Poor Design & Function LTC Rooms

Long Term Care Facilities/Nursing Homes obsolete in room design and function.

Set up for residents with high physical function or no need to access various areas.

We made adjustments to our home to accommodate Mom's progressive age advancement and her physical needs.

While some rennovations are costly, others can be done with simple adjustments.

Long Term Care Facilities I've visited and where Mom lived expected the resident to adjust to whatever surroundings they were given with very little consideration for their needs, especially in the "common" or "public" areas.

NOTE:  This blog does not address those "high end" and "elegant" facilities where money buys new everything. We write about the average, the most prevalent and the many that are perhaps at least 40 plus years old and showing it. 

Mom's facility had a "face lift" on the very public, very pricey, Rehab Floor, a "showcase" for obtaining future business.

Even here, though, whoever designed the place had in mind people far younger and more capable. 

Elegant, dark colors predominate. 

Each room with a large flat screen TV. 

Few lights, though, and the bathrooms although a little more modern, were still small.

Someone with limitations could use it but anyone with more advanced needs would have great difficulties.

The rooms are all one person to a space in this "privileged area". 

Rooms on the "regular floors" accommodate two usually or one if you pay "a premium".

Doesn't matter what they "contract" as that is where they will stay.

Most hospitals in the US have changed from wards and multi person rooms because of the spread of disease and the trauma for anyone who becomes "capable" seeing the distress of another human being.

How long has it been since a renovation has been done at your loved one's facility?

How old is the building? How old are the furnishings? 

How long ago was the bathroom redone?

Chances are the facility has a face lift in the "public areas" but the rooms and the areas used by residents are the last to see any "redo" or upgrades"

THE SHOWER ROOM. This is a separate location usually located down the hall from the rooms. 

Look as closely as you look at your own bath/shower area. 

Don't just give it a quick "once over".

ASK when it was last renovated. Chances are you'll see by the tile, the grouting, the layout and design, the area used to "bathe" or "shower" will tell the story. 

Think of what happens in your home with usage; you have to clean constantly. HOW OFTEN IS THIS AREA CLEANED? 

Mom looked forward to her shower(s); sometimes she received more than one a week. 

Times were at the convenience of the Aides and since they were understaffed, some residents received showers well past the time they'd regularly "go to bed/go to sleep". 

BUT, IF THEY WANTED THEIR SHOWER, they accommodated. They waited. And often, they were disappointed. One Aide given too many showers and too many other responsibilities just couldn't manage everything.

THE BATHROOM -- one facility per resident room for one person at a time. If your roommate "has to go" you have to wait. 

In Mom's facility, there were restrooms in the hall. You had to walk the length of the corridor where your room was located (those at the end were really walking far) and halfway down the side hall to get there. 

These restrooms were "handicap" BUT the size of the stalls were too small to have a wheelchair enter inside and very small for turning around from entering to trying to actually use the commode for its intended purpose. 

ENTRY AND EXIT IN RESIDENT ROOM BATHROOM.  

With a walker it was a challenge; with a wheelchair, you had to be a really excellent driver and manipulator. 

The door would swing closed on its hinges if you didn't place the upright rectangular (about 12 inches long by 6 inches wide) trash can AGAINST THE DOOR.  

And it had to be placed "just right" to hold the door open. 

If you happened to move it, the door could close -- against you and if in a wheelchair, the weight of the door and its size meant a struggle and possible injury.

I often wondered why Mom and other people had black and blue arms or cuts and abrasions on their legs -- that may be the reason.

Using the toilet in the room.

Height.  Adding on a higher seat and side bars was common. 

What wasn't common was any other bar or railing on the walls to assist with turning the body or allowing someone to stand and move "into" the opening of the high sided rails attached to the toilet seat. 

Condition. Don't look too closely. 

No amount of scrubbing can get rid of all the built up residue and areas that are in need of constant repair but should be replaced. 

When was the last time the toilet was replaced?  

Remember, theses are rooms with two residents and the "going rate" is as much as $5,000 or more per person per month.

CLEANLINESS.  We scrubbed Mom's many a time. 

We'd ask and it was another one of those "housekeeping has to do it and they're busy somewhere.

Meanwhile, Mom has to go or her roommate had to go and that wasn't going to happen on our watch with "remnants and remainders" contaminating the seat and surround.

TOILET TISSUE HOLDER: Two. Sounds great, right? 

Inevitably the closest one would be empty and the other one would be just far enough away that a resident had to lean forward (you guessed it, causing them to possibly get off balance and fall forward and onto the floor).

Paper the quality of writing paper. Seniors are known for having hemorrhoids and this aggravates and irritates and causes bleeding and infection.

But that's to be expected, right? 

Those irritations and infections are just "growing older".

No. They do not have to be with good  peri-anal care.

CALL LIGHT.  If you're lucky, someone has attached a string that stretches horizontally and within reach of the toilet. 

If not, no string and the "light switch" is too far to reach, again, without putting yourself way off balance and falling. 

No matter how soon you put the light on, inevitably, due to the lack of adequate numbers of Aides on duty, you'll wait at least 10 -15 minutes or longer. 

You'll "tell yourself" you can take care of this "basic need" and before long, another FALL happens and it's onto a hard, unforgiving floor capable of causing cuts and bruises and breaks.

WASH BASIN.  No adjustment here for anyone in a wheelchair.

Installed at a height for someone standing, anyone in a wheelchair has to try to move it at an angle.

Consider this: the waste can is right beside you and you have Dementia, so, it's really fun to try to figure out. 

Washing your hands is challenging because the spigot isn't very long and the handles for the hot and cold water -- two separate handles -- are quite a stretch and you have to lean forward when there's little space to accomplish this "acrobatic feat".

SOAP DISPENSER.  Located high on the wall, to the side and on the back wall with no room to get to it by moving your walker or chair.

It's leaning and a possible fall. But, who takes notice? 

They find you on the floor and it's never noted the challenge with the design and layout of the bathroom is the contributor to the accident. 

THE MIRROR. Someone did think to put it on a slant but obviously didn't sit in a wheelchair while determining the slant as it barely lets you see the top of your forehead, not your entire face and front of your body. 

THE MIRRORED STORAGE CABINET WITH TWO COMPARTMENTS SIDE BY SIDE located to your right as you sit in front of the wash basin.

The only place you can store your toothbrush, toothpaste, denture cleaner, deodorant, etc. 

UNLESS... like we did, we gave Mom a three drawer plastic unit that went between the toilet and the wash basin. 

ONLY ONE COULD BE ACCOMMODATED IN THE SPACE SO, FIRST COME, FIRST SERVED and the other person, no matter what their limitations, had to "make do". 

The cabinet to put your toothbrush, toothpaste, comb, brush etc was also at a height to accommodate someone who could stand. 

If the room is for two, are there two medicine cabinets? 

Remember, these are people usually with changing mental capacity -- how are they supposed to be able to differentiate between "their" cabinet and the one used by their roommate?

The small and difficult to "grasp" with arthritis mini knobs are challenging to get your fingers on and the glass shelves provide an accident just waiting to happen. 

NOW, CONSIDER THIS.  

Each side is labeled according to the bed location: "A" and "B".

No name, just that. 

WE'RE DEALING WITH PEOPLE WHO HAVE DEMENTIA!

People "sharing" items they should not have to share but because the facility is old, outmoded and totally unsafe, it's what there is to use. 

Someone "using" another person's toothbrush or even dentures simply because there's no real separation of place that someone with advancing Dementia can always adjust to. 

And people with Dementia can't always determine what's "theirs" and what belongs to someone else.

THE CLOSET -- a fixed bar far too high for anyone in a wheelchair to reach without the possibility of getting off balance and falling. 

Mom tried using a hanger to pull her clothing down. 

She wanted to be "independent" and to at least get her clothing but what usually happened was more on the floor inside the closet and outside and when she did try to reach for them.

It caused another fall. 

Of course, the facility didn't tell us that was how it happened; while Mom was still able, she could tell us.

Accordian style doors. A shelf up high and a floor down below. 

It was up to the resident to make any "adjustments" or "additions" and most don't have the money, the ability, or the family for this. 

Try to get your shoes off the floor underneath a rack of clothes from a wheelchair or balancing with a walker. 

THE DESK complete with chair without side arms. 

Show me, please, someone in these facilities capable of using this type of chair. 

When Mom lived with us, as Mom's balance and range of motion/movement declined and became challenging, we made sure wherever we went, and especially when looking for Adult Day Care, there were chairs with not too soft seats and definitely had usable side arms for pushing down on and aiding in lifting a body up.

THE CHEST OF DRAWERS -- inexpensive when first purchased, now definitely showing age and wear although not falling apart as in some facilities, drawers aren't "locked in" and can fall out if pulled out too far.

THE BED -- dare you to try to sleep on the mattress that's thin, hard and made out of material, along with the pillows, that takes some time go get used to using for the purpose of sleep. 

NO WAY TO ADJUST THE BED'S HEIGHT by raising or lowering by the patient -- whoops! "resident". 

Yes, that's right, these beds residents lay on night after night are "hospital type" beds. How quickly did you want out of "that type" of bed when hospitalized. Think about spending years there.

Mom had a fracture in her neck and laying in the bed was very painful; she slept every night in the chair we brought from home, the chair we'd bought for her (the one I insisted she have several years before, yes, me the "abusive" daughter called so by the "new friend', Julia, who really provided nothing but took everything she could from Mom and from us).

THE CALL LIGHT  The mandated light supposed to be connected to the wall and connected to the system that alerts the Nurses and the Aides to a resident's need for attention. 

IT'S ALWAYS SUPPOSED TO BE WITHIN REACH.  

We often found it detached and laying in a circular pattern on the bed. Now, Mom couldn't remove it because of how it was attached to the wall and where it was attached. 

But there it was, disconnected and obviously useless in time of need. The question was: Who done it?

THE TELEPHONE You have to remember to dial "9" to get an outside line. Try that one on someone who has Dementia! 

It has the numbers to press but it's an older model phone and there are no adjustments to turn up the volume (something really needed by most residents who suffer some form of hearing loss). 

The numbers are way too small but you're supposed to be able to locate them by "memory" -- again, fun for someone with Dementia. 

You can supply your own, of course.

THE WALLS  -- Any space to hang or display besides just plain old open wall space? 

Most probably this "unit" is bare bones. 

The resident can "display" what they'd like but there's nothing to accommodate any display of anything. 

And, because most rooms have the furnishings (low level dresser and desk) two pieces for each room resident, along one wall, it's a challenge to keep "your" things separate from "the other persons'".

LOCKED DRAWER OR SAFE?  Not in "average" units.

Everything is out there and "up for grabs" and with many advanced Dementia patients, chances are things will "walk" and may never reappear.

FALLS ARE INCREASING. 

RESIDENTS ARE BEING BLAMED.

 

When you point a finger in one direction 

There are four pointing back at you. 

FACILITY OPERATORS TAKE NOTE!