Back to School -- in a Nursing Home
An Education in a Nursing Home
Courtesy of Viki Johnson
Viki Johnson may be just 29, but already the second-year medical student has had a taste of what it’s like to lose your independence and rely on a nursing home staff to take care of your basic needs. That’s because Johnson recently participated in Learning by Living -- an innovative program run by the University of New England College of Osteopathic Medicine that sends med students who are studying geriatric medicine (or other medical disciplines) to live at nursing homes for 10 days. “That feeling of not being able to decide what I wanted to eat or when I wanted to go to bed or wake up will stick with me for a long time,” says Johnson, who spent her 10 days this past May at Highlands Long Term Care Center in Fitchburg, Massachusetts.
Each med student who participates gets “diagnosed” with a condition, and they are treated the way an older resident with that condition would be treated. Johnson’s diagnosis was congestive heart failure and chronic obstructive pulmonary disease (COPD) and she had to have an oxygen tank attached to her wheelchair and nasal tubes (though they weren't actually hooked up). The staff primarily responsible for Johnson’s care knew that she was a med student, as did her roommate -- and she told any fellow resident who asked her. But the vast majority of residents never asked her if she was truly a patient there. “It was quite shocking to me. Most just accepted me into the culture there,” she says.
So far, 10 students have gone through the program, says Marilyn Gugliucci, Ph.D., director of geriatric education and research at UNE College of Osteopathic Medicine and creator of the program. Gugliucci got the idea to create the program in 2005 when a student admitted that she didn’t really know how to communicate with older people in nursing homes. “I wanted a program where students could learn to look beyond the frailties and connect heart to heart with older adults,” Gugliucci says. If students could experience firsthand what it’s like to live the life of a nursing home resident, Gugliucci thought, that insight would ultimately make them better doctors. She found a nursing home in Maine that was receptive. Since then, nursing homes in New York, Massachusetts and Ohio have signed on. The nursing homes don’t receive any money from the program. In fact, it taxes their staff for the 10 days and winds up costing them money. But they’ve been eager to participate because they see the value of training better doctors, Gugliucci says. The med students keep daily journals while in the home, and meet with staff afterwards to talk about the experience.
Most of us fear nursing homes, fears which may start as early as childhood when an older relative suddenly gets sick. Adulthood, fear of our own mortality and possible loss of independence does little to allay those fears. UNE med student Kristen Murphy, 38, who spent 10 days in Sarah Neuman Center for Healthcare and Rehabilitation in Mamaroneck, New York, definitely feared nursing homes. In fact, she signed up for the program because she was interested in being a geriatrician, but realized that she was fundamentally uncomfortable with nursing homes. She looked forward to developing better communication with older adults, but was also apprehensive about her stay. “I expected isolation, loneliness, and depression,” says Murphy, whose diagnosis was an 85-year-old stroke survivor with weakness on one side. On one level, Murphy was pleasantly surprised. She discovered that there was quite a social scene and quickly made friends. “The people there were incredibly warm,” Murphy says. She had wonderful conversations with residents about life, death, love and everything in between.
But on the other hand, walking in the shoes (or wheeling in the chair) of a nursing home resident also gave her insight into how isolating and frustrating it could sometimes be as well as the things that could be different. For example, she suggested that family be more involved in the activities at the nursing home. The center is actually looking into doing this after talking with Murphy about her experience there. Murphy also noticed that when she walked into the nursing home and the elevator doors opened, there was a line of residents in their wheelchairs or in chairs watching the doors, hoping a family member would appear. “I learned that you shouldn’t deliberately ignore all the people sitting there when you come in. Visitors tend to drop their eyes because they think residents just want to be left alone. But that’s not what they want; they want to be acknowledged -- even with just a wave and a quick hi,” Murphy says.
Johnson came away with similar insights. The staff are absolutely dedicated, she says. But it’s the little things she noticed right away, like tone of voice in which the staff talked to her (especially since some of them didn’t know she wasn’t truly ill) and to other residents. “Sometimes, they talked to me like a 5-year-old and didn’t expect me to even understand,” Johnson says. She just wanted to be talked to as an adult -- as a peer. That’s a lesson she certainly won’t forget once she begins working in the field.
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mysti chic04 07:12:27 PM Sep 14 2009
Two words too long on my previous comment, whoops...After seeing how she and my other grandmother were neglected during previous nursing home stays, I fear for what will happen wherever we send her for rehab. I do believe it's mostly due to understaffing, but I have seen some that is just uncaring laziness.
mysti chic04 07:09:13 PM Sep 14 2009
Touring a facility can only give you an idea of what's on the surface, and I would think the same would apply for the most part to this experience. You are not witnessing what really happens to an elderly person in a skilled nursing facility when you are telling everyone who asks that you're there as a student. My family has learned that even at the hospital we have to keep an eye on the conditions and have someone from the family with my 93 year old grandmother the majority of the time (she's currently hospitalized following hip surgery and will soon be moved to SNF for rehab). Just yesterday, for instance, she was left on her bedside commode for over an hour and the staff was prompted 3 times in that hour before someone actually came to move her. After seeing how she and my other grandmother were neglected during previous nursing home stays, I fear for what will happen wherever we send her for rehab. I do believe it's mostly due to understaffing, but I have seen some that is just
futuremrswindham 05:31:23 PM Sep 14 2009
My grandmother is the Director of Nursing at a local Retirement Facility... and on a daily basis she is writing people up for the way they talk to or treat patients.... if you are in any medical field you have to try and take a side job here and there to keep you from geting 'cold' to the public... Like for example: if you work EMS you need to do a few clinic shifts or work an emergency room ... or fill in at a local doctors office, something to keep you from getting used to the norm so you dont treat your patients like you dont care... I personally am a Volunteer Firefighter and certified First Responder .... I only make about 25% of our calls due to work and a personal life but every patient is different and deserves to be treated like you would want to be treated... if they are old dont talk to them like they are children ... damnit they are adults and you should treat them like it... I think this program that UNE has is great ... but i think they need to put them in 'real' situat
mamabo1988 05:11:11 PM Sep 14 2009
To get a true picture of what it is like to be in a nursing home, nobody should know that you are not a real patient. I worked in nursing homes and the abuse and neglect made me ill. Speaking to the patients like they were 5 years old is one of the nicer things I saw. And yes, I did report it to the Department of Health, in person, while they were there doing their "inspections". As far as I could tell, my complaints were treated with unconcern and disregarded. A patient with dementia does not need to be wrestled to the ground and sedated because they don't want to change their pants. They do not need to be ignored because a stroke has impaired their speech. Yelling at them and calling them stupid is not necessary when they don't finish their meal. If you have relatives in a nursing home, please keep in constant touch, not by phone, but visit, and look for signs of abuse. Bruises do not just happen, bed sores do not occur overnight, check for bruises and cuts around the mouth
Fishfolk 05:03:46 PM Sep 14 2009
I think this is great! Although I was a little discouraged to see that only 10 students have participated so far. I think all medical students and or residents should have to go through similiar situations. Be admitted to a hospital with a designated disease and then have to have I.V.'s and tests and procedures that will not be detrimental to their health. Many, if not most docs have no idea how it feels to have these tests and procedures. They order them like they are nothing and to a patient they are a big deal. It might improve their bedside manner and let them relate better to patients.
Masterpacec221 04:29:00 PM Sep 14 2009
Oh and I'm not sure how they run things where those of you who are commenting on foreign workers and how they get paid so I am going to tell you how they do it where I worked....I worked at nursing homes that payed the same amount to everyone based on how long they worked for the companies. Unfortunately that also meant that someone would be getting more than they deserved, as in those that were abusers or lazy got the same as others doing more than their fair share.
Masterpacec221 04:23:38 PM Sep 14 2009
Cabinwanda,Actually I am far from a trouble maker. I am someone who was always respected for my tender treatment of nursing home residents and also the mentally and physically challenged. As for you and your reaction, it sounds like a hit a nerve. Right?? If not, if that wasn't the point you were trying to convey, I suggest that you write a rough copy of your comments in the future, then, before you post them, re-read unbiasedly and if it sounds how you wanted it to, then and only then, post them.Oh and you need to go back to school darling and learn how to spell. Oops sorry, you provoked that one.
Scarpenteri 04:12:46 PM Sep 14 2009
Stop play-acting and do it right. First, liquidate ALL your assets and put them into an account so the administrator can milk you dry, day after day, charging you MORE per day when you have your own money than they can when you finally run out and go on Medicare! Also, no visitors (because you've got dementia and don't remember them half the time) and none of your favorite foods or drinks because that's EXTRA! Nursing homes are a necessary evil but, hard as the staff may try, their are shackled by stingy corporate owners and administrations that get bonuses for saving money! One home I worked at took the water heater out all summer and bathed the patients in cold water or water heated on the kitchen stove! The nurse's aides do ALL the nasty work and get minimum wage while the nurses sit behind a desk, dole out pills and take the lion's share of the money. Administrators run all over the country looking for private pay patients so they can get more $$$ per day (until the patient's accou
jrotced02 04:11:53 PM Sep 14 2009
Cabinwanda: Ever wonder why there are so many foreign doctors and nurses working in our healthcare system? Same reason why we have so many undocumented workers in this country. They work cheap! We have healthcare recruiters who actually go to India, the Phillipines, and Pakistan, to recruit healthcare workers, and ship them over here like cattle.
