Myths & Realities of Living
In a Nursing Home

Many people fear the move from their own home to a nursing home. They do not know what to expect at the nursing home. Health-care professionals understand these concerns, and want residents and their families to know the difference between myths and realistic expectations of life in a nursing home.

Myth #1: A nursing home is like a hospital.
Reality: A nursing home is not a hospital. Many people, especially after recent hospitalization, think of the nursing home as an extension of hospital care. They expect the same kind of intensive care they received in the hospital. A nursing home is different. First, it is a home with nursing care available as needed, 24 hours a day, 7 days a week.

The goals of the nursing home are to:

• Rehabilitate the resident to maximum potential and enable him or her to return to independent living arrangements if possible;

• Maintain that maximum rehabilitation as long as possible within the realities of age and disease;

• Delay deterioration in physical and emotional well-being; and

• Support the resident and family, physically and emotionally, when health declines to the point of death.

Myth #3: There is no privacy in a nursing home.
Reality: Because so many nursing home residents need constant supervision, nursing homes are designed so that staff can be aware of residents' whereabouts at all times. However, each resident has the right to privacy. Staff, family members, and visitors are encouraged to observe the common courtesy of knocking before entering a resident's room. The nursing staff, both professionals and nursing assistants, are trained to respect the individual resident's modesty and prevent unnecessary exposure when providing personal care. Family members and residents should expect privacy and remind staff of its importance if they seem to become careless in this area.

Myth #4: Nursing home personnel are not always gentle and caring.
Reality: Some things about working in a nursing home make the job difficult. Lifting and moving adults who are unable to help themselves is physically demanding. Understanding the needs of residents who may be confused or unable to communicate for a variety of reasons is emotionally exhausting. Nursing home staff members care and try hard to do a good job. However, they will have times when, because they are human, they will fail to be their very best selves. Residents and families understanding will help as will their praise for a job well done. Residents have the right to expect good care and the privilege to complain if it is not received.

Myth #5: If I enter a nursing home, I'll never go home.
Reality: The primary goal of the nursing home is to rehabilitate the resident so that he can return to the community. In fact, 30% of all residents are discharged to home-like living arrangements. Those who cannot return permanently to their homes make short visits, health permitting. In some states Medicaid-certified nursing homes are required by law to hold a place for a resident who wants to leave the facility for a few days. You can find out about the law in your state by asking the nursing home administrator or by calling the state Medicaid office. Physicians, families, and staff should truthfully answer the resident's questions about the possibility of going home.

Myth #6: Nursing homes have an unpleasant odor.
Reality: Nursing homes should not smell of urine or feces. At times unpleasant odors may be noticeable; that is true in a private home also. Some residents do lose control of bowel and bladder functions. Many times residents who can regain control are offered retraining programs to correct the problem. For others, proper attention to bathing and changes of clothing eliminate stale odors. The facility that is furnished with materials that do not absorb and retain odors and is kept clean with today's effective cleaning materials should have no noticeable unpleasant smell.

Myth #7: Because nursing home care costs so much, the staff should wait on the residents.
Reality: Some residents feel that because there is a charge for care that the staff should be their servants. In reality, though, if the nursing home is to meet the goals of rehabilitation, maintenance, prevention, and support, the staff must encourage each resident to do as much as possible for himself. Independence is important to self-esteem. To plan and carry out care that promotes self-care, the nursing home staff must have expertise. It is that for which you are paying.

Myth #8: Nursing home residents do not receive adequate care.
Reality: Stories about neglect of nursing home residents make news precisely because they are not typical. It is true that a patient's request for attention is not always immediately answered. There may be an emergency elsewhere in the building that requires the staff's attention. Other residents may be receiving care at the same time so that assigned staff has to delay responding to the request. Repeated incidents should be brought to the attention of the nurse in charge or the administrator.

Myth #9: All residents in nursing homes are female.
Reality: It is true that women outnumber men. In fact, 80% of nursing home residents are female, a situation that reflects the truth that women outlive men. It also means that one of every five residents is a man.

Some married couples enter nursing homes together and share a room. The patient's bill of rights mandates that this be permitted in Medicaid and Medicare institutions.

Myth #10: Families and friends abandon nursing home residents.
Reality: When an elderly person needs more physical care than his family can give, and he or she is admitted to a nursing home, the professionally trained staff takes over a portion of the care. However, the continued social and psychological support of family and friends is essential to the patient's well-being. Many families visit daily. Most nursing homes have liberal visiting hours and are willing to extend those hours in special circumstances. Nursing home staff members are encouraged to make visitors feel welcome and, ideally, relationships between residents and their family and friends continue as they were before the nursing home placement.

Myth #11: The food is terrible in nursing homes.
Reality: Good food is a matter of individual preference. Everyone has certain customary dishes and styles of preparation that no one else can duplicate. In the nursing home some residents are on restricted or special diets as ordered by their physicians and thus have limited food choices. Furthermore, eating similar menus in the same surroundings day after day becomes monotonous. After a while nothing seems appetizing. However, nursing homes employ dieticians to plan menus that are palatable, attractive, and meet the nutritional needs of the individual. Food that is well-prepared and attractively served, warm or cold as appropriate, is the standard for any nursing home. Dietary staff should be available to discuss problems concerning food and should be expected to alter menus within the limits of prescribed diets. Most nursing homes allow family and friends to bring favorite foods to residents from time to time and also give residents an opportunity to do some cooking for themselves.

Myth #12: My possessions will all be lost or stolen in a nursing home.
Reality: In any institutional setting there will be misplaced objects, errors in sorting clothing, and even theft. Before anyone assumes that an item has been stolen, he should consider that a disoriented or forgetful resident may have misplaced it. If other relatives have visited recently, they may have taken the item for laundry or mending.

Many homes recommend that valuable jewelry and large amounts of cash be kept in a central safe to which the resident has access during business hours. All residents should have a drawer, closet, or chest that can be locked. Family members are reminded to label all clothing and personal effects with the resident's name.

Despite all the safeguards thefts may occur. When that happens, administration should be expected to cooperate fully with the family in apprehending the person responsible and notifying proper authorities. A staff person guilty of theft can expect immediate dismissal.

Myth #13: I should be able to bring my own bed into the nursing home.
Reality: Most nursing homes do not allow residents to use their own beds. There are two reasons for this. First, almost all nursing homes have hospital-type beds in all rooms. These beds can be raised or lowered to help the resident get in or out of bed. The head or foot position of the bed can be raised or lowered. This makes providing care easier for both resident and staff. Second, nursing homes must satisfy safety and health regulations that allow only certain kinds of beds in a nursing home. Home mattresses seldom are fireproof, and it is not uncommon to find that the hygienic standards required by law have not been met with home maintenance techniques.

Myth #14: I'll be given medications that will cause me to lose control of my thoughts and actions.
Reality: Every person has the right to know what medications he or she is taking and has the right to refuse any or all of these. Tranquilizers, pain-relieving medications, sleeping pills, and mood changers are all powerful drugs and do have a profound effect on how alert one remains. Properly prescribed, these medications help rather than harm individuals. Staff, residents, and family all have a responsibility to ask for a review of prescriptions by their physician or a pharmacist if they suspect medications are being used improperly.

Myth #15: I'll be physically restrained in the nursing home.
Reality: Restraints (cloth bindings on chairs or beds) may be used in nursing homes only under two conditions:

1. When an individual is confused and unable to comprehend or remember that by moving about he may harm himself or someone else, and

2. When a person is unable to maintain his position because of a severe physical handicap such as paralysis. Restraints are used only for a resident's own safety; they are never to be used without a physician's order and then only for the span of time absolutely necessary. People in restraints are checked often. The restraint is then repositioned and the patient moved every hour.

Entering a nursing home should be approached with as much thought and preparation as any major life change or any major expense. You should meet the administrator and discuss thoroughly the base price and any extra expenses you can expect to incur. Some homes have extra charges for such services as hand feeding, incontinent care, and personal laundry. Obtain in writing what your basic charge will be, and understand clearly all financial arrangements before signing a contract.

Myth #17: Because I am physically weak and helpless, I have no one to help me get the services I want and need.
Reality: Every state government has a nursing home ombudsman program. Representatives of that program have the authority to help nursing home residents resolve problems that are not of a medical nature. They may resolve complaints with persuasion, or they may encourage legal action if necessary. Information on how to contact the local representative of the ombudsman program is available from the nursing home administrator or his/her number is in the local telephone directory in the government section.

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