Additional Observation on Personal Care Exploration

Posted by Allan Tear on September 3, 2008

Observations on Wound Management and Infection Control

Wound care and Infectious Disease prevention in the Nursing Home are issues which may be state regulated and inspected, much like bedsores and medication regimens.  At Tockwotton the government oversight of these issues is irrelevant as the Home’s self-imposed standard of care is far higher than state, which has an allowance for a limited amount of bedsores, while Tockwotton would accept none. In the instance of roommates coming down with infectious diseases the ill resident uses the private bathroom while the other may use a commode or the common bathroom. Some illnesses must also be reported, in some instances requiring staff and other residents to take preventative meds as for the flu. A wound nurse comes in monthly, and patients with lesions that are painful or problematic may go to the Wound Clinic for oversight. Different treatments are administered for different wounds. In the instance of showering the wounds or skin tears may be covered for 2-5 days by a plastic adhesive bandage, called Opsite, which keeps the wound dry and allows for healing. This also isolates the wound from infection. For Assisted Living residents, who have much less medical monitoring and caregiver assistance, lesions which do not heal and which residents cannot care for are a self-identified cause for the move from assisted living to nursing home care. However, this may be misleading as residents who are forced to shift to nursing care prefer to claim a physical/acute reason rather than admit to cognitive failings, increasing balance problems, etc.

Additional Observations on Showering/Bathroom in the Nursing Home

Common/shared bathrooms are cleaned daily and disinfected with commercial/institutional products, Bathing products seem fairly institutional but have age-specific and skin-specific focuses, certainly far from luxury brands used in the consumer bath world. There is little personalization or humanization in the showering experience. Gloves and protocol must be followed but even so could be more spa then hospital. At Tockwotton the staff is very aware that bathrooms (shower and toilet rooms) are inadequately designed space for elder needs. In reaction they gave staff freedom to decorate the bathrooms, to try to make them less unpleasant places, as having difficulty in such activities can be deeply disheartening. The staff and residents collaboratively painted them with themes and nice decorations, which lend a pleasant veneer to a still-unaccommodating environment.

Aside from handrails, the architecture, furniture and fixtures make no consideration for needs of the elderly in general.

Staff believes that residents in Nursing Home side often don’t wash hands because the space is ill suited for poor mobility. To wash one’s hands independently involves placing self (with or without walker):

1. in front of sink, leaning forward to wash
2. readjusting position and leaning forwards to get soap
3. readjusting back to sink to wash off soap
4. readjusting position to side again and higher for paper towels
5. then moving over to trash bin with towels

This process remains difficult or insurmountable for residents despite some adjustments made during the recent redecoration of the bathroom (e.g.; soap and towels moved closer to the sink). Although Tockwotton has implemented Culture Change, allowing residents to choose when and how frequently they bathe, most do only once a week, the same as the non-Culture Change norm. This lends more weight to the anecdotes that the showering process is not a pleasant one, is to be avoided. Assisted living residents who must share bathrooms with suitemates passionately dislike doing so. This is a limitation of the current facility. Although most fixtures are mostly from domestic design (not industrial) in the assisted living bathrooms the overall feel is not that of ‘Home’. Residents are also unable to clean bathroom and happy to allow cleaning staff to do so. Because this space is not really “theirs”, it may explain the lack of personalization and hominess in bathrooms. In today’s America we have an obsession on personal care, spending endless time and money in bathroom products and experiences. The elders we’ve observed do the opposite – they ignore the experience, or try to minimize it. Except for the bathrooms, every inch of most assisted living residents’ rooms are full of possessions and personalized, both to feel at home and because a whole life has been crammed into a small space.  Spaces in cabinets are limited and storage is at a premium.