Know what you're walking into
You wouldn't embark on a mission trip to Thailand or Yuganda without spending some time in preparation. You would make sure your passport was up to date and that you had all the recommended vaccinations and medications. You would also spend time learning the culture of where you're headed, understanding social customs and expected behaviors so that you are setting up yourself and your mission trip for success.
The same is true of going into a nursing home. It really is a different culture. You need to understand the language of long-term care, the way facilities and their staff operate, and the behaviors of the residents you might encounter.
The Language of Long-Term Care
First, let's talk about the staff of a nursing home. Many times we hear people refer to pretty much everyone who works with residents as a nurse, but in reality, there aren't many registered nurses in nursing homes. Federal law only requires one registered nurse be on site eight hours a day. It costs more to employ registered nurses, so many care homes employ other types of direct caregivers. So in most nursing homes, you will find:
Certified Nursing Assistants (CNA's)- majority of folks providing direct care
Med Tech- person who distributes medications
Director of Nursing- over all the nursing staff
Administrator- This person must hold a license to operate a nursing home.
Activities Director- Person who plans and implements all social activities for residents. This is the person you want to get to know first!
Social Worker
Dietician/Food Services Coordinator
Housekeeping/Laundry Coordinator
Maintenance
Various Office Personnel- folks who handle admissions, HR, billing, etc.
Keep in mind that these terms may vary slightly from facility to facility. Also be sure to visit our FAQ page to learn the difference between the various types of long-term care. This too is important because people often use the word "nursing home" to imply any type of care home, and there are important differences in the types of facilities.
The Residents of Long-Term Care
Statistics tell us that the average age of a person in a nursing home is 79. (It's important to remember, however, that not all residents of long-term care are elderly.) Research also shows that more women end up in nursing homes than men, and 35% of Americans will find themselves in a nursing home at some point.
Over half of people living in long-term care have some type of cognitive impairment, whether that be dementia, Alzheimer's, or some other type of mental disability. That's an important thing to keep in mind as you visit with nursing home residents. Sometimes, they will tell you things that simply aren't true at the moment. That is not because they are being dishonest, it's because for them, what they're saying is very true. For example, you will nearly always hear residents say, "I'm going home soon." In most cases, it's usually best to go along with their thinking. This may feel like you're being dishonest, but remember that their perception of reality is different than yours and probably oriented to a different place and time. So if a resident says, "I'm going home soon," you might reply with, "Oh, that's wonderful. Tell me about your home."
A resident might tell you that she is worried about her husband and he's very sick, when in reality, he has already passed away. But she has forgotten that and is very distressed. The most kind thing to do is to say, "I'm so sorry. Can we pray about that right now?" And pray that she will feel God's love and peace. You don't need to remind her that he's already deceased. In that moment, she needs reassurance and peace. You might even offer to read Psalm 23 with her or ask her if she can recite it with you.
At least 60% of nursing home residents never receive any visitors. Our experience says that number is much higher. There are several reasons for this: residents often get placed in care homes that are far away from their hometown, residents have no living family members, or residents have family who simply never comes to visit. Additionally, many residents have legal guardians who are responsible for their affairs. More often than not, in Kentucky, that ends up being the state. This is important to understand because it may mean that the resident has more restrictions placed upon him than other residents. For example, a resident with a guardian usually is not allowed to have his picture taken. Always check with the activities director before you take a resident's photo.
The stereotypes about nursing homes having foul odors and residents who cry out are unfortunately true for some. Nearly all residents in a skilled nursing facility are incontinent; it's one of the qualifying factors actually for needing skilled nursing care as opposed to personal care. It's difficult for the staff to keep up with laundry and housekeeping in a scenario like that. Residents who weep or scream or call out for help should not be viewed as frightening, rather try to keep in mind that they have likely lost the verbal and cognitive skills needed to explain why they are in distress. Much like an infant who cries to communicate a need, many people in care homes have no other way to express themselves. There is also a real medical issue called "sundowners." Residents with Alzheimer's are particularly prone to this; they will begin to cry in the afternoon and evenings, often for no apparent reason at all. They may also become more agitated or increase their pacing and wandering. If you are visiting a care home in the late afternoon, you are likely to witness this in several residents. Do not panic. Offer comforting words, reassurance, and perhaps redirection to the appropriate location for them.
Taking some time to understand what life is like inside a long-term care home will help you be more successful in your ministry efforts and will also help to put you more at ease before you arrive.
Tips for Visiting Residents
- Pray for God to lead you.
- Leave purse/wallet/money in your car.
- If allowed inside a resident's room, always knock before entering (this is his/her home!).
- Introduce yourself. Ask for their name.
- You can say, "I'm here to visit with you today!"
- Conversation starters: Where are you from? Where did you go to school? Tell me about your family. What kind of work did you do? Do you have a church home?
- Ask if you can pray with them.
- If conversation is tough, try reading to them. Bring along your Bible and/or newspaper or favorite book of short stories. Reading from the book of Psalms is a great place to start!
- Depending on the covid restrictions, a light touch, hand pat, light hug is probably ok. Do not attempt to assist residents with moving.
- Do not take residents a snack or drink without checking with staff. Many residents have fluid restrictions, choking problems, or dietary issues.
- You may consider taking your pet if the nursing home will allow it and if you think your pet will be cooperative. Animals are a great ice-breaker and most residents love them. Some nursing homes will currently allow pets but will not allow the resident to touch them. Always find out the rules before you bring your pet.
- Afternoons are generally the best time to visit residents. Mornings usually consist of medical appointments or therapy.
- Keep in mind that nearly all nursing home residents will have some type of memory issue, whether it's simple forgetfulness due to advanced age or actual dementia. Therefore, you have to keep in mind that they may say things that aren't exactly true (not purposely). For example, some residents will tell you they're going home soon. For some, this may be true, but most likely, they are saying that because they so desire it to be true that they believe it. Try not to correct a resident. Just engage and enjoy their world, or try to redirect the conversation.