Nutrition And Care For Nursing Home Residents (Con’t)


In trying to mitigate the negative effects, terrible conditions of the nursing homes and provide proper nutrition for the elderly, the major obstacle is the finances. Without the support of the state and well-wishers to offer better living conditions in such homes and ensure that they are well staffed, the problem is likely to escalate and even become worse.

A major cut down on the budget financing by the state of California towards the elderly was seen as a move that would save the state $111 million as depicted by Medical News Today. On the other hand, this was to negatively impact about 1100 residents of the counties of Alameda and Contra Costa who are dependent beneficiaries of the program. A large number of the beneficiaries are old people who will be forced to seek help from other sources such as general assistance programs.

There is a need for change in attitude towards nursing homes despite the fact that it is a challenge that has more to do with personal choices that are not illegal. Whenever one chooses to quit his or her job as an employee in a nursing home in NYC, it is not a crime but the negative implication is that there will be a shortage of staff. As this continues, there will be an ever diminishing number of people who are willing to work towards the welfare of the elderly in society. This cuts across all professions that are relevant to such homes such as nutritionists who are key players in ensuring old people get the best nutritional help they need. The negative attitude permeates to all other kinds of employees working in nursing homes and not only leads to a breach in the special duty of caring for the old but also extends to levels where some engage in acts with the intention of harming the elderly.

State of the Society

Besides the regulatory requirements, there are other important factors that need to be considered by families of the elderly before committing them to a particular home. Some of the factors that can offer guidance on choosing the right home are discussed below.

Nursing Home Staff and Credentials

In addition to considering whether the members of staff as well as the institution itself is licensed, it is important  for the family to establish whether the staff has necessary qualifications and that there are training provisions. A family should also consider whether the facility has the required number of licensed RNs staff at any given time.


Cafe in Nursing Home

Nursing Home Care and Service

Be sure to ask for the resident’s bill of rights and have a keen look at the neighborhood ideology not to mention the distribution of residents in the facility with dementia. The facility should also have social service workers who have a huge role to play in ensuring new as well as existing residents have a smooth transition and can stay easily with the rest of the residents. Other factors you need to consider are the meals they provide, the noise levels in the surrounding as well as the general cleanliness and sanitation levels of the facility.

Nursing home safety and accessibility

Ensure the facility is secure enough and easily accessible for both you as the family and the elder. In fact, this is a top priority when looking for the right facility. Some of the security detail you should be keen enough to check include the emergency preparedness, location of fire extinguishers and the history of their checking, stairways and emergency exists, safety facilities such as smoke detectors and the ease of movement for the elderly including those on wheel chairs. The secret is to pay attention to detail and ensure that there are minimal risk factors. Have a look at the floors and establish whether they pose any danger as a result of slipperiness. Spaces between tables in the dining areas need to be enough and the bathing devices must be safe and well fitted with handles for enhanced support.

These are but some of the major considerations each family should make before choosing a particular home to care for their loved one. Secondary considerations which are equally important include the type of amenities and general comfort the facility offers. This may include resident grooming, laundry facilities, friendly communication, banks, heat and air conditioning facilities fitted with emergency response systems and even salons.

A good nursing home should be geared towards ensuring all residents are comfortable and in their best state of health. Some homes even go a step further and provide various recreational facilities such as gyms with licensed fitness instructors, nature walks and computer rooms in addition to social platforms such as religious provisions where the elderly can get spiritual nourishment. The whole idea is to look for a facility that is able to offer more than just the ordinary so that your loved one receives all rounded care.

Nutrition And Care For Nursing Home Residents

Elderly Care by Nurse

People who have attained the age of 65 years and above are considered to be the elderly and senior citizens in the USA. The country considers such citizens to be at the age where they have fully contributed to nation building and can retire to the retirement homes in the countryside, some opt to leave the county and spend the rest of their lives in other countries.

The Federal Interagency forum on Aging-Related statistics has it that in the present generation, the population of the older Americans is living longer than before and growing much faster than ever before. The report indicates that Americans at the age of 65 years can expect to live an average of 18.5 more years which is an increase in 4 years from indications in the 1960s. Moreover, those men and women who live to 85 years have averages of 5.7 and 6.8 more years to live respectively.

As much as this is good news, the longer life does not come easy or cheaper. The annual healthcare costs not to mention the effects of inflation make it harder for the senior citizens to earn a strong and healthy lifestyle. Estimates have it that the annual healthcare cost in 1992 was $9,224 and rose to $15,081 in 2006. Even worse is that the trend is expected to keep rising each year according to the National Institute of Aging.

There are quite a number of challenges that the aged face in this current society. The two major sociological challenges faced are poor nursing home facilities which result in social isolation and poor nutrition that leads to the prevalence of medical conditions. The two challenges may occur concurrently or may manifest independently.

Definition of concept

The average American worker is often too occupied and busy to spare some time to care for the elderly. They are busy looking for a livelihood and building their careers for better financial security. This is one of the main reasons why the elderly are sent to care homes as a way of helping them retire with dignity and live comfortable lives after their active years are over. The result is usually the opposite of the expected. Life for the elderly, in most cases, is neither comfortable nor desirable. Most of the elderly folk end up leading lives of isolation. This concept paper aims to examine the extent to which the two issues of quality of home care institutions and nutrition have deteriorated, examine the possible reasons for the deterioration and suggest possible remedies to the problems for a healthier and better American society.

Defining attributes

Social isolation of the elderly does not only mean being alone but also lacking in the basic necessities that would otherwise be provided in a normal social setting. One of the reasons for social isolations stems from the type of nursing home that the elderly retire to. Choosing a good nursing home can be quite challenging at times as most of the nursing homes are nothing close to what the elderly expect of a decent life. Most facilities are deprived of sufficient facilities and the elderly merely end up more stressed out, lonely, uncomfortable and in daily risk of their lives. The situation is even made worse by being compelled to take wrong diets for their ages by members of staff who are neither competent enough nor qualified to work with the elderly. In fact, most staff members in such facilities are intolerant and do not care about the people they are taking care of. It is on this basis among others that this paper provides guidance to those looking for nursing homes by taking into consideration several factors before settling for a particular nursing home. The paper also outlines that it is important to consider the nutritional care the elderly are put under so that it is appropriate for them whether in the nursing homes or at home.

Several factors have been identified as those that lead to segregation of the elderly and isolation to unfortunately poor health care in nursing homes in the USA. These factors are economic, political, ethical, legal and practical among others covered below.

Nursing Home

Economic factors

This refers to the factors related to the financial assistance to the homes so that they are kept running daily and to the acceptable levels. A survey conducted in 2002 in the state of California revealed that most of the free standing nursing homes in the state did not meet the minimum threshold for the state’s staffing criteria for nursing homes. As reported by Consumer Affairs, the California Healthcare Foundation established that the low staff levels was largely attributed to high staff turnover as about two thirds of the people employed at nursing homes left their jobs. This was mainly as a result of the economic forces and poor quality of care in the nursing homes.

Legal factors

Nursing homes are often plagued with legal issues that come up quite often thus compromising the life of the elderly in the respective homes. The legal issues arise from factors such as negative attitudes and sheer resentment of the elderly. As depicted by Narinder Singh, such abuse can manifest in the form of physical, sexual or emotional not to mention severe neglect. In some cases, abuse is in the form of financial fraud or even extortion. These are only but some of the legal issues the elderly face in nursing homes every day contributing to a diminished quality of life in such homes.

Reasons for such abuse vary. Some nursing home employees simply enjoy the sense of power they have over the elderly whereas others engage in such abuse out of resentment. It may also be a form of intimidation probably for financial gain. Such abuse has a very huge negative impact on the elderly and makes them uncomfortable at the nursing homes. It even gets to an extent where they feel isolated and that society no longer cares for them.

Medical factors

The elderly require proper nutritional care and heath as they are generally very sensitive. So as to maintain a healthy state and strong body, proper nutrition is very important as they are prone to malnutrition and obesity if the food they take is substandard. Proper nutrition is essential in ensuring they have good vision, maintained levels of blood sugar to avoid diabetes, proper digestion, maintained muscle and bone strength and enough energy as observed by Elder One Stop. Society has not done enough to ensure the elderly get proper nutrition the lack of which can result in severe nutritional problems. This is why it is important to better the social lives of the elderly in such nursing homes.

Cultural factors

People come from different societies with varying practices and ways of doing things. Once the elderly leave the comfort of their homes and head to the nursing homes, they often find some changes they did not expect and are rather strange to them. This includes a change in the cultural practices or the cultural environment. Most of the people currently in nursing homes are from older generations where cultural practices play a significant role in life. This is one of the reasons they get cultural shocks when they can no longer identify with a culture they are used to. This is also exaggerated by the fact that they meet people from different cultural backgrounds and different beliefs yet they have to live with them. This culture shock has a significant effect on not only the lifestyle of such elders but also their eating habits as established by the American Speech-language Hearing Association (ASHA). It is an issue that affects both the nursing home in its ability to provide comfort as well as the overall well-being and nutrition of those in the homes.

The Ovewhelming Challenges Of Emergency Room Care

Baylor Health Care System

Baylor Health Care services seven counties within the Dallas Fort Worth metroplex. This is a not-for-profit medical network, and it is faith-based. It consists of primary care centers, senior health centers, the Baylor Research Institute, rehabilitation clinics, and hospitals. The fiscal year statistics for 2003 show that Baylor is carrying a $543.9 million dollar long-term debt, along with $2.0 billion overall assets, $180 million dollars in community benefits, and $1.7 billion dollars of total operating revenue.

Its emergency rooms, on an annual basis, treat more than 54,800 patients per year. In 2004 alone, the total number of emergency room patient visits was 247,224 (this figure reflects combined facilities). Baylor delivers full emergency services and are available 24/7. Their physicians and emergency staff hold years of training and experience. An article posted on WebMD states that 18 people die every hour in the U.S. due to injuries. The Center for Disease Control published a report that stated “Unintentional or accidental injuries are the 5th leading cause of deaths within the United States, and are responsible for one out of every three people arriving at the emergency room to get treatment.

Roadblocks & Constraints

Like other departments, the emergency room has gone through radical transformations over the past few years. The services it once offered have been expanded and are more complex. Stephen Williams states that because of healthcare changes and the overwhelming number of under-insured and uninsured, our medical emergency rooms are now treating more patients for primary care. What emergency room treatment was intended to be, was to a way to treat those who were actually under distress or in a medical crisis, not for treating runny noses or bad coughs. Emergency room abuse has gone on for around 20 years or more now. They’ve found themselves being integrated into other community resources like mental health centers, voluntary agencies, and drug and alcohol centers. During this time when so many hospitals are closing down their emergency departments because of staffing issues and over-utilization, Baylor stays continuously focused on having the ability to service its surrounding communities. In the majority of hospital settings a normal emergency room visit can last from 4 to 6 hours. Many emergency rooms lack space and inpatient beds. In general emergency room situations a lot of the emergency room staff have to be prepared to deliver immediate medical attention for a large amount of patients without being overwhelmed. They need to have the ability to assess and prioritize situations quickly (triage). This enables them to treat the patients who are seeking care, in a way that gets the most ill or injured patients taken care of first. Hospitals are essential and irreplaceable resources when it comes to planning, responding, and recoveries associated with emergencies. However, they carry with them, a unique set of constraints. These constraints make effective and efficient participation in these kinds of efforts a challenge at best. On the whole, hospitals face very difficult financial times. Nearly 30% of all U.S. hospitals are now operating with a financial loss. The costs have not been the only item that is increasing. Healthcare facilities too, are not exempt from government regulations. One recent example of this is HIPPA (Health Insurance Portability & Accountability Act). They are also strongly affected by the changes in patterns of Medicare reimbursements. Accredited hospitals also have to deal with nongovernmental agencies like the Joint Commission for the Accreditation of Healthcare Organizations. To achieve and then maintain their accreditations, these hospitals must comply with JCAHO’s consensus standards as they are demonstrated during periodic remote and onsite surveys. These standards are diverse and are generally derived from ethical, clinical, environmental, technological, or occupational indications. As it is with many government regulations, there is a tendency to add more expense without being accompanied by new streams of revenue.

Hospitals rely as much on public trust as they do reimbursement revenues. More than most governmental agencies or corporations, healthcare facilities suffer a crisis they are unable to respond to. They stand to lose both their funding and their patients, as well as their reputations. The expectations (mainly blind assumptions) are that these hospitals ought to have the ability to take whatever they get, and do everything right first time out. In regard to emergencies that includes -

  • Managing medical assessments, treatments, and the continuing care of acute incidents that involve a large number of patients.
  • The effective management of contaminated patients.
  • Recognizing, then identifying, and finally managing the consequences of bioterrorism.
  • Protecting their employees, their patients and families, as well as anyone else within their facilities.
  • Dealing with all the above while continuously providing everyday emergency care and treatment.



The Solution

Although there is no solid and certain solution for minimizing hospital misuse in emergency rooms, there is one sure thing – Baylor continues to rise up to meet the challenge head-on, keeping staff and patients in the forefront. That helps to give them the ability to accommodate the plethora of challenges that today’s emergency rooms face.

It has been required of hospitals for many years, to have and to exercise solid emergency preparedness plans. (commonly referred to as ‘disaster plans’). The JCAHO, since January of 2001, requires that hospitals keep a comprehensive plan ready and in place, for covering emergency management. There are four traditional phases of this management, which are -

- Preparedness
- Mitigation
- Response
- Recovery

An analysis of hazard vulnerability, which is part of these new standards, would be used to not only determine what is most likely as well as what are the most catastrophic events, but would also help to identify an overall range of the hazards seen for any one hospital.

This type of ‘all hazard’ approach, as it is with municipal emergency operation plans, enables preparedness and also a measured, as well as flexible, response to a broad range of potential incidents. Information posted on states that plans are intended to be tested and then updated by no less than one tabletop, or a similar exercise, as well as on actual activation or full scale exercise per year. Additionally, aside from these preparedness requirement, the hospitals also fall under the regulations of OSHA (Occupational Safety & Health Administration).

As it is with so many federal standards, these requirements for the hospitals under the OSHA standards are always open to interpretation. A lot of this rides on non-standardized sources, like OSHA interpretations and opinions, which are actually the closest you can get to the ‘de facto standard’. This lack of a clear or consistent application of the OSHA regulations has proven to be a real obstacle to developing consistency. While there has already been, and will most likely continue to be, substantial improvements, the majority of hospitals are still quite unprepared for effectively managing the results of major incidents like terrorism, infectious disease breakout, mishap, facility evacuation, staff protection, or natural disaster. An incident that is contemporaneous with regional or local infrastructure disruption, is not only going to magnify the shortcomings of hospitals, but also further the hampering of effective hospital response as well as community recovery. In retrospect then, to be prepared for handling such emergencies on every level, whether it be a national or a community level, these hospitals need to receive solid financial support as well as good technologies and ongoing internal training. Society is ever-changing, and hospitals have come under harsh scrutiny, and this is perhaps the only way they will be able to overcome the challenging demands of unforeseen emergencies.