or Dad in a bedroom just talking. While they are visiting in a nursing home, they find themselves either running out of what to say in ten minutes or talking excessively, in order to fill every second of the visit with words. Residents have remarked, following a visit from their children, that they had no idea what their children were talking about. They explain how exhausted they both seemed with the unusual amount of talk provided, and how seemingly hundreds of topics were covered in a very short time.

The manner in which we interact with our family members may change when one is placed in a nursing facility. Talking is not as important to the visit, as just being there is. Sitting quietly can be more rewarding than the need to fill a room with syllables. Children of parents need to give themselves permission not to feel the necessity to always talk. It is more important to respond to what a loved one is saying. If they express discomfort with the environment, do not try to fix it right away, but admit the difficulty both of you face with having to see each other in a nursing facility.

Simple is better when it involves conversation during visitations. Most residents want you to help them feel connected to the outside world, as well as to their extended family members. Reviewing what is going on in each family member's life, from the grandchildren all the way to the family pet, is a great means of increasing a sense of connectedness. Bringing in recent pictures of these same people/pets can encourage memory and conversation.

In addition, a visitor should not assume that nothing occurs in the resident's day. They are often involved with a whole host of professional staff and are attempting, at a much later age, to make and sustain relationships with a great many caregivers. Talk about these people, regardless of whether or not your parent recalls their respective names, and discuss the role each one plays in their daily life. Do not accept 'nothing' as a resident's response to the question, 'Tell me about your day.' A visitor, as well as the resident, shares in the responsibility of communication when a visit occurs. Ask to see what they have done in some activity - artwork, etc., if appropriate.

2. Where and How Loud?

Most people feel uncomfortable with raising their voice in casual conversation. If the person you are visiting is hard of hearing, position yourself in a comfortable manner closest to the resident's best hearing side, but not so close so that it is difficult for the person that you are visiting to read your lips. If a resident is in bed, it can be overwhelming to have a visitor come into the room only to place themselves in the towering position over the bedside and attempt to have a conversation in a pitch which is close to actual yelling. Have a nurse make the person you are visiting get into a comfortable position before the visit occurs. Realize that residents themselves have a lot of frustrations with their attempts to find fellow residents who not only can remember things that are being said to them, but who can basically hear what is being said as well. Finally, realize that the staff of the nursing facility is in many ways used to people speaking loudly in order to accommodate a productive visit.

3. Quality not Quantity

'Should I visit daily?' ' How long should I stay?'

These two questions are commonly asked in nursing homes. The answer is unique to the person visiting, and the person being visited. It is important to look at the visitor's time and ability to visit on a consistent and convenient level. What is helpful to a facility, is that a family member attempt to provide established times when visits may occur. In other words, establish in a resident's calendar, and alert the nursing staff of when you will be visiting and the approximate time this may occur. This can help a resident have something to look forward to, as well as help the staff provide you with updates, knowing that you will be arriving on a certain day. There are always exceptions to this rule. When your loved one asks, 'Where is my daughter?' by checking the calendar the nursing staff can reassure them that your visit will occur on a particular day. Do not set days and times that are not realistic to your time schedule. Visits can be exhausting, and you do not want to start a visit in an already exhausted state.

The fact that you visited, is more important than the actual time you spent. An hour can be too much time for certain residents, and exhausting as well. A resident's sense of time in a nursing facility is different than ours. Clocks and timeframes lose some of their meaning in a nursing facility, and are replaced by a connection to an established routine. If a visit feels complete in ten minutes, do not feel that you have done a disservice to your loved one by leaving at that time. They will not recall the time you spent, as much as they will recall that you took the time to visit.

4. Things to Do Together

When we look back at the way we visited our family members before they entered a nursing home, it is often rare for us to see ourselves one on one, face-to-face in a prolonged conversation with a family member sitting in their bedroom. Most visits, prior to a nursing facility stay, occurred over an activity. It may have occurred while the television was actually on, while dinner was being prepared or over an actual meal. It also was commonplace to visit family members with more than just one person in the room. Children of an elderly parent will usually visit their Mom or Dad at home, and do a chore for them, during which time a visit would occur. This also helps a family member stay in a helpful role, as well as having a meaningful interaction with their Mom or Dad.

Thinking about the visit, before the visit occurs, can make an interaction with a person in the nursing home more meaningful. The goal is to attempt to find something that you can both do together, while the visit is occurring. This could mean even watching TV. A humorous television program can act as a positive distraction, if the visit is becoming uncomfortable. If you do watch TV, realize that the staff is very used to the volume of television shows being louder than what most people are normally used to. Bring in a food item and, after checking with staff to make sure that the resident may have the item, feel free to enjoy that food item in the room together with your loved one. Do not feel that it is rude, by any means, to pull the curtain in the room if you need privacy to be with your loved one. You need to feel comfortable. Shopping catalogs to pursue clothing and gift ideas is also a wonderful activity for a resident in a nursing home. Even though the catalog shopping may not involve coming to a purchase, the act of just sitting and looking at items in a catalog can be fun for a resident who is not able to shop the way they may have been used to. Bring the newspaper in, and read it bedside to your Mom or Dad. If you do the laundry at home, bring it back unfolded and fold the laundry together with the resident, making them do some of the work needed to help. Find an activity posted within the facility which encourages family participation, and bring yourself to taking your family member to that program, where you'll find other family members doing the same thing. Also, arrange to have the staff at the facility bring your Mom or Dad to the front seat of your car. With proper positioning and assistance, take them for a long or short drive around the community.

5. When to Visit

A family member, or friend may visit a nursing facility in Massachusetts at any time. It is not required to let the staff of the facility know when you are visiting, but it is always advisable to do so if you plan a late, or a night visit. Some facilities have posted visiting hours, but they are only guidelines.

The worst possible time to visit may be during any change of the nursing shifts. In my consulting of family members, they are discouraged from visiting between the hours of 2:00 to 4:00 PM. This is when the staff of the day shift closes out the written work, and reviews the events of the day with the next shift. The staff's attention during this time is usually focused on getting everything in its place, so that the new shift may enter the facility with relative ease. Hence, it can be a time when the noise level and the sense of responsibility of the staff, is at its highest.

As a visitor during this time, you may sense this disruption. Facilities try to minimize the transition from shift to shift, but it can be difficult to do so. Having excess visitors during changeover times accentuates the level of activity on the floor, and can be very distracting to having a meaningful visit.

6. Be Patient and Flexible!

The best thought out and planned visits, require a moment by moment approach. If your loved one falls asleep then let them! Alert the staff of your departure, and do not make a big deal about it. If you visit, and find that your family member is in an extremely bad mood, it is all right to come back a little later, or just have a shorter visit and return on a different day. Take a break if a visit is not going well. It is fine for a family member to leave the building to take a walk, and come back if they need to.

Visiting a nursing home is not easy for anyone who is not used to the experience. There are people in nursing homes who can help. The worst thing a visitor can do, is to not talk about the experience, frustration, or discomfort that they experience when the visit occurs. Isolation never leads to progress in visiting a loved one in a nursing home. It is important to recognize how hard it is to cope at times. Talk with people who are familiar with your experience and are able to listen and provide a sense of understanding. Ask for help. The Department of Social Work, the Nursing Department, the Director of Recreation or the recreational staff, have a great deal of experience in helping family members cope with the experience of what it is like to be in a nursing home. Many facilities have family support groups that connect families who share similar circumstances. Together they discuss their concerns and come through with remedies to work them out. Most staff working in a nursing facility want to help families. It is important for families to recognize their role on the care team. Seek out one of the staff members to sit and talk privately about some of the frustrations you encounter when visiting your family member in a nursing facility. Together, the experience can be a lot less daunting, and actually quite rewarding as well.

   

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