Category Archives: Interviews with experts

Guest interviews help readers figure out how to solve care dilemmas.

The Nursing Home Puzzle — Advice from Dr. Neville Strumpf

My family has made the choice to keep my mom living at home for as long as possible. But some days can be trying. She wakes up in the grip of sad dreams and I have to lure her closer to some sense of happiness. Washing her, dressing her, and counting pills are chores that I now manage for Mom. Once she is prepped for the day, her determination to enjoy life often returns. She forgets that she was sad and remembers that she’s funny, cute, and worthy of love.

I know this phase of the disease will not last forever. Dementia erases a bit of her skill everyday and we will reach a point where her medical needs may exceed my caregiving abilities. Only then, will we consider placing her in residential care.

To get some advice on the question of choosing a nursing facility, I interviewed Dr. Neville Strumpf, professor emerita of the University of Pennsylvania School of Nursing. While she served as a nursing professor, Dr. Strumpf focused on gerontological care. She has written extensively about nursing homes and health interventions for the elderly. Although she’s been a professor, researcher, and Interim Dean of the school, Dr. Strumpf began her career as a nurse and she still looks at medical issues from a nurse’s perspective. My questions to Dr. Strumpf focused on how to choose a nursing home if a family member becomes too medically fragile for home care. She advised that caregivers should, “Definitely visit the places you are considering and get a good sense of the environment. Talk to a resident and ask them how they feel about living there.”

The big issues that seem to affect the quality of care at any facility have less to do with price and more to do with leadership and the skill level of the staff members. Dr. Strumpf observed that high priced private facilities can have just as many quality problems as publicly financed nursing homes. She says that the main factors that affect care quality are “good leadership, low staff turnover, and the capacity to develop individualized health assessments which will be followed up.

One key item to look for when touring a care facility is the schedule of activities offered for residents. Will their daily offerings engage your family member at a level that is appropriate to their remaining abilities? Will activities help them to maintain a sense of dignity and independence? If you tour a facility and see people sitting around in chairs they can’t escape from, you may be looking at a site that won’t offer its residents many reasons to stay alive or use their remaining skills. That truth may not be obvious when you look at a welcome packet or a website. So it’s very important to visit, ask a lot of questions, and see for yourself.

You should also ask about the number of credentialed nurses on staff and the extent of their experience and training. As Dr. Strumpf pointed out, “The salary levels at nursing homes are much lower than at hospitals and many nurses with higher credentials will pursue those higher paying hospital jobs.” But the fact that a caregiver does not have a Bachelor’s Degree in nursing does not mean they can’t deliver good care. Quality of care is usually driven by the supervisory standards of the site administrator. A site with a compassionate, experienced administrator may be the real jewel families should search for when they consider residential care options.


Enter the Maze — Finding Services for Elderly Parents

When my mom’s dementia began to wreck her quality of life, our family reacted as quickly as we could to resolve the crisis. But it was a bit like having a baby without the nine months of preparation. One night she was weeping because her kitchen sink was leaking and a week later I moved her into my house. Every decision was fueled by worry and adrenaline.

Though I desperately wanted to take good care of her, I was also running a freelance writing business. When you have your own business, you have more freedom to decide when and where you work. But contrary to popular illusions, YOU WORK ALMOST NON-STOP! Most people who write at home keep strict rules about how they organize their efforts. It’s too easy to get distracted if you don’t stick to a schedule and most of us are writing for several bosses at once. The sudden arrival of my distraught mother upset all my work habits and brought the added the stress of keeping her occupied.

During the first weeks of our experiment, I gave her projects like hanging laundry on the line and organizing donation items for Haitian earthquake victims. But my mom could not remember instructions for more than two minutes. She would ask me how to do something, walk into the kitchen, and return a minute later to ask for the millionth time where those blankets should go. Meanwhile, my commas and periods were not getting the attention they needed.

Although I felt guilty, some days I’d drive her to the Senior Center and leave her there for a few hours while I hustled to meet a deadline. But more often, I’d stop and take her for a walk by the pond. The sight of water and steadfast fishermen was one thing that calmed us both.

Eventually the people at the Senior Center told me that although she was welcome there, she would be better served by an Adult Day program. I had never heard of this kind of program and didn’t know how they could help my mom whose dementia was advancing faster than we could respond.

When I finally found the Adult Day Care Center in Palmerton, it brought enormous relief to both of us. Staff members there are kind and highly skilled. The place gives off a strong family vibe and the atmosphere exudes compassion. The first day I left her there, I cried like a parent whose child just started kindergarten. Today the only weeping Palmerton inspires is the occasional tear of joy when I realize how lucky we are to have access to such a good place.

I wish it had been easier for us to figure out how to help my mother. Every decision we made was either random or driven by an off-hand suggestion from a stranger. Since we began this journey a year ago, I’ve done a lot of research on services for the elderly — especially those who suffer from dementia. Some regional resources can be found in this link to my recent article in Carbon County Magazine. Upcoming posts will feature information from state and national experts who may offer insight to families in other places. Like most mazes, you can enter the puzzle of elder care at many different points. But we could all use some kind of compass to guide our choices as we proceed.