Nursing Centers are no longer entirely long-term care facilities. As a Geriatric nurse for 20 plus years I have witnessed much of this change in focus. Many centers are now in the business of providing rehabilitation for short-term stay residents. Residents who have fallen and gotten injured or have had hip or knee replacement or other surgeries are now looking to nursing centers for their intermediate care. They need a short-term stay in a facility that houses and cares for residents who need several weeks or months of rehab therapy and then plan to return home.
Some nursing centers focus their entire effort on rehab, both for the short-term rehab resident and the long-term resident. Rehabilitation is often thought to be for everyone, including those who have not walked or fed themselves in years. Is this outlook feasible for all residents?
Some families don’t think so. Sure, it would be wonderful if Mom or Dad could all of a sudden pick up their spoon and take a big bite of something from their plate or if they could sit up or stand on their own. What daughter or son would not feel like that would be a grand thing! However, some family members have doubts that anything like this could be accomplished and really feel like their loved one maybe too feeble or demented to even hope for anything like that. And with the very real prospect of “Aunt Sally” or “Uncle Bill” not wanting to learn a new skill or even wanting to attempt it. Fear has much to do with this. Elderly people are many times afraid to attempt new skills due to fear of falling or even failing to be able to accomplish them.
The other side of this argument has to do with the definition of “rehabilitation.” Many occupational therapists agree that any progress in a skill is “rehab.” If an elder has been picking up her fork but not putting any food from her plate on it, then the next step in rehabilitation would be working with her to put the fork into the food so as to get some on it. If she has not been quite getting the fork to her mouth, then perhaps that would be the next skill to try to teach her. The reasoning behind this is that if the elder has the capacity do to part of a skill, he or she may have the capacity to learn and follow-through with the next step.
Progress in physical therapy is also dependent on the elder taking the next step literally. If the elder can stand with help, then the therapist may even be able to teach the elder how to position his or her body, and push with their arms to stand without help.
There are risks with therapy as there are risks with learning most new skills. Sometimes an elder, after learning the first basic step of a new skill, will think they can do more, and without assistance, will try. Sometimes the elder does not have the mental capacity of reason to realize that they cannot try new skills alone. Many times falls or other injuries are the result of this type of thinking.
The question then becomes, for the resident, the family and the physician, whether the risk is worth the possibility of positive results. Much of the time the positive results for the lucid resident is worth every bit of the risk. The resident is soon a non-resident and is at home, taking care of themselves as previously. However, the demented resident may not have such a positive outcome. At times the elder may be lucid enough to follow-through with performing tasks, or parts of tasks, of daily living and even enjoy doing them. However, when the mind of the elder is not clear or if a period of confusion should occur, the elder may be injured trying to get out of a chair or bed without help. I have also seen residents who have learned to feed themselves, eat things not considered edible. The elder may have gotten used to attempting these skills and may not be able to reason that he or she is in any danger. Another factor is that a family may consider whether or not the resident will be supervised on a continual basis.
These are all situations that may need to be taken into account before a resident enters a nursing center and faces the decision of participation in rehabilitation. Learning new skills for a resident may lead to a rewarding and complete recovery. For some residents and their families, however, there may be considerable risks that must be contemplated.