As a former head of nursing for several
senior care facilities and a state ombudsman over senior care
facilities, I've had the opportunity to see senior care in the
home and in institutions of all sizes with various amenities,
budgets, and staff programs. Each combination varies
depending upon the administrative influence all the way down to
those at a patient care level.
Most programs are well supervised and most
staff personnel put forth a tremendous effort to care for their
patients. Sure, there are a few ringers but for the most
part, they don't last and most people know who they are in very
short order. There are also a few facilities that are so
driven by profit motives that patient care isn't a top priority,
especially if it conflicts with the potential for profit.
The biggest factor in the quality of
With few exceptions, the number one
influence on the quality of patient care, whether by homecare
staff, assisted living/residence management, or nursing home
staff, is the level of family interaction and interest from the
patient's family and friends.
How often the senior client/patients'
family sees the family, how active they are in the senior's life,
the more the family asks questions, talk and interact with the
staff, and generally watch and keep watching the level of care,
all makes a huge difference in the level of care that the senior
Most management personnel will tell you
that there isn't any difference the quality of care that they give
and for the most part, that is what they intend and what they
perceive about the quality of their own care. When it comes
to a minimum expectation or even a reasonable expectation, they
may indeed be correct. There might not be any differences.
However, evaluating "care" is
extremely subjective and the difference between tolerable care,
acceptable care, and exceptional care is hard to measure and of
course, it depends on whose standards you go by. What I am
talking about, is patient care that is exceptional, relative to
the other patients in the same situation.
How long does the staff spend with each
patient? If there is a special need, which patients get the
attention the fastest? How much time does staff spend
talking to each patient? These are all questions which
relate to care but when asked relative to each patient under the
same care, can differentiate between received care.
There are several reasons in my opinion
why this is, even in the most honest and well-intentioned care
1) Staff get to know more than just the
patient. By building a relationship of sorts with the family,
staff seem to have a better attitude and a higher degree of
responsibility to the patient. There is also an affinity that is
built between the patient and the staff because personal
communication is enhanced when the staff knows the family to which
the patient is referring. A sense of familiarity is developed and
that always facilitates increased personal care.
2) There is the case of course that staff
is often over-worked and must make care decisions/choices. The
human tendency is for making the choices for care of patients
whose families are involved because it reduces the risk of having
to deal with an unhappy family member who thinks that care is
3) Involved families also communicate more
with the senior adult. Lack of care is one topic that involved
families will not only notice and ask about, but are more willing
to confront the situation.
4) One little understood fact is that
seniors who have actively involved families have a greater sense
of personal self-worth and are generally happier and have higher
expectations. This leads to a greater expectation of care from
responsible staff members. A patient who sees themselves as worth
of quality care is going to expect it and demand it where the
patient with a lower self concept is more likely to be compliant
or accepting of lower standards of care. Bottom line, you pretty
much get what you expect and what you are willing to demand.