Wednesday, May 11, 2016

Steve: First Day of Class: Can nursing homes do more?

Jönköping University 2016

It was a marvelous day today in Jönköping, Sweden, with sun and a deep blue sky. After a morning of discussions of old age care in Sweden, we went on a visit to the first of 3 nursing homes we will see during the course.

The building was old, built on the model of a hospital, and not like more modern designs that are homelike and encourage activity and interactions among residents. On the plus side, residents had their own rooms with their own bathroom. None of the lunacy of roommates.  Really, if you are old and frail and maybe have a bit of difficulty remembering, would you want to share your room with a complete stranger? The rooms were filled with residents' own furniture.   Importantly, residents signed leases to their apartment, a small matter perhaps, but one that calls attention to the staff about how they should be treated. As the director told us, she wants the staff to see themselves as going into someone's home, and not thinking, "It's my workplace."

The director stressed the importance of giving care that "helps people keep living their life the way they were."  She talked about new initiatives in Sweden to learn residents' values and to plan care and activities around these values.  And not to do the expedient thing.  This can be hard when what the person wants to do involves safety and hygiene, for example, to refuse repeatedly to shower.  "We have ethical discussions and reflections" to find a way to solve these kinds of problems and give care that supports the person's values. When have you ever met a nursing home director who has ethical discussions with her staff?

American nursing homes are also emphasizing person-centered care that respects the person's own preferences and values. Some places like the Abramson Center outside of Philadelphia get it right. In many places, however, they’re just empty words. Here, it's the law and everyone is expected to find a way.

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