From Chapter 18: Hope Rising (continued)
 I have been made aware of other reformers who emphasize a holistic approach to how nursing homes are run. They eliminate rigid job descriptions so that staff are more broadly involved in all aspects of the nursing home, thus breaking down the walls of employee isolation as well as competition that can sometimes undermine the cooperation necessary for optimal functioning. Authority is also redirected by placing as much control as possible into the hands of residents.
Joanne Rader, a nurse, has been hard at work for many years finding ways to redirect nursing home resources, specifically to help reduce the use of restraints and to individualize the care of nursing home residents. Her work has been aimed at "teaching staff how to be creative and compassionate when addressing behavioral symptoms related to dementia, and to see that persons with dementia still retain the right to direct their own care." A primary principle in the accomplishment of her goal is for staff to be willing to modify a resident's environment in order to best suit the resident, rather than expecting the resident to modify herself to accommodate the facility.
Ms. Rader tells a wonderful story about an elderly woman who did not sleep well in her bed. This resident also presented a number of other issues, including a tendency to behave aggressively toward others. Then the staff found that the woman was most happy when sitting in her wheelchair behind the nurses station. Because this also meant less trouble for the staff, they made the necessary alterations in that area to make it safe and convenient for the woman to be there. Once the woman grew drowsy, though, she would slowly slide out of her chair and into the space beneath the desk, where she would continue to sleep soundly. To my amazement, instead of hauling her out of there, the nurses got the woman a mattress, pillow, and linens to make a comfortable bed underneath the desk. They even took the trouble to explain this novel approach to visitors who noticed. Meanwhile, this elderly woman had finally found a place to sleep where she apparently felt contented and secure. Not only did she sleep well for the rest of her life, but she grew less anxious and opened up in ways that had been unseen prior to that unique arrangement. The staff of this nursing home had helped this aged woman to live and die in peace. . . .
As the nursing home reform movement continues to gain momentum, not only do we have the addition of hundreds of facilities embarking on this all-out change, but we also begin to see hints of change appearing in nursing homes that are still operating along traditional lines. Staff in key positions are becoming increasingly sensitive to and aware of the psychological and emotional needs of the residents, and aware of the need for their staff to be more humane and considerate toward their charges. This may even be seen as a reflection of the gradual maturing of our culture and of the growing recognition of how valuable compassion is and what it means to implement it.
In the meantime, it is up to each of us to open our eyes and hearts to the shameful plight of our dependent elders, and to commit ourselves to the idea that nursing homes do not have to be the way most are now. It can be overwhelming to think of reforming something as huge and complex as the American nursing home system—there is no question that it is a massive and multifaceted endeavor—but it becomes manageable when one nursing home at a time, one issue at a time, is addressed. This is how it is being done, and this is how it is working.
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