By Benjamin E. Ruark
The Internet is steeped with relevant publications making available various how-to literature on administering end-of-life care, treating the cognitively-impaired, and numerous other patient care subspecialties. Regardless of patients’ physical, mental, and current health status, if we effectively interviewed them about non-medical long-term care concerns, a majority of them would unanimously espouse healthcare staff complying with the 3-Rs. They refer to everything surrounding the practice of healthcare for the elderly. How it’s carried out, when and where it’s carried out
So, borrowing that old Latin phrase—omne trium perfectum: everything that comes in threes is perfect—each of the 3-Rs is examined in detail, below. Although the terms, ‘patient’ and ‘resident’ are interchangeable, with respect to their twin roles in long-term facilities, each term is intentionally used as context best indicates.
Retain Patient Dignity – All staff questions and discussions concerning residents’ private details—for example, bodily functions, medications taken, current symptoms’ status—are restricted from public areas such as hallways, dayrooms, dining halls, and commons. The same applies to areas having close proximity with other residents and non-involved staff. Dignity includes refraining from endearing forms of condescension; they still constitute condescension: thus tone of voice and chosen words—for example, dearie, sweetheart, honey, etc.—are unacceptable; as well as any form of conduct that can be inferred as demeaning. Subliminally, there’s more meaning going on behind those words than leaves the tongue; and that can get reflected in other ways just as demeaning of the dignity of patients.
With consistently, staff are therefore vigilant about addressing patients, adult-to-adult; by explaining medical and health-related procedures, regardless of a patient’s level of cognitive functioning. Professionalism is not, and never will be,contingent on patients’ levels of cognition and awareness. Staff also consciously refrain from a broken-record patter of ‘Okay?’ when giving explanations and discussing schedule requirements, etc., with residents; the exceptions being hearing-impaired and impaired cognitive functioning that’s due to depression, delirium, or dementia. Staff obviously need to ensure these patients comprehend what’s be said to them.
Render a Stress-Free Environment – The prevalence of loud noise is to be ubiquitously staff-controlled. Ideally, the facility will have a policy: high noise volumes are limited to relevant group activities and special events. Patients are given an option of not participating if the volume is stressful. Staff-lounge notwithstanding, as in many privately- and even government-operated facilities, staff now refrain from cavorting and initiating animated discussions of the type that tempt raucous gaiety at the expense of patients nearby; some of whom may find it stimulating, while others experience the opposite: highly stressed, their symptoms notably exacerbated.
Administration will set a ceiling standard on TV/radio volume in resident rooms and dayrooms. This standard constitutes a trade-off between the (a) volume level needs of the hearing-impaired with (b) respect for other residents’ serenity; given whatever the physical configuration of private and semi-private rooms, and also proximity with dayrooms, etc. The added advantage, here, is that of potentially lessening resident complaints about neighbors’ disrespectful customs around noise volume. Earphones and listening devices with downloaded sounds-of-rainfall and other calming apps could be assigned as (outside-the-box) diversions for patients suffering from chronic symptoms of crying out for help, due to dementia and other psychological factors.
Respect Residents’ Retirement Status from the Game-of-Life – Regardless of residents’ cognitive level of functioning, all staff desist from encroaching on resident’s private lives with all manner of the usual life stressors routinely experienced in mainstream society. Hence, ceasing with persistent questions over billing issues; neglecting to provide expert and speedy resolution of neighbor disputes; infringements on residents’ personal time with unapproved drop-in appointments that clearly exploit their vulnerability as a ‘captive audience.’
Also to be respected is residents’ psychological freedom from situations compelling them to self-advocate. For example, heatedly arguments with patients over their occasional refusal of a non-critical medication, where they’ve assessed its side-effects as currently greater than its benefit. In step with society’s preference for care-dependent adults being safely tucked away from the incessant bustle of the real world, the pendulum swings both ways now: residents are literally exiled from the game-of-life as we know it. They neither want to summon—nor put to the test—the requisite mental energy necessary for negotiating difficult and/or complex social and business demands that constitute the game-of-life so well.
This also includes any institution’s own cluster of demands that, depending on each resident’s strengths and weaknesses, can be overwhelming in both the level of a demand and the volume of demands being placed upon them. From slated entertainment activities to physical therapy, from wakeup calls to mealtime roundups; from them getting wheelchair-parked in a commons to filling an empty slot in front of a dayroom television. In a phrase: residents have become inured to ‘tuning out the mainstream world.’ Their present need is to possess a secure slot in a facility whose mission is to ensure that their remaining days are spent in relative peace, easy contentment, and anticipated harmony.
In summarizing, residents ask that these three wishes be an inherent part of healthcare delivery: retain their dignity; render their world a stress-free one; and respect a desire for this last leg of their life to be literally and figuratively away from mainstream society; ideally, may it be in a pastoral setting.