Participants: Don Mackintosh, Kevin Bryant
Series Code: HFAL
Program Code: HFAL000038
|
00:51 Hello and welcome to "Health for a Lifetime"
00:54 I'm Don Mackintosh, your host, 00:56 and today we're joined with Dr. Kevin Bryant 00:59 from Wichita, Kansas. 01:00 Welcome Dr. Bryant. Hello 01:02 What kind of medicine do you practice there in Wichita? 01:04 I'm in family practice, but primarily in the area of 01:08 geriatrics and long-term care medicine. 01:11 So when you say "geriatrics" what age group would that be? 01:14 Most people think of that in the 01:16 over 65 retirement age population... Which is an 01:20 increasing population in America isn't it? Absolutely 01:23 Today we're going to talk about a subject that 01:26 many people in that age category, but OTHERS 01:29 you know, family members deal with, and that's 01:31 nursing homes, and more specifically, 01:34 choosing a nursing home, 01:36 and I think that's probably a very important topic 01:38 for the time in which we live. 01:40 Yes, studies show that in America, 43% of Americans 01:45 at some point in their lifetime will spend some time in a 01:51 nursing home, so it is an important topic... 01:54 and for children of aging parents, or sometimes spouses, 02:00 this may be one of the most important decisions 02:03 that they need to make in their lifetime. 02:05 Probably a lot of anxiety too, that goes with that decision, 02:09 both for the people that are considering it, 02:12 and those that are maybe going to be in that home. 02:16 Is that the only choice they have... 02:18 Is the nursing home the only choice they have? 02:20 Well our first illustration talks about some of the 02:24 other options, and obviously, a home setting is going to be 02:30 your best environment, because it provides that 02:33 familiar setting and surroundings; 02:36 people that the person has known for a long time... 02:40 And if they have some memory impairment, these become 02:46 very important to helping them remain calm. 02:50 But it does frequently require 24-hour a day coverage and care 02:57 So that's why, at times, it becomes almost impossible 03:02 for families to care for their aging loved ones at home. 03:07 There are some ways that they can try and supplement 03:11 that 24-hour coverage by adult day care centers 03:16 where if they're working, they can take their 03:20 family member to an adult daycare center, 03:23 and sometimes respite times. 03:27 These are where they can take the aging parent to, 03:33 for instance, a nursing home for maybe a week 03:36 if they're wanting to go on a vacation or something like... 03:40 it gives them a break so that they can recoup their energy. 03:44 These sound like excellent ideas... 03:45 I don't know if everybody would know about those ideas, 03:49 but let's say, someone there is saying... 03:51 "Hey, you know, I'm watching this program, and I know 03:54 that we have to face some of these decisions," 03:57 who really should they be talking with? 03:59 Who should they go to, and counsel with concerning 04:03 finding the right type of situation... 04:05 the right type of nursing home. 04:07 Well as a Christian physician, I believe we have a source 04:13 of knowledge that we can tap into... 04:17 And our next illustration gives us a verse from Psalms 32:8 04:23 where God promises that He will instruct us and teach us 04:27 the way we should go; guide you with My eye. 04:31 And I think this goes even to the point of being able to 04:34 guide us to just the right nursing home environment 04:39 for that parent, or spouse... 04:41 And I believe God is interested even in those choices. 04:45 Claiming that promise! 04:46 Have you had people that have claimed that promise 04:48 or have really done that that just come 04:51 and felt driven to talk to you? 04:53 I can't remember any exact instances, but I know 04:59 of the families that I work with, many of them Christian, 05:02 are deep in prayer about this issue. 05:06 What kind of... you know, someone is just starting out, 05:10 maybe they really have been in prayer about this... 05:12 Maybe they have counseled with people professionally. 05:16 Maybe they're not really doing some of those things, 05:20 what initial advice would you 05:22 give anyone looking for a nursing home? 05:24 Well first of all, one trap that I see in this next illustration 05:30 talks about it, is that frequently, people fall into 05:34 a trap by thinking "I need to find the closest long-term care 05:39 facility to my home so that I can be quickly there if needed 05:45 And actually, being able to look a little bit farther out, 05:50 maybe that extra 5, 10, 15 minute drive may be able to 05:55 expand your search to facilities that would actually 05:59 serve that loved one better, 06:01 and so don't be cause in thinking, "I have to stay close" 06:05 Is that for the people as much 06:08 as the person that's in the nursing home? 06:10 Is it good for the person that's in the nursing home 06:12 to be further away? 06:14 Not necessarily, but just that you don't want to 06:18 keep your focus of where you're looking so close that you 06:23 leave out other facilities that may be actually better 06:26 than those closest to you. 06:28 Another trap is looking at the expense... 06:32 Now I know that nursing home expense and long-term care 06:38 facilities are a tremendous expense, 06:41 but sometimes just a little bit more spent per month 06:45 can get you into a whole new 06:49 arena as far as nursing home care. 06:53 And not always, as we show there, the fanciest home 07:00 may not be always the best, because the care being given 07:05 by the individuals in that facility is the 07:08 most important issue, not necessarily the 07:11 surroundings that they're in. 07:14 And what you have here, the large chain homes, 07:17 versus the smaller... is bigger better? 07:19 The large chain nursing homes do bring some things, 07:24 as far as being able to have sometimes expertise of 07:28 consultants that can help that nursing home with certain issues 07:32 But on the other hand, a smaller privately owned home 07:37 may have a more stable staff, 07:40 and may have people that are there more concerned. 07:45 It depends on the staff. 07:47 You see a lot of nursing homes, 07:48 I don't think those who've joined us would know, 07:53 but how many homes do you see a year? 07:56 How many places do you frequent? 07:58 I have patients in roughly 20-25 different nursing homes. 08:04 So I see the whole gamut of what's out there 08:08 in the long-term care industry today. 08:10 So you're looking really... 08:12 we're talking with someone here who really has seen a lot. 08:16 So when we're talking to you, we're talking to someone 08:18 that can give us a lot of good ideas. 08:20 Let's say you've found a home that you feel fairly 08:23 comfortable with... initially, 08:25 how do you gauge next concerning the staff, the stability, 08:31 and all that? How do you get at that? 08:33 Well again, in our next illustration, we'll look at 08:38 this issue of staff stability, and that really is the key 08:42 to the care that your loved one can receive. 08:47 And the way that I've seen in trying to determine 08:52 the stability, or an appropriate gauge of the 08:56 stability, is looking at the director of nursing, 08:59 and the administrator. 09:00 Those 2 positions, are the most important. 09:05 They provide the most stability long-term in that staff... 09:09 And I've seen that if, roughly, if they've been there 09:12 for 2 years or more at the facility, 09:14 you can recognize it carries a stable environment 09:19 for my loved one to be in, because they'll have the 09:25 ability to know, over the long-term, 09:29 what's been going on in that facility and be able to help. 09:32 So they've been there a while... 09:33 Anything else that you should look for? 09:34 Well, there are other ways to look at the staff too... 09:40 When you're looking to go to 09:46 that facility for the first time to look at it, 09:48 sometimes going unannounced may be important. 09:55 Going on the second shift; for most people they go 09:59 to visit their loved one on the second shift, 10:03 the evening shift. 10:05 And so going there before you... 10:07 ...Normally do, or when people would expect you to come 10:11 Going someplace where they don't know you're coming. 10:13 Right, and seeing how they respond to you... 10:16 How they help you can be helpful. 10:18 Is it important to go at mealtimes? 10:20 Seeing how they help the residents at mealtime. 10:26 Seeing how they interact with them. 10:28 How friendly are they? 10:30 How do they treat the residents? 10:32 You know, the "golden rule" in Luke... 10:35 "Doing unto others as you would want them to do unto you" 10:40 really plays a big role here in seeing how they interact 10:44 with those residents. 10:45 Can you trust someone that's a resident there, 10:47 talking to them... do they know what's going on? 10:51 Or, you know, how would you be able to tell? 10:53 Is that a wise thing to do? 10:56 Well in the nursing home population today, 11:01 roughly half of them have Alzheimer disease 11:07 of varying forms, so you have to be careful because 11:13 sometimes you may be talking to someone that is unable to 11:16 really give you that information. 11:18 Let me ask you a question that you and I were discussing 11:23 before the program a bit. 11:24 You know, this is sometimes a very hard decision for people 11:29 in the family; sometimes it's a very hard decision for the 11:32 person that may be in the nursing home... 11:34 And when you're dealing with those situations... 11:37 where you're dealing with those family dynamics, 11:39 I know they're all different, but let's say there's 11:43 someone watching today that they've been struggling 11:46 with this and their mom or their dad says, 11:48 "Look, I NEVER, EVER WANT TO GO... 11:51 I've never wanted to go to a nursing home. " 11:53 And they have these pictures in their mind of nursing homes 11:56 being terrible places... 11:57 Is that the reality? 11:58 Are nursing homes really terrible places? 12:00 You know Don, in the last 10 years, 12:05 as I've practiced, I've seen a tremendous change, 12:09 really, in nursing homes, 12:11 and I think that's true across the country. 12:14 Now there are places where that may not be the case. 12:20 But by and large, they have improved, and a lot of that is 12:25 due to the survey process that takes place. 12:30 So in other words, the idea is don't just assume that every 12:35 nursing home is bad, or that you shouldn't look at that. 12:41 Now, let me ask this other thing... 12:43 We live in the baby boom generation so-to-speak 12:48 where they're getting older, 12:49 they're starting to have to use these facilities, 12:52 and I think that's one of the largest population bubbles 12:56 in recent times... 12:58 Is it really realistic to think that all of those folks 13:02 will be able to stay at home? 13:04 I heard one time, tell me if I'm wrong in the statistics, 13:06 that only 5% of people when they 13:10 get older go to a nursing home. Is that right or wrong? Right 13:12 It's a small percentage really that have to end up 13:18 going to a nursing home. 13:20 And there is a larger and larger push for home health care 13:25 ...those kind of things, trying to keep people at their home 13:30 And that has made a tremendous benefit to the elderly. 13:36 We've been talking with Dr. Kevin Bryant 13:39 He is a specialist in family practice focusing on 13:42 the older person, the geriatric patient, 13:45 and also really dealing with nursing homes. 13:49 We're talking about how we can choose a nursing home... 13:52 And when we come back, we're going to look a little more 13:54 closely and I'm going to ask Dr. Bryant questions about 13:58 how we can really look a little closer at a nursing home 14:02 and make the right decision at what he has told us is 14:05 one of the most important decisions we could make. 14:08 We hope that you join us. 14:23 Have you found yourself wishing that you could shed a few pounds 14:26 Have you been on a diet for most of your life, 14:28 but not found anything that will really keep the weight off? 14:32 If you've answered "yes" to any of these questions, 14:34 then we have a solution for you that works! 14:37 Dr. Hans Diehl and Dr. Aileen Ludington 14:40 have written a marvelous booklet called... 14:42 "Reversing Obesity Naturally" 14:44 and we'd like to send it to you FREE of charge. 14:47 Here's a medically sound approach successfully used 14:50 by thousands who are able to eat more and lose weight 14:53 permanently without feeling guilty or hungry 14:56 through lifestyle medicine. 14:57 Dr. Diehl and Dr. Ludington have been featured on 3ABN 15:01 and in this booklet, they present a sensible approach 15:04 to eating, nutrition, and lifestyle changes 15:06 that can help you prevent heart disease, diabetes, 15:09 and EVEN cancer. 15:10 Call or write today for your free copy of 15:13 "Reversing Obesity Naturally" 15:14 and you could be on your way to a healthier, happier YOU! 15:18 It's ABSOLUTELY free of charge, so call or write today. 15:34 Welcome back, we've been talking with Dr. Kevin Bryant 15:38 from Wichita, Kansas. 15:40 He is a specialist in family practice, 15:44 more specifically, in geriatrics. 15:46 And we're talking about how to choose a nursing home. 15:48 Dr. Bryant, how important is it to include the person 15:53 who is going to be living in that nursing home 15:54 in the process of selecting it? 15:57 Let's assume that they don't have Alzheimer's, 16:00 or they don't have organic brain syndrome, 16:02 or they don't have some of these different things 16:04 that we've mentioned in the first part of the program. 16:06 Well given that, then having that person involved in 16:11 that decision is paramount. 16:14 I've seen many cases, unfortunately, where the person 16:18 was left out of that decision, and it was devastating to them, 16:24 and led to, I think, sometimes an early demise on that person 16:30 as they give up hope, and they don't see this 16:34 as an opportunity to possibly even grow in that setting. 16:38 What are some ways that we could get them involved 16:40 in the process? 16:41 Obviously having them look at the facility with you; 16:48 going there, visiting, maybe talking to the staff, 16:52 talking to other people. 16:54 You know, one thing, if I could just share a little bit of 16:58 my own personal thing, experience... 17:00 I know I have an aunt that her family lived not too close 17:04 to her, she's a diabetic. 17:07 She's actually a great aunt. 17:09 And, she had a large house; 17:11 she had a lot of things to take care of... 17:13 These things were getting overwhelming for her... 17:15 She couldn't mow the lawn, keep up with the garden, 17:17 do all the laundry... 17:18 Plus it was a bi-level house, so she was going up and down 17:21 the stairs... a lot of hazards there. 17:23 And no one really to help her if she got into problems. 17:27 But she really didn't want to go anywhere else! 17:30 She is sound of mind, and many different things... 17:32 all these things are positive. 17:33 So her family did like you said, 17:36 they took her to different places. 17:37 She really didn't respond until someone said to her, 17:40 "Well, why don't you try living in this extended living center" 17:44 ...well, it wasn't a nursing home; assisted living, and then 17:48 there was a nursing home next to it... 17:49 "Try that for 6 months, keep your house, 17:51 keep all those different things, keep involved in that. 17:55 And so they arranged that, and she did that, 17:58 and, you know, just a couple of months ago now, 18:01 I was talking with her on the phone, and she says, 18:04 "You know this is a GREAT place!" 18:05 "They have a piano for me to play; they have this, 18:07 they have that, and I think I don't want to worry about 18:12 my house anymore. " 18:13 And so she made the decision! 18:15 Yeah, for some people as they grow old, they become isolated, 18:19 and this becomes an opportunity for them to get reconnected 18:24 to their society in some of these facilities. 18:27 You know, before we leave that subject... 18:30 Some nursing homes, I know for years I've visited nursing homes 18:36 on weekends; we would go there, we'd sing songs to the people, 18:39 and we'd have a little worship with them. 18:42 And my parents liked to do that; we did that together 18:45 with other people in our faith community in our church... 18:48 And I noticed that some places had a lot of programs for people 18:52 They had a lot of things, and whatnot. 18:54 What kind of questions should you ask? 18:57 Maybe that's the unannounced visits and looking at things, 19:00 but how can you TELL this is a good place? 19:03 Well, you're going to actually visit when they have 19:07 an activity going on, and most facilities have a calendar 19:11 where they actually list all the activities that are 19:13 going to be taking place. 19:15 So you can see, are these activities that your spouse, 19:20 or your aging parent would enjoy... 19:26 Each facility is to have an activities director that is to 19:30 even personalize for that person, activities 19:33 they enjoy doing. 19:37 Let's look a little closer, okay, you've gone to the place; 19:40 maybe you feel comfortable with the nursing home; 19:42 maybe your family member feels comfortable; 19:46 maybe they're ready to make that decision, 19:48 and you want to look through someone else's glasses, 19:53 and you want to look at what other people are 19:56 saying about them... What's the next step? 19:57 Well, there is one other way to look at a facility's performance 20:03 and that is through what are called "state surveys. " 20:06 And, each state is required by the federal government 20:13 to do a survey of the facilities. 20:15 And they look specifically to see what deficiencies they have 20:22 in federal regulations that are 20:26 involved with the care of patients. 20:28 Now, each facility is required by law to have available 20:33 for anyone, the results of their most recent survey. 20:37 Those are sometimes difficult for lay people to look through 20:44 and read, but probably the most important thing to remember 20:48 out of state surveys is that they're categorized. 20:52 The deficiencies are categorized into various levels, 20:58 and if it is a level "G" or higher deficiency, 21:02 this would be a red flag because that means that 21:06 actual harm has been done to a resident. 21:09 So a "G" rating may be good for the movies, 21:12 but it's not for the nursing home. 21:13 For the nursing homes, "G" rating is not. 21:16 Will people be forthright with that kind of information? 21:19 If you asked them, "Hey, is your survey a "G" rating" 21:22 Are nursing home administrators and staff, do they HAVE to tell 21:26 you what it is, or do they try and get around that sometimes? 21:31 Different homes may have different levels of 21:33 transparency as to their state survey, that's true. 21:37 Do they have to let you see it? It's there for anyone to look at 21:40 and they usually do try and let you know what's been going on. 21:46 Now having worked in a hospital for a while myself, 21:47 I know that we had Joint Commission that came 21:50 to our hospital and they would review it, 21:52 and it was kind of dependent on the team that came. 21:56 If somebody was just having a bad day and they just 21:58 wanted to get through their day, they didn't look so closely 22:00 ...where I happened to work, it was an emergency department. 22:03 But other times, they were very, very meticulous. 22:08 Can you really trust a state survey? 22:10 I believe, by and large, you can 22:14 It does depend, as any survey process, is dependent on 22:19 the human being doing the survey. 22:22 But it has really dramatically improved, I think, the care 22:27 overall in long-term care in the last 10 to 20 years 22:31 that these surveys have been done. 22:33 So it's something you should look at. 22:36 Is there anybody that can HELP you with looking at that survey? 22:40 You said it's kind of hard... I mean, simply you said 22:42 "Look at the "G" rating" 22:44 But let's say you want to get a little more specific, 22:45 is there anybody that can help you, look over your 22:48 shoulder and help you with that? 22:49 There are what are people called "ombudsmen" 22:53 that are assigned to each nursing facility, 22:57 and the phone number to reach them should be available 23:02 in each nursing home. 23:04 They can help you understand some... 23:06 I don't know if I can say "ombudsmen" too often, 23:08 but if you say, "Hey, I want bud's phone number," 23:11 they may be able to help you and they WILL be able to help you. 23:16 Well, that's going to be very helpful. 23:20 What else can we do to really 23:25 assess the care that's being given in a nursing home? 23:30 Probably your own eyes, your own ears, your own nose 23:38 in some cases in a facility is going to give you... 23:43 And going with your instincts as you see, 23:47 trying to talk to residents that 23:51 are able to give you answers is helpful. 23:54 But once a person has chosen the home that they're 23:59 going to go into, NOW really the work begins 24:02 in being able to ensure that the good care is given. 24:05 In our next illustration, in the last remaining minutes, 24:08 we want to look at what I think is the most important part 24:13 and that is... how to ensure that the care you're looking for 24:19 can be given, and it starts right with, even to the point of 24:25 acquainting yourself with the staff members by name. 24:29 Getting to know those staff members by name let's them know 24:32 you value them as a person, and are wanting 24:37 to know them personally, and that reflects then in that care. 24:42 Being willing to help where you're able to help. 24:47 Hands-on care. 24:49 Don't just assume they're going to do everything... 24:51 Hand them the water, do this, don't demand that they do this, 24:54 or that, but more of a family approach. 24:56 Right... a family, a team approach. 24:58 You're part of the team. 24:59 You're wanting to help where possible let's that staff 25:02 know that you're pulling with them in the care of that person. 25:06 And then I think one of the most important things is 25:09 the issue of praising; trying to find everything and anything 25:14 that you can to praise in the staff as they give that care. 25:19 This is some of the hardest work I think, done in America... 25:23 is caring for our elderly, aging population. 25:28 We need to appreciate and affirm people to do that well. 25:30 That's right, and praise will go a long way towards them 25:35 being willing to go that extra mile with your loved one. 25:39 And being able to show it, even with gifts, 25:47 not contrived or anything, but 25:49 anything from baked goods, whatever... 25:51 Letting the staff know you appreciate the care 25:54 that they've given to them. 25:57 And then not wanting to nag the staff. 26:04 I've seen this before where they almost get into a 26:08 confrontation with the staff and that leads to disaster. 26:14 It doesn't help because the staff pulls away. 26:16 I notice here you say that it looks like you need to follow 26:20 the chain of command here if you do have a problem. 26:22 Right... the chain of command going to the person that 26:26 you have a problem with initially. 26:28 If that doesn't resolve it, then moving up to their 26:31 supervisor, and then finally ending up with the 26:34 director of nursing or the 26:36 administrator can help resolve issues. 26:40 And it's showing respect to level of that probably, isn't it 26:43 ...saying, "what's going on here. " 26:45 You know, my mother works in a nursing home, 26:47 and she says that all the time. 26:49 People will come and will bypass here; 26:51 they'll go talk to someone else 26:52 and then it just doesn't work well. 26:55 And she says, "Why didn't you talk to me?" 26:57 My mom has been a nurse in a nursing home for... 26:59 I don't know, 20 years now, and she loves these people. 27:03 She'll just be crying if someone dies, 27:06 and she gives her life for that, 27:08 and I think that's very good counsel. 27:11 Tell us about the storybook... 27:12 We've got about 30 seconds. What's that about? 27:14 Well, in helping the staff come to recognize this person 27:19 as a very valued member of your family, 27:23 sometimes developing picture storybooks, 27:26 pictures that explain different phases of that person's life. 27:29 When they were a child. What they did for work. 27:31 All those different kinds of things. 27:33 It can be very helpful for the staff to recognize 27:36 who this person is... what they've contributed. 27:38 And they're not just in that little gown. 27:40 And they're not in this situation, 27:41 they are a REAL person. 27:44 Thank you so much for being with us today, Dr. Bryant. 27:45 I KNOW this will be helpful information... 27:47 And thank YOU for joining us. 27:49 We hope that what you've learned today 27:51 will help you help your relatives, 27:54 help others have health that lasts for a lifetime, 27:57 and is MEANINGFUL right up to the last moment. |
Revised 2014-12-17