Look Behind The Curtain

Let's take a look behind the "marketing" and "tour presentation" statements for many Long Term Care facilities. 

First area of "inspection" -- DINING.

Dining As It Appears:  Walking in you'll see tables, often a TV, maybe it's a combination "community room" used for visiting musical groups or for other uses. You're told how residents are "encouraged" to come to the dining room. How the staff has been trained in "white glove individual service" and it's like dining in a nice restaurant. 

You're told, if for some reason they can't get to the dining room or would prefer to "dine in their room", this is simply accomplished by the resident calling ahead and ordering what they'd like.  And, of course, they can do that for the dining room, as well.

Picture if you will someone with poor eyesight given a list with items on it about the size of this type. The list is in columns but isn't organized, just randomly posted. 

And on any given day certain items "may not be available" so the resident, who has difficulty making decisions due to advancing Dementia or just indecisive, now has to make another choice. 

REALITY DINING:  This mulitpurpose room may be used several times a quarter for meetings and other events and closed to residents. Residents must dine in their dining room on their floor or in their room. This can be for one meal: breakfast, lunch or dinner OR it can be for an entire day.

Dining on the resident's living floor is in a small area where the residents who cannot travel the distance or do not have the mental or physical abilities to sit with others due to either behaviour or limitations are regularly dining. No conversation possible.

Sights and sounds that to the more capable person are not just distracting, they're disturbing; you get to see what it's like, how you'll be, where you're headed. That's demoralizing and can cause the "moods" to be constantly down that are regularly measured as mandated by Federal and State Rules and Regulations in LTC Facilities.

Dining begins and service ends at a set time. If you don't make it, you may have to settle for whatever might happen to be in the refrigerator on the floor and due to "cutbacks" that's possibly now limited to ice cream, bologna sandwiches and maybe some low fat milk.

Why wouldn't you make it to dining on time? Multiple reasons.
Your roommate is in the bathroom and you need to wait until she/he finishes because there are no other bathrooms set up to accommodate your need to have a bar to transfer and enough space for your wheelchair to be moved behind you safely. 

You can roll yourself in your wheelchair but you can't get out of your bed or chair without assistance and staff shortages mean you wait a minimum of half an hour or longer for help that should have taken just a few minutes.

Or many other challenges faced every day by residents trying to adjust and adhere to schedules while they cope with limitations and deterioration.

Table Service isn't just one to one, it's one at a time and each person is asked what they want but no "written orders" are taken so the server heads back to "adjust" the order and wait to have it ladled out. She/he then walks slowly over to the person and delivers it and moves on. 

Fast food we may not want it to be but faster service would be easier on the residents who often wait over an hour before their turn to be served.

Assistance with anything in the dining room? The lady who broke her back has to ask repeatedly for her dish ring so it won't move while she works to feed herself. IF she wants assistance, she must be fed at the dining area on her residential floor, no accommodation in this dining room. 

Guess it doesn't "look good" to those who might be visiting. Besides, they only have so many "allocated" feeders so they'd have to pay an additional cost. You can always provide it yourself, of course, anything that you'd "like" to have, and pay independently.

REALITY IN-ROOM DINING:  Served from what's been brought to the upstairs dining room you may be served first or last. It's just like downstairs: one person scoops out for one resident at a time. Snails move faster. Then, one staff member takes one dish to one person either in their room or in the upstairs dining area.

Now, all this time, upstairs and down, residents are really lucky if that particular meal someone is kind enough to ask them if they'd like something to drink. They often wait from the time the arrive or are brought into a dining area for service to begin and for their "turn" to finally come to get some form of drink or food -- and seldom are they given within a short period of time of one another.

Room trays are assembled from a "ticket" that's been put together and sometimes the food is "preassembled" and usually very cold and very "tough". It's usually been sitting (goodness knows for how long and where) since someone assembled it downstairs to go up with the carts. It often arrives as long as thirty minutes after everyone's been assembled in the dining area by staff members. 

Many of those who "dine" upstairs on the floor where they live have been started to be assembled at least an hour before dinner's officially scheduled. Some have been sitting in the area almost all day long. Maybe they've been checked on and maybe not; maybe they've been changed, maybe not. Who keeps track? 

DINING ON SPECIAL OCCASIONS.  The facility posts an "Invitation" for friends and family to "join the festivities" and lists a menu with a set cost per person. This Invitation is limited to being posted in one of the two elevators so if you happen not to get that elevator, you don't know about this "opportunity".

Added staff appears for service. There's even someone acting as maitre'de to escort "families" to their seats. Tables are set up specifically for "reservations". It's not at all like everyday but visitors see and believe it is.

Missing are tables or areas for "singles" or "groups" of residents who don't have someone joining them for this "special meal" They're expected to "eat upstairs" -- either in their room or with the people who need supervision and assistance. 

Happy Holiday!

As mentioned about this past Christmas dining, name tent tags on the tables was a nice choice as were the tablecloths but adding "and family" and not having tent tags for residents who wanted to eat in the dining room but did not have a "place at a table" was upsetting.

QUALITY OF FOOD.  Prepared ahead most food is cold to lukewarm. Sometimes "water bath" serving containers are used, sometimes not. Everything is prepared alike; few seasonings and very little salt. But they're heavy on the sugar in the sweets!

Variety is limited. One choice of entree per meal. One set "menu" per meal. You can try to substitute but if it's "forgotten", too bad. And, you have to make sure you call at least two hours before the scheduled time which means you need to call by 5:30 AM for breakfast; kitchen staff isn't around to "take your order" the evening before; the person who does that is gone for the day before service begins.

COVERS TO PROTECT CLOTHING. Need a covering for your clothing because your arthritic hands have difficulty balancing the regular fork and spoon? Even though you use one every meal, no one thinks to put it at "your place". Every day your name is put at a certain place and although you've eaten there forever, no one thinks to provide this benefit for your arrival.

Covers have a nice pocket in the front to catch dropped food but they have a snap in the back even someone with capable hands and good eyes has difficulty closing. I tried. It took several attempts. Ladies with any hair length are greatly inconvenienced because they can't hold up their hair while trying to manipulate and place those small snap and closure in just the right configuration.

DISHES AND UTENSILS.If you want to use "special utensils", there has to be a "special order" for those. So, you struggle to balance food in a small bowled spoon with a very narrow handle you can barely hold onto. Grasping a slender handle on the fork they place in front of you is difficult but it's even more frustrating because you constantly drop food as you try, unsuccessfully, to balance it from the plate to your mouth.

Glasses!  Who in the world provides glasses filled to the top with liquid and expects a Senior to be able to ensure it gets to their lips and down their throat without spilling half the contents?  And a glass so small it's barely capable of holding 3 or 4 good sized swallows.

STRAWS. Ask for one and it's like you're asking for something that hasn't been invented yet. Do they have "special cups" similar to "tippy cups". YES.  What does it take to get one? Waiting half your meal and asking half a dozen times or more. 

Again, there is no consideration, no "remembering" what a "dining guest" likes/needs. That would be REAL service along with getting food that isn't dried out and cold, of course.

A PLACE FOR EVERYONE AND EVERYONE IN THEIR PLACE.  Yes, you can ask to sit with "someone" or in a "group" of people. But if that group isn't hospitable, you're soon looking for another place to sit. If you don't "ask", you're "assigned" and that means it's really difficult and sometimes impossible to get staff to move you or for you to move to another location.So, tables are set with "name signs" and you sit there every meal with the same people, hospitable or not.

It's not dining with whom you want and choices made each meal to dine with this person or that one.

TV IS ON WHETHER YOU WANT IT OR NOT.  Conversation? Depends on where you're seated. Close to the TV and you can barely hear yourself think but since some residents want it on, it's on. Sometimes I think it's more for the staff, especially in the "floor dining areas" so they can watch their "favorite programs" while serving the evening meal and feeding residents who take a longer time to eat.

AND TO THINK. THIS IS "DINING". THIS IS A "PLEASUREABLE EXPERIENCE" and as such is a "highlight" of your tour of the facility.

For many it's one of the few times they're social. Some days there are no activities. No events. And they don't have the strength in their aging bodies to make it up and down, up and down, up and down, more than three times in any one day.

ASSISTANCE?  At times. But because the facility is almost always short staffed, it's everyone for themselves and so many start down to the lower level dining room far in advance just to ensure they get there on time. 

Of course, those who have "challenges" in weak bladders truly have a choice -- stay on the floor and eat with those who provide no chance for conversation or socialization or take a chance they'll have an accident because there are no restrooms past their room that can accommodate their needs for entry and exit.

MOM never wanted to go into a "facility". She made me promise I wouldn't send her until she had no idea where she was going or where she was.

Well, Julia, the woman who came into our life and used Undue Influence on Mom helping her to "disconnect" from our family didn't have to "honor your mother" as I felt obliged..

Julia saw Mom's declining ability to reason as a trained Registered Nurse AND as someone who specialized in providing care giving for men and women with Dementia. She knew Mom's mental capabilities had diminished far beyond what we realized or saw. 

Julia succeeded in getting Mom and the State of Missouri Department of Health and Senior Services to "consider" and to "believe just enough" to put into action several steps that took Mom from the home and family she loved out to experience the raw, rough and hardship world of living permanently in Long Term Care.

BE EVER VIGILANT, FAMILIES.  Be ever vigilant Seniors. It may eventually be necessary as Mom and I always talked about but going before "your real time" is going where there are too few rules and regulations and too little enforcement to successfully ensure the safety and well being of one of our most precious gifts, long life.