Monday, December 04, 2006


I was in a nursing home yesterday, because as a favor we gave a ride to one of its residents, bringing him home there. He had a stroke many years ago, and the left side of his body is pretty much paralyzed. After getting him out of our car and into a wheelchair, we rolled him inside.

I almost gagged when I went through the doors, partly at the smell, but partly at the whole depressing atmosphere of the place. It was lunch time, and the smell was a combination of that of hospital food, disinfecting cleaning agents, and recently used bathrooms. Seeing the people there was almost as bad as the smell. Many were just sitting in the halls in wheelchairs, with nothing better to do. One was talking nonstop and nonsensically, another was smiling with an other worldy look on her face. The majority of residents didn't seem intact mentally, perhaps from Altzheimer's, maybe from a stroke, or maybe from previous long standing mental disease.

I don't write this to mock these people. I just feel tremendous sympathy for them; what an awful way to spend your waning years on earth. For the people who are mentally intact, it must be almost worse, because they can realize how lousy this is. And this, I might add, seemed like a fairly clean nursing home, although it was far from luxurious, making me wonder how much worse some less clean nursing homes can be.

It reminded me of one reason I went into pediatrics. It was partly because I could deal with dirty kids, maybe with smelly clothes, or babies with dirty diapers and the like, but I was somewhat repulsed by adults who were unbathed or incontinent, even if they couldn't help it. Kids are almost supposed to be dirty, at least at times like when they've been playing hard or before they are toilet trained, but a dirty or incontinent adult can be very unappealing. It's a bit ironic. When we get very old and infirm, we revert to the ways of infants and toddlers, unable to care for some of our basic bodily needs and functions. Unfortuately, we don't revert to the cuteness and hopeful potential of young ones.

When we walked out of the nursing home into the fresh air, I took a huge breath, trying to purge my lungs of the air and smell inside. "If I ever need to go into a place like that to live," I said to my companion, "just shoot me." I don't know if I really want that or not, but I would sure give it serious consideration.

P.S. Check out a new pediatric grand rounds - and a yummy recipe - at the Granola Rules.


Anonymous Anonymous said...

my prayer to the father above is #1: let me die with a clean heart #2:let me pass quickly and painlessly please.

9:56 PM  
Anonymous Anonymous said...

This is a really interesting theme. The reasons that made you go into paeds are kinda the reasons I am thinking of going into geriatrics when i finish med school. My term on a geriatric ward was one of the best I had all year... partly because of a unique supervisor, partly because the patients were lovely to spend time with and partly because the way people ignore geriatrics makes me so mad! My passion to make a difference was really awoken on that term.

I have just done a short term in a NICU and I have to say that though the stories are often tragic (and cut particularly close to the bone since i am currently expecting my first child in a few months) it gets my goat that these tiny creatures who are hardly sentient get so much better press and support than the elderly in our society.

How luxurious are children's health facilities compared to geriatric wards? How many charities are devoted to childhood illness and kids in hospital compared to the elderly. And for me, the worst part is that the elderly usually are far more fearful of what's going on since they understand and are aware.. even when suffering terrible disabilities such as dementia.

Neonatal Doc, thanks for your fantastic blog... i love the daily insights... they are humbling and educational. Thankyou thankyou thankyou.

11:32 PM  
Anonymous Ariella said...

I think this is an exceptionally interesting post. My husband works for a non-profit company that monitors the quality of care in nursing home and hospice chains throughout the country. His job is very rewarding at times, and at other times it is incredibly depressing. (if you know anything about quality of care monitoring, the company developed and uses the QIs in order to determine whether the quality of care from the nurses and doctors and nursing homes is up to par)

I'm so pleased he has the job he has. Yes, it means he travels all the time, but it also means that there are elderly people all over the country who are getting better care because of his company. It's definitely slow going, but he's so rewarded when a chain or even just a site improves its quality of care.

11:40 PM  
Blogger Ali said...

This comment has been removed by the author.

11:44 PM  
Blogger Ali said...

Sorry, deleted my comment because of a silly spelling mistake.

I know where you're coming from. There has always been something about nursing homes that kind of creeps me out (for lack of a better description), I think from the few times I visited distant relatives in nursing homes as a child. I think influenced me when I began to lean towards pediatrics when I started my nursing program. I actually managed to avoid having a placement in a nursing home, and instead went to a spinal and brain injury rehabilitation centre, which was a fantastic experience. I'm glad that our program has certain areas that we have to experience, and I have enjoyed my experiences in most of the other areas. Maybe I will still end up in peds eventually, we'll see. I know that nursing home work isn't for me, but I respect and admire those folks who enjoy working there. It takes a special person...

11:46 PM  
Blogger Flea said...

I really wish more folks took care of their own folks. You know the folks I'm talking about? The ones who gave us life?


5:19 AM  
Anonymous Anonymous said...

In COMPLETE agreement with Flea on this.

8:13 AM  
Anonymous Bryan said...

Hmmm. Interesting. My decision to pursue pediatrics was influenced by a close encounter in a nursing home. It was the yellow toe nails so common among the elderly. I realized that I could be nowhere near these nails.

8:43 AM  
Blogger Kelly said...

I agree with Flea, as well. However, I can also understand the strain of caring for a loved one, and how a nursing home seems like the only option. Thankfully, there are state funded programs designed to help people stay at home.

My handicapped daughter is already on this program. She is only a child, but already her needs are growing and becoming more and more cumbersome. The help we get at home has been a blessing, and will someday be a necessity.

And I understand where you're coming from ND: I have thought many times about how my daughter's incontinence and drooling is no big deal since she's a child, but what about when she's a teenager? And then an adult? I don't believe people will be so willing to be near her and hold her as she ages.

It's sad, but it's human nature also. I comprehend it, but I sure wish she could stay a small, cute, huggable child (at least in everyone else's mind) for the duration of her illness and time here on earth. I truly think that MR adults and the elderly need more of that close interaction.....I think I could handle doing that now---now that I want the same for my own loved one.

10:41 AM  
Blogger Laura said...

like you, one of the reasons i chose th nicu was because of the poop factor. i also joke i will only work with patients i can easily restrain with one hand.
seriously, i saw my own mortality in a nursing home or the geriatric unit while doing my clinical rotations. i believe i found my niche. conversely, a cousin of mine who is also an rn chose gerontology and LOVES what she does. watching her interact with her patients, i can see this is the best place for her. when her son was patient in my unit, she commented to me how scary and depressing the nicu is to her. different strokes! although we chose different areas of practice, i believe we both are making a difference to the patients and families we encounter.

11:14 AM  
Blogger SuperStenoGirl said...

You have given me an interesting topic to post about today.

I completely understand your reaction to the smell, it is less than appealing at times and I think more than just the aroma is what effects you; it's the general aura of the end of the line, so to speak. People in nursing homes, whether they are afflicted with mental illness, Alzheimers or otherwise, KNOW it is the end. I think you can almost feel the hopelessness some residents have and that makes my stomach turn far more than the other earthly smells.

As for people taking care of their parents? Wholeheartedly agree. In other cultures, elders are highly respected and it is the children that inevitably take care of thim. An example of this is Japan, while a daughter may move into her husband's home, his parents usually also move in eventually. As far as I know, Western culture is one of the only ones (though I'm sure it's not THE only one) that treats its elderly the way it does. Shame.

12:10 PM  
Anonymous Shamhat said...

As a nursing student, I found myself at a home visit to take a shut-in's blood pressure. After a long, winding conversation that included his demonstation of how he held his rifle above his head when he landed on Iwo Jima, he mentioned a letter that he couldn't read.

It turned out that he had taken his wife to the doctor 2 weeks earlier, and she had been taken to "the hospital." She had apparently been diagnosed with Alzheimer's and transferred to a nursing home. He couldn't afford to pay to have her phone turned on, nor a cab to visit her. On the letter, he could read the large print, "$450/day," but not the small print listing the documents needed to document her Medicaid eligibility. The "please respond by" date had passed.

Well, we managed to find every document on that list in his drawers--except that her birth certificate was a statement by a census worker staing that she was three years old in 1920. They needed three years' worth of bank statements, and I managed to talk the bank into giving them to him for free.

Then we got into another cab and I realized that, ohmigod, I was headed for a Medicaid nursing home. By this time, my fellow student, a 23-year-old, had bailed out because she wasn't sure we were "allowed to do this kind of thing."

When we arrived, we were greeted warmly--not like your typical hospital security---and escorted to the office of the financial office employee who had sent the letter. He was of course happy to see the paperwork. He clarified the phone charge, which was $8/month rather than $8/day. He also showed the client a paper with several type sizes, asked him to pick which one he could read easily, and made a note on the file to send all correrspondence in 20 point.

When we went up to see his wife, smiling employees held the elevator door for us and gave us directions. Residents were dressed and walking around. A cafeteria smelled pretty good when we walked by it.

His wife was with a group of other women, rather than alone in her room. Remember, they weren't expecing us and she had never had a visitor before. I left him with her and $5 for the cab back home, and never saw them again, but I sure did feel good about the home our taxes were providing for her. "Isabella," in Washington Heights, in Manhattan.

12:34 PM  
Anonymous Anonymous said...

So Flea's going to quit his job and become a stay at home son to take care of his parents?

Because they might just require full time care, not a visit every evening, but full time, day and night to keep from wandering care.

It sounds great when someone tosses it in, but the practicalities of caring for an aging parent (or parents) while working full time to feed oneself are more complex.

1:07 PM  
Blogger SuperStenoGirl said...

Just because Flea said we should take care of them doese not mean that he thinks we should stop working so we can provide 'round the clock care. Don't you think your comment is sort of going from one extreme to another?

I took Flea's post to mean that we should take care of them whether they are able to live at home with assisted care, in-home care, full-time care or in a nursing home. I think he meant that even if they are in a nursing home they shouldn't just be forgotten there and visited only on holidays or their birthday (if the family even remembers).

It's not feasible, in most cases, to quit your job and care for your parents at home full time. Even if you could, and I've known people who have, sometimes their care is more than you can handle and you can easily burn yourself out with the job. Also, if you're not trained at least in the basics of caring for them; such as proper lifting and the like, you endanger not only yourself but your loved one. In such cases, leaving physical care to the professionals is the best advice but you are still responsible for their emotional care.

THAT is what I think he meant.

2:03 PM  
Anonymous Anonymous said...

shamhat,what an edifying experience,wtg girl!

4:14 PM  
Blogger Surgeon in my dreams said...

My dog Thomas and I do pet therapy at a nursing home, which basically means we walk around and let the folks who want to love on him. I almost didn't go back after the first time. It is so sad. I cried all the way home and was depressed for days later.

If I still have my mind when I am old, I pray that I won't wind up in a bad place. If my mind has left me I don't guess it will matter, but if I had my preferences, I'd rather just "not be".

4:22 PM  
Blogger Dream Mom said...

I agree with you on this one. I remember a few years back visiting someone in an adult PT rehab facility; I will never get that "smell" out of my mind. I also remember last year, when Dear Son was in a PT rehab hospital, which was primarily adults with mental and physical issues. They would line the halls with their wheelchairs and call out to me whenever I went down the hall-just wishing someone would visit them.

I certainly agree that pediatrics is much more appealing than geriatrics, at least for me. Seeing their sweet little faces makes caring for them much more enjoyable.

On the flip side, it was a bit of an adjustment when Dear Son went through puberty-caring for a teenager (small adult) and changing diapers for a child is a big difference. Much harder too physically.

As for Flea and those who think they can care for an adult at home, I suggest they do a little research first. It's not so easy. We have two insurance companies for Dear Son, neither of which has private duty nursing so I have zero help unless of course I go on Medicaid, then there is nursing and oh yes, they are the ONLY ones that pay for diapers too. And you need more than diapers, you need the underpads, wipes, etc. It's a lot harder too to find someone to care for them-there is no daycare for teenagers. Period. So it makes working full time, caring for someone at home a little different ballgame. And then when you do find people the turnover is huge and you have to do background checks on them. And, can you really trust anyone else to give your child meds and not make a mistake? Something to think about when people make statements about caring for them at home.

I love caring for Dear Son but make no mistake, it's hard work without a lot of sleep, without a lot of income (I work part time not full time now.)and without a lot of help. Oh, and you need a lot of muscles too. It's not for everyone, that's all I am saying, but it's important to understand that most people don't make these decisions lightly.

Good post.

6:33 PM  
Anonymous MR said...

My father is in the dementia unit at a nursing home, where he's been for a little over a year. Prior to that he was in assisted living. My brothers and I have had to grapple with making the decisions about where he should live, and it's not easy when you are finally faced with making an actual decision.

I suppose that if a parent is just at the assisted living stage, that they might do fine at home with a son or daughter. But when they reach a point where they are in poor health, I think having a parent home only works if there are several sons or daughters who can share the responsibility of giving medications, taking Dad/Mom to the doctor, handling ALL of their healthcare needs, bathing them, dressing them, feeding them, giving them something to do besides watch TV,etc. It's not like caring for a child. It is caring for an adult in poor health, whose health is only going to decline further. It is 24 hours a day, no breaks.

Sadly, too often the above responsibilities devolve onto one child, usually a daughter.

My father is in better health, both physically and mentally than if he were with one of us kids. He's happy where he is, he's getting far more expert care than whatever we kids could provide, and he's got aides, therapists and nurses around 24/7. The best thing is that he's in a secure place that he can't wander from, and there are a lot of structured activities that help keep him more firmly rooted in reality. And best of all, his family doctor visits him in the home once a month.

Luckily, my father is in a good place, that has some of that disinfectant smell, but nothing much else. When I go there, I don't see residents lined up in the hallway in wheelchairs, thankfully. The staff there does a good job of providing enough activities for the residents, so they aren't just languishing there.

I do get the idea that the residents who only have physical problems, but not mental ones, are more distressed about being in the home. They are perfectly aware of their limitations, and I think this really wears them down.

8:05 PM  
Blogger Dream Mom said...

P.S. If you liked the recipe at Granola Rules, check out Alton Brown's (Food Network) recipe for Granola Bars. It's delicious and the house smells great too. I have made it a few times and use organic dried apricots as the fruit. You can find it here:

11:08 PM  
Blogger Shinga said...

Some of the cultures that have this much admired respect for elders also have traditions that involve killing superfluous children (by whatever definition), killing women whose families default on their dowries, killing children who are the wrong sex, indulging in honour killings. You definitely need to cherry-pick what you admire before singling out any particular group for praise. I doubt that any culture/country/society has a wholly admirable, morally consistent position that is embraced by all its members.

Regards - Shinga

6:49 PM  
Blogger neonataldoc said...

Thanks. I'm not surprised to see tht others feel like I do about nursing homes. I too am glad to know that there are some who enjoy working with adults, and, like Ali, I respect and admire them.

Anonymous 11:32, you make an interesting point about charities for kids and so on. But on the other hand, seniors have the AARP, a powerful lobby that poor children don't have. Poor kids can't vote, and sometimes it shows in programs. Also, thanks for the compliment.

I agree with both Flea and those who say how difficult it can be to care for them at home. There's no easy solution, although I like the program that Kelly talks about.

Shamhat, great job!

Shinga, that's kind of a depressing comment, but you're right, although I don't think all cultures that care for the elderly well do those bad things you mention.

8:46 PM  

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