Nursing Home Problems

What to Do if Things Go Wrong in a Nursing Home
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How to handle a common, nonthreatening nursing home problem

If you suspect or know of a problem with your family member or close friend's care, the first thing to do is spend some extra time just listening to her and encouraging her to talk the problem through with you.

It also helps if you know in advance what to keep an eye out for. Here are some problems that may arise, and what you can do to help:

  • Trouble adjusting to new living arrangements. Early days in a nursing home can be difficult and sometimes frightening, especially if she's getting used to not only a much smaller living space but also a new or worsening health condition. Even a small problem or irritation during the settling-in phase can feel overwhelming if she thinks she's going to have to live with the problem for the rest of her life.

What you can do: Hear her out, encourage her to try new things (like joining an on-site club or signing up for an activity), share a meal or two with her in the dining room, and help her focus on the positives. This may help her get her bearings and find her place in this new environment.

When specific gripes arise, you can take a more hands-on approach, helping to "shrink" a problem by getting to its source and finding a solution. Is that new roommate really "intolerable," or is the main problem that she keeps the TV on all day, making it impossible for your friend or relative to get the rest she needs? If you listen closely, a simple solution may present itself. Many nursing homes will give residents remote headsets for the TV, for example, but you may need to help her ask for a set -- and then help further by asking the roommate to wear it.

  • Not getting along with another resident. Moving from living alone or with a spouse to a group setting can be especially challenging if some residents are beginning to show signs of pre-dementia or other conditions that can cause aggression. Conflicts can arise, from small misunderstandings to full-fledged flare-ups.

Nan Hayes, president of RightSized Living, suggests that if a new resident is the target of aggression from a long-standing one, staff and family should also take time to evaluate the behavior of the target, who may unknowingly be contributing to the situation. For example, a disoriented new resident may wander into another resident's "space," which could create fear or anxiety and result in verbal abuse.

Family, friends, and staff can support new residents by making sure they're familiar with basic logistics and daily routines. Residents should understand procedures for reporting abuse within the home and feel comfortable sharing fears or concerns.

  • General boredom. A good nursing home will have a full calendar of activities to keep residents active and engaged -- but just because activities exist doesn't mean your friend or relative will automatically take advantage of them. When you come to visit, take note of whether she's habitually in her own room or bed rather than in a communal area engaged with other residents. Does she complain of loneliness or say that there's "nothing to do"?

What you can do: Simple shyness can keep older adults from taking advantage of the very group activities that would lift not only boredom but the social isolation that can contribute to declining health. Invite yourself along to an initial meeting of a club or activity group to help break the ice. If her health permits, take advantage of visits to go on a simple outing to a nearby restaurant or movie or to see old friends.


How to handle a potentially serious nursing-home problem

Sometimes an issue is more than a simple matter of your friend or relative getting adjusted to the home. Your help and intervention can be essential in such a situation.

  • Out-of-control aggression from another resident. Unfortunately, researchers have found that aggression and even violence among nursing home residents is much more common than is generally recognized. Researchers at a large urban nursing home documented 35 types of physical and verbal abuse, including screaming, pushing, punching, and fighting.

What you can do: For anything more than a simple slight, it's a good idea to involve staff to help check facts and determine the cause of the conflict. An experienced staff member should be familiar with the different personalities and able to help sort out misunderstandings.

When direct aggression or threatening behavior is involved, suggests Donna Quinn Robbins, CEO of Ultimate Moves, go directly to the administrator rather than to a nurse or nurse's aide, who may be too overwhelmed with daily responsibilities to provide the immediate intervention that's required. "Request a room change if the aggressor is a roommate, and keep up the pressure," Robbins advises. "The administrator is the key."

  • Problems with a staff member. It's hard to suddenly be dependent on strangers for basic care, so it's not uncommon for older adults to complain about their new caregivers initially. Whether or not these complaints are well founded, it's important to hear them out and try to help resolve them.

What you can do: After you've gotten the story from your friend or relative, try gently bringing the subject up with the caregiver -- not necessarily to point a finger but to figure out whether, together, you can come up with a solution. You know the resident best, so sometimes simply explaining a personality quirk or special need can help smooth a relationship.

Caregivers vary from one shift to another, so make sure you ask who is assigned to your loved one each time you visit or call, and make a point of getting to know the various caregivers.

If speaking to the immediate caregiver doesn't solve the problem, you may need to go up the chain of command to the charge nurse, then the director of nursing or the nursing home administrator. Exactly whom this will involve depends on how the particular nursing home is run and how its administration is structured, so it's a good idea to ask for a facility manual early on, before your friend or relative signs a contract and moves in (unless, of course, the move was made on an emergency basis).

Line staff, or those at the front desk, should also be able to answer your questions about the chain of command and steer you in the right direction if you have a serious concern.

  • Signs or complaints of poor care, neglect, or abuse. Because many older adults were raised "not to make a fuss" and may not speak up for themselves for fear of alienating caregivers, it's important to ask questions that leave the door wide open to report serious problems. Instead of just asking "How are you?" from time to time, you may want to gently ask a more directive question, such as, "Is everything OK? Are there any problems I can help out with?"

Visible trouble signs to watch out for include frequent bedsores, unexplained weight loss, or older adults who spend long periods unattended in their beds or in wheelchairs in hallways or common areas.

What you can do: If you have reason to believe that a particular caregiver is neglectful or abusive, then ask that your friend or relative be moved or assigned to a different caregiver while the concern is investigated.

If a serious problem does arise, this is an area where she may really need you to advocate for her, rather than waiting to see what happens. So if you try to contact an administrator and don't get a response right away, don't hesitate to be insistent. They may be busy, but your loved one's health and happiness are at stake!

If at all possible, you'll also want to make frequent, unannounced visits to check on her well-being during a period when a serious concern has been raised. Or, if you live out of town, ask a close family friend or relative to do it.

If, after going up the chain of command, you still have serious concerns, you can contact your local or state long-term care ombudsperson and consider filing a complaint. Of course, if your concerns have reached this level, it may also be time to think about looking into a different nursing home.

Nell Bernstein

Nell Bernstein's writings have appeared on Salon. See full bio