"This Nursing home is like a Prison"
As a nursing home clinician and geriatrician, I used to internally scoff and guffaw when my residents said this. But now I just take it as just the fact of their reality.
I’ve worked at my current nursing home job for about 15 years. Because of where I am in my career and the nature of the specialized population and employer I work with – I am able to work at a single facility, as opposed to what I used to do as a nursing home consultant - running around consulting at several private skilled nursing facilities trying to scrape together a living. I’m lucky.
Because of how my career has gone - first as a roving consultant and now as an in-house, salaried staffmember - I have a bit of perspective. I’ve worked at some of the best nursing homes – I’ve worked at the the ones with the sleek grand pianos in the activity rooms and the degreed volunteers who come and play music for the residents and do lectures for them. I’ve worked at the so-called “Eden homes” – the ones where there is music, and animals, and artwork, and an emphasis on making a nursing home less into a hospital and more into an actual home – at least as best as can be created under the circumstances.
I’ve also worked at some of the worst nursing homes – the ones where they are “on probation” – i.e., where the Centers for Medicare and Medicaid Services (CMS) essentially is threatening to shut them down for serious violations. The paint is always an institutional faded blue or green, and is often peeling. There are few or no decorations and homelike touches in it. It’s gray, drab, and institutional. The residents look depressed. Most telling of all - these are the nursing homes that have that horrible stench – that smell that follows you no matter where you go in the facility.
So when I started working at my current facility – which I was glad to do – to have an office and to not have to run around to multiple nursing homes, and earn a salary – I was extremely glad to be working at a quality facility.
Where I work now. Pre-COVID - we used to be an Oasis!
At my nursing home, we have dedicated staff that others take for granted – for example, we have Recreation Therapy (RT) staff – actual therapists, rather than just “activity coordinators.” We have physicians on-site at our facility five days per week. We have a psychologist on staff. We have dedicated volunteers who for years have ran wonderful activities with our residents. Our facility has never had “that smell” – it’s always smelled like cleaning fluid, or food.
Residents used to regularly leave our facility for outings – for visits with family, friends, or our RT staff for movies, restaurants, home, famer’s markets, or what have you. Since we are a skilled nursing facility and we are unable to provide 1:1 care for our residents, many of our residents’ families would pay to have a “paid companion” service to come sit with them (these are non-medical services typically provided by services like Visiting Angels[1]). Many of our residents have greatly benefited from these paid companion services – which have made a difference in some cases between declining functioning and depression (e.g., often called ‘failure to thrive’) and some measure of a pleasant quality of life – the simple pleasure of having a friendly face to look forward to on a regular basis.
We used to have a full, packed calendar of activities and community outings available weekly for our residents. Opportunities to come and go with family and friends for day trips and (if family or friends could arrange the care - which we would help with) overnight trips with the family if family desirable. Volunteers of all kinds regularly visiting - and the holiday celebrations we had! Christmas, New Years, Thanksgiving, Memorial Day, Fourth of July, barbecues almost back to back during the summer months - bingo games, et cetera.
Basically, for all intents and purposes - prior to COVID, my nursing home was, comparatively speaking anyways - a complete oasis compared to probably 90% of the nursing homes I had consulted in before. In fact - our upper management had a saying which I used to hear regularly for years. The point of providing services in our nursing homes was to provide them with a “homelike environment.” We weren’t a hospital - we were a home.
So - and here’s the point - over the last decade and a half or so when I worked at my nursing home my residents would sometimes complain to me that living in a nursing home was “like a prison.”
This always provoked a reaction in me.
First of all, as I used to be a roving consultant before I became salaried staff at my current facility and was aware of what really bad nursing homes were like, I would sort of shrug and think to myself that these guys and gals really don’t know how good they actually have it here.
Second - and I didn’t mention this before - I actually briefly worked as a medical consultant at an actual prison once, a long time ago (and yes, it was very unpleasant - they couldn’t pay me enough to stay).
So, between those two experiences of mine - when a resident told me “doc, this place is horrible, it’s like a prison” I would be able to almost internally guffaw at them. "No it’s really not,” I would say to myself, and kind of almost roll my eyes. Of course - it’s stressful and definitely not fun to be stuck in a nursing home for whatever reason, and so I can have empathy for that - but no, that’s silly. My nursing home? It’s NOT like a prison. Of course it wasn’t.
How things are Now
The point is – and as I’ve belabored now in two separate articles – these things have all basically completely changed over the last two years.
There are (still) no more paid companion services at my nursing home. They have all stopped, “because COVID.” Outings are also banned, except for pre-approved medical appointments. Can’t visit home, can’t go to a movie, can’t go to a restaurant.
Scheduled, time-limited, in-person, managed family visits with PPE and social distancing (no hugs or kisses) have been allowed for a few weeks or a month or two at a time over the past 2+ years. But – these have been broken up by ‘snap lockdowns’ reimposed as positive COVID cases – not necessarily symptomatic ones either - pop up amongst residents or active staffmembers, and residents are then relegated to having family visits take place over iPads only (e.g., Facetime or Zoom).
Regarding outings - over the last few weeks, our RT service has began taking residents outside of our building 3-4 at a time in our van for a drive around town. But - they don’t get out of the van. Much like the so-called “virtual visits” with family members, where instead of visiting with family face-to-face, we instead put an iPad in front of residents and have them do it over Facetime – residents aren’t actually allowed to directly interact with the outside world – they just get to see it behind glass. They never get to actually be out. They just get to look, and that’s it.
Conclusion
It is like a prison. Living in my nursing home is, with very little exception - is far, far more like a prison than it ever was. They are not allowed to leave. Visitation is tightly managed. Everything they do is subservient to virus control. My residents have not had one single chance to visit home since they’ve come to stay with us.
It is like a prison.
[1] Not an endorsement!
You’re right. I have lived it and I am certain covid restrictions have, in these 2+ years, “slowly” killed or significantly destroyed the health of more healthyish retirement home residents than covid ever could.