Advantages and Disadvantages of Nursing Home Care

A patient will be transferred from a Hospital to a Nursing Home when they are
cleared of all infections and of all artificial supporting devices. The patient needs
to be cleared of all artificial support devices (like a respirator) in order to be
admitted into a regular nursing home (the patient can be on a respirator if they
are being sent to a Skilled nursing home facility) and it is OK for the patient to
have a feeding tube. In addition, the hospital staff must feel that they have done
all that they can for the patient such that rehabilitation is the next step or the
hospital staff may feel that they have done all that they can and nothing else can
be done to better the patient's condition (the patient's condition is irreversible
and the patient cannot be made any better). The latter case was the case with
my mother and the doctors wanted to send her to a skilled nursing facility so
that she could receive comfort care and hospice care (or end of life care). She
was sent to a nursing home since there was nothing more that could be done for
her medically. There are several types of nursing homes, but the two that I am
the most familiar with are regular nursing homes and skilled nursing home
facilities. In regular nursing homes, patients do not have any severe health
problems and rehabilitation in the main objective. Usually, successful recovery is
possible for most patients. In a skilled nursing home facility, patients are usually
on respirators for breathing assistance, have feeding tubes and have a wide
range of other problems that need to be treated medically. I like to think of a
skilled nursing home facility as being the next step down from a hospital since
patients in such facilities are not in such a dire condition that they need constant
emergency care such as is given in a hospital. The nurses in skilled facilities are,
however, trained to dealing with problems relating low oxygen saturation, can
conduct CPR if necessasry and can address any severe problems that threatens
the patient's life. All nursing homes offer 24 hour care to patients and, in general,
skilled nursing home facilities are smaller than regular nursing homes. There are
advantages and disadvantages to residing in a regular/skilled nursing home and
the disadvantages especially need to be accounted for.

Advantages:
1. The Nursing Home facility is much smaller than a regular hospital and
therefore, it will be easier for you to get into contact with relevant individuals
such as physical therapists, physicians, admissions staff, and nurses. If there is
an aspect of the patient's care that you are not satisfied with, it is easy to get
such issues resolved in a nursing home. You can do so by bringing the issue to
the attention of the facility's social workers who will work with you to figure out
what the problem is and how it can be resolved. Social workers are also there to
help you find information about other services (such as hospice care), to help
you make changes in any preferences regarding the patient's care (like whether
to revive the patient if the heart should fail) and to gather any necessary
documentation regarding the patient's stay that you might need in handling the
patient's affairs outside of the nursing home (health insurance, bank issues,

etc...). Based on my personal experiences, I have found that it is just easier in a

nursing home to find the people that you are looking for and to continually touch
base with them since a hospital is so much larger and workers serve a greater
number of patients.

2. Nursing homes are more focused on rehabilitation and so there will always be
physical therapists, occupational therapists and speech therapists on hand if you
have any questions. Also, there is a focus on engaging the patients socially in
activities with other residents.

3. Nursing homes have a care team that consists of most of the individuals that
will provide direct care to the patients. The team consists of Occupational
Therapists, Physical Therapists, Speech Therapists, Physicians, care team
coordinators, Social Workers, Respiratory Therapists (in skilled nursing home
facilities) and Dietitians. Meetings are arranged between the caregivers and the
care team bimonthly. The meetings serve as a great opportunity to get all your
questions regarding various aspects of the patient's care answered at the same
time and to get an idea of how different services are interacting with each other
for the benefit of the patient.

Disadvantages:
1. Especially when a patient is being transferred from the Intensive/Critical Care
Unit (I/CCU) of a hospital to a nursing home, the difference will be especially
pronounced since in a nursing home, one nurse takes care of several patients
and thus, patients do not get anywhere close to the individualized attention that
they got at the hospital. Thus, it is very important to be with your loved ones as
much as possible since the supervision of patients by the nursing home staff is
not strict and thus, the nurses can miss important things. This is especially the
case when the patient is immobilized or cannot express their needs to the
nursing staff. When my mother was in her first nursing home, she could move
her lips to talk, but no sound would come out and she was very much bedridden
since she was in the nursing home in the first place so that her limbs could
become functional again after not being used very much in the hospital. Thus,
she couldn't really tell the nurses what she wanted or alert them to what she
needed if they were far away. Since my mother had a feeding tube, very often
she would move in a way that would cause the feeding tube to become
disconnected which resulted in the feeding tube's contents spilling all over her
bed and wetting her nightgown. The nurses that took care of her almost never
picked up on this. The problem was addressed only because me and family would
notice the problem when we came to visit her. The lack of cautious nursing home
care became very pronounced to us when my mother had a cardiac arrest and
the nurses got to her too late since there were no heart monitors to alert them

and the nurses station was so far away from her room. Although the nurses were
able to revive her heart, her cortical brain activity suffered greatly due to the
moments of oxygen deprivation. Consequently, she went into a persistent
vegetative state that she never recovered from.

2. There is only a few (2-3) doctors in nursing homes. Thus, one doctor is
responsible for MANY patients. It is hard to catch the doctors if you have
questions and their decisions may not always be the best since there are no
specialists in the Nursing Home. If a specialist is needed (like a Cardiologist or a
Psychiatrist), usually the patient has to locate a specialist outside the nursing
home and has to arrange outpatient transportation in order to see that specialist.

3. Perhaps the biggest drawback is the fact that there are no machines available
that monitor the patient's vital signs and which alert the staff when there is a
problem with the vital signs. This is the case since when the patient is admitted
into a nursing home, the patient is thought to be in a condition where it is not
necessary to monitor their vital signs. In other words, patients in a nursing home
are usually in a stable condition since otherwise they would not have been
released from the hospital. Nurses do check the patient's heart rate, oxygen
saturation and temperature every couple of hours, but they are not able to pick
up any changes in the time in between. Thus, it is crucial for caregivers to obtain
their own personal Pulse Oximeter so that they themselves can monitor the
patient's oxygen saturation and heart rate when the nurses are busy. A pulse
oximeter should only be purchased and used when the patient's problems
involve their breathing rate and heart rate. In skilled nursing home facilities, if
the patient is on a respirator, they will usually be closer to the nursing station
than those patients that do not have a respirator and the respiratory machine
makes noises when it detects that something is wrong with the patient's
breathing or when it detects that the machine has been disconnected somehow.
The feeding tube machines makes noises as well.

4. The Nursing staff in general is not as good as what you will find in a hospital.
Nursing homes mostly employ LVNs (Licensed Vocational Nurses) instead of RNs
(Registered Nurse). RNs are very common in hospitals since hospital work
requires a greater amount of knowledge and training in the field of nursing that
an RN can provide. LVNs usually handle the changing of a patient in hospitals
(when the patient is in a regular room, not the ICU) and CNAs (Certified Nursing
Assistants) usually handle changing the patient in nursing homes and they are
also the ones that check the patient's vital signs every few hours. The plus side
to having CNAs in nursing homes is that if there is a problem with the patient and
the main nurse (usually LVN or RN) is busy, then you can always report the
problem to the CNA who can help alleviate the problem.

Despite such disadvantages, some patients have no choice and must go to a

nursing home in order to receive rehabilitation services since they cannot stay in
the hospital since they do not need anymore medical care, but they also cannot
go home since they cannot do everyday things without severely hurting
themselves. As a caregiver, it is essential that you be with your loved ones as
much as possible when they are in a nursing home so that you can tell the
nurses what needs to be done and so that you can pick up on serious things that
the nurses might overlook. Your role must be active in taking care of your loved
one in a nursing home since the staff are not as diligent when it comes to making
sure that the patients are as comfortable as possible.