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Rev. Ted Bashford
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A Handbook for Nursing Home Ministry
Fifth Edition
6/27/04
A product of the church-wide Christian outreach of:
Copyright © 2004 Christian Concourse Ministries, Inc.
Please Read:
Conditions for making
copies of this document.
A Handbook For Nursing Home Ministry
Fifth Edition
Contents
For The Handbook
For a hardcopy of this
manual, click here.
The Call to the Church . . . . . . . . . . . . . . . .Section 1
The Ministry of Christian Concourse. . . . . .Section 2
Our Mission
Our Outreach
Care Facility Ministries
Original Christian Poetry and Testimonies
Small-group Bible Study and Prayer
"Chapter & Verse"
"That the World May Know"
Prayer Meetings
The Leadership of Christian Concourse
Our Support
About This Handbook. . . . . . . . . . . . . .Section 3
The Purpose of This Handbook
The Scope of This Handbook
Geographic Area
The Interdenominational Christian Community
The Cold Within
“Care Facilities”
Long-Term In-Home Care
The Volunteer Needs of Care Facility Residents
Copyright Information About This Handbook
How to Use This Handbook
Profile of the Care Facility Industry. . . . .Section 4
Overview
Factors In Care Facility Population
Types of Facilities
Rights of a Nursing Home Resident. . . . .Section 5
Rights
Family Members Note
Ombudsmen: Who They Are and How They Can Help
Prevention of Abuse in Care Facilities
Indicators of Abuse in a Care Facility
Reasons a Resident May Not Mention Their Abuse
Warning Signs From the Resident
Warning Signs From the Abuser
Some Reasons Abuse May Occur in a Facility
Preventative Measures for Family Members
Preventative Measures for the Staff
Profile of the Care Facility Population. . . .Section 6
Health
Physical Illness
Alcohol Abuse
Arthritis
Constipation
High Blood Pressure
Hyperthermia: A Hot Weather Hazard
Osteoporosis: The Bone Thinner
Prostate Problems
Stroke
Mental Illness
Alzheimer’s Disease
Stage 1
Stage 2
Stage 3
Alzheimer-like Diseases
Multi-infarct Dementia (MID)
Pick’s Disease (PD)
Huntington’s Disease (HD)
Parkinson’s Disease (PD)
Diffuse Lewy Body Disease
Age
The Changes That Come With Age
Changes in the Senses
Changes in Memory
Changes in Personality
Changes in Intelligence
Changes in Wisdom
GenderRace and Culture
“Sin of the Skin”
Religion
The Spirituality of Seniors
Faith
The Christian Attitude
The Residents’ Spiritual Needs
Religious Orientations
Definition of Religion
Major Religions of the World
Religion in the United States of America
Religion in the State of Virginia
Denominations - What difference Does it Make?
Four of the major questions of religion that Christianity answers
What about the “other” religions showing up in our neighborhood?
A Little History of the Christian Church
The Orbits of Current Christianity
The move toward relational and functional unity in Christianity
Pure Religion - Merging ministry and religion for the residents
Accentuating the Central Theme of Christianity – Jesus Christ
A Prayer for the Vulnerable and Their Caregivers
Activity Professionals . . . . . . . . . . . .Section 7
The Activity Director
The Volunteer and the Activity Director
Hampton Roads Activity Professionals’ Association (HRAPA)
From the Desk of the Administrator
Profile of a Volunteer . . . . . . . . . . . .Section 8
Physical Abilities
Social Abilities
Taking Orders
A Condition of the Heart
The Forgotten
How to Volunteer in a Local Care Facility. . . . . .Section 9
Step One – Read God’s Word
Scriptural Meditations on Ministry to the Elderly
Step Two – Pray
Step Three – Do the Questionnaire
Care Facility Volunteer Questionnaire
Step Four – Choose a Facility
Step Five – Go to Your Pastor
Pastor’s Recommendation Form
Step Six – Go to the Facility
Facility Applications
Step Seven – Begin Your Ministry
Special Skills
Hints for the Volunteer
When You Meet a Person with a Disability
Hearing Impairment
Visual Impairment
When You Meet a Person Who Uses a Wheelchair
Mental Impairment – Dementia
Behaviors Associated With Dementia
Wandering
Anger/Frustration
Hallucinations/Delusions
Depression
Paranoia/Suspicions
Refusal to bathe
Sundowner’s Syndrome
Repeat actions
Inventing new words
Using curse words
Language disturbances
Guidelines for Care Facility Visitation
A Prayer for Those in Nursing Home Ministry
Programs . . . . . . . . . . . . . . . . . . Section 10
Care Package Program
Horticulture Therapy
Pet Therapy
Caregiving One-On-One
Tips On Visiting Friends and Relatives
Who Should Visit?
Planning for the Visit
The Visit
A Note on Visiting a Comatose Resident
Visits Outside the Nursing Home
Ideas for One-On-One Activities with Residents
“Church Services”
Our Goal
Setting Up
Opening the Service
The Song Service
Poetry
Prayer
Sermonette
Sermonette Sample One: “God Strengthens!”
Sermonette Sample Two: “How Much Rat Poison Is Too Much?”
Sermonette Sample Three: “The Power of Love”
A Word About Bible Translations
Memorial Services
How to Do a Memorial Service
Memorial Service Invocation Prayer
Memorial Service Benediction Prayer
Sample Notice To Staff and Residents for Memorial Service
Sample Letter to Friends and Family for Memorial Service
Memorial Service Programs
Volunteer Chaplaincy Program
Introduction
Chaplain’s Pastoral Visitation
Hospital Visitation
Family Bereavement Support And Funeral Services
Bereavement Support for Facility Residents and Staff
Chaplain’s Information Form
Computer Lending Program
Computer Equipment Loan Agreement
Transportation
Church Shut-In Visitation Program
Visitation Committee — Leader’s Worksheet
Regular Visitation Recipient
Visitation Report Slip
Individual Visitation Record
Games and Activities . . . . . . . . . . . . Section 11
Games and Activities List
Ideas for Games and Activities
Ted Baehr’s Top 20 Movies of the Last Century
Some “Thinking” Games
Do You Remember?
“Memory Jogger” Game
Do’s and Don’t’s
“Complete the Sentence” Game
“Name That Hymn”
Show Me
“Complete the Verse”
For More
Poems. . . . . . . . . . . . . . . . . . . . Section 12
I’m Fine, Thank You!
Little Ones of the Master
A Dear Old Dame
A Young Girl Still Dwells
You Say I Have No Choices?
The Morning is Still Dawning Now
Blessings
I’m a Senior Citizen
Prescription For A Laugh
A Chaplain’s Thought – “Yes Lord”
Unfolding a Rose
Old Grandma Shoes
Latest Update On Mom’s Will
Blessings
How Can I Sing?
Four In The Fire
A Bit Of “Sonshine”
The Trail’s Not Home
How Do You Tell A Gramma When You See One?
The Parent Becomes The Child
Bloom Where You’re Planted
Watch The Signs, Stay In Your Lane!
Tools. . . . . . . . . . . . . . . . . . . . Section 13
Talk Board
Five-week Master Calendar
Consent To Photograph, Video, or Record Form
Care Facility Questionnaire
Our Hymn Book
Reference Resources. . . . . . . . . . . . . Section 14
Bibliography
Related Web Sites
A Handbook for Nursing Home
Ministry - Fifth Edition
Copyright © 2004, Christian Concourse Ministries, Inc.
1543 Norcova Ave., Norfolk, VA 23502-1720
All rights are reserved as provided by applicable United States and international laws. We have loaned this handbook to you, your church or care facility for the benefit of the residents of care facilities and it remains the property of Christian Concourse Ministries, Inc. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the explicit, written permission of Christian Concourse Ministries, Inc.
The only exception to this claim is as follows:
For use in care facility ministry see Section 3 for the conditions for our permission to copy parts of this handbook. Thank you for your consideration.
Leave your message, comment, or request in our guestbook.
Section 1
The Call to the Church
Greetings in the Name of Jesus Christ. Christian Concourse Ministries is honored to bring to you this tool to assist you in your ministry to the residents of our local care facilities. We invite you and your church to use this handbook as a resource to improve your service in this important field of ministry. Nursing home ministry is not an option for the Church of Jesus Christ. The call comes from the teaching of our Master Himself:
And the King shall answer and say unto them, “Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.” Matthew 25: 40 (KJV)
Yes, there are many legitimate areas to which the local congregation may direct its resources and energies . . . but there is a universally accepted responsibility for the strong to see to the care of the weak in their own natural family; how much more so for our spiritual kin? The hard, cold reality is that there are many lonely Christian brothers and sisters in care facilities who are neglected and forgotten by the Family of Faith. In some facilities, as many as 60% of the residents never have a friend or family member come to see them! How will we answer God in the last day if we ignore these facts while we enjoy His gift of good health and independence lavished on us daily?
This handbook is our invitation to you and your fellowship to help in meeting the volunteer needs of these precious saints. Financial provision is made for their shelter, their medical needs, and some meaningful activities – but no amount of money can buy them a friend who will share with them in their faith in Christ. It won’t happen . . . until someone like you walks voluntarily into their lonely room.
And what of that elderly resident waiting with a heart opened by the suffering and the loss of passing time, who does not know our Lord and Savior, Jesus Christ? . . . . Will you go, . . . one hour a month?
Pure religion and undefiled before God and the Father is this, To visit the fatherless and widows in their affliction, and to keep oneself unspotted from the world. James 1: 27 (KJV)
Thank you for your interest in this field of Christian service. For all Christian believers of all persuasions within the Body of Christ, we gladly, freely, place this handbook at your disposal. And, on behalf of the thousands of residents of our local care facilities, we invite you to read on.
Back to Handbook Table of Contents
Section 2
The Ministry of Christian Concourse
Our Mission
Since our beginning in 1991, the mission of this ministry has been to share
the Gospel of Jesus
Christ and to see Christian believers of all races and denominations relating
and working together as children of the same Father. We seek to equip and
empower Christians to encourage, exhort and build each other up in their faith
in Jesus Christ – across the spectrum of theological orbits of Christianity. All
of our endeavors incorporate tools that bring believers “in the trenches”
together in meaningful activities. The single greatest factor in world
evangelism is the unifying love that we have for one another. We strongly
believe that in God’s eyes, though there are many local assemblies, there is
only one Church in each locality. And we are equally convicted that our Heavenly
Father wants us to act like it! It is our prayer that these efforts will, in a
great way, effect that reality.
The prayer of our Lord just before His crucifixion is the Biblical foundation
for this mission:
“Neither pray I for these alone, but for them also which shall believe
on me through their word; that they all may be one; as thou, Father, art in me,
and I in thee, that they also may be one in us: that the world may believe that
thou hast sent me. “ John 17:20-21
Our Outreach
We are missionaries called by the Lord to minister in three areas:
Care Facility Ministries
Christian Concourse conducts “church services” in many
long-term care centers throughout Hampton Roads. Each audience is
interdenominational - they are microcosms of the answer to Jesus’ priestly
prayer quoted above.
We also offer inspirational presentations and workshops for Christian
groups who wish to expand their understanding of the volunteer needs of care
facilities and their residents. We publish nursing home ministry aids in
which we attempt to cover the full spectrum of volunteering and ministering
needs in all types of care centers with an emphasis on the spiritual dimension
of care for the residents.
Our materials are produced and assembled with the help of volunteers and
provided without charge. They are not only given to those who attend our
workshops for nursing home ministry, but to anyone who requests them from our
website, to activity directors of care centers and to other volunteers and
ministers we meet. The ministry aids include:
A Handbook for Nursing Home Ministry - this is the book you are reading: a comprehensive collection of ideas, information, guidelines, resources, tools and programs.
Our Hymn Book - 36 timeless hymns and Christmas carols in large print bound in paperback.
Music CD for Our Hymn Book - a two-CD set with all the songs that are in the hymn book. Our current CD set is an instrumental version. A version with vocal backup is being prepared.
We manage a computer lending program for care center residents. With the help of a faithful volunteer, Jeff Hadsell, we are able to receive donations of old computer equipment, reassemble them and place them, free of charge, with activity departments and residents of care facilities. The machines have many games, the Bible, and basic productivity software on them when we send them out.
Accepting donations of items approved by nursing home staff, we distribute “Care Packages” that are given to the residents of facilities. For a list of such goods, and a description of this program we refer you to this topic in Section 10.
Christian Concourse is participating with the Christian Fellowship of Care Center Ministries. This is a growing association of representatives of nursing home ministers from across the United States and Canada. Membership is for those who are ministering in a regional outreach involving more than one congregation and more than one facility. The purpose statement for CFCCM is: As a Christ-centered fellowship, we are committed to gather to provide encouragement for leaders of care center ministries. We do this through spiritual renewal, networking, fellowship and sharing resources. If you are involved in regional nursing home ministry, please consider participating with CFCCM. For more information on membership and upcoming meetings call us at 757-714-3133.
Original Christian Poetry and Testimonies
Christian Concourse Ministries publishes and distributes poems and testimonies of sincere Christians via a booklet titled The Journal for Jesus’ Sheep. We print and assemble all publications ourselves. The Journals are given without charge to anyone who requests them. They are also available on our website. Authors are encouraged to share their work with us. If we select a particular piece for publication, our only requirement is that the writer sign a copyright release form. There is no charge to the author for his or her work being published.
Small-group Bible Study and Prayer
Chapter & Verse
We promote and facilitate small-group Bible study in an inductive-study format. Using a system developed by Jerry Johnson called Chapter & Verse, we provide the setting and the tools for believers to share their walk with the Lord and their observations from Holy Scripture on topics specifically relevant to their individual lives. Chapter & Verse is a “true” inductive study using a “true” seminar-style model. This means that we do not tell you or lead you to draw our conclusions from the Bible and, with oversight by an experienced participant, all members prepare for the same subject and share their work on an equal basis with their peers. This system provides a unique opportunity for Christians to develop personal discipline and integrity in their prayer life, their Bible study habits, and their interaction with fellow believers.
That the World May Know
As our schedule allows, we offer a tremendously rewarding video series by Ray Vander Laan, That the World May Know. Exploring the fascinating geographical and cultural backdrop for scriptural events and personalities, we discover their significance to us today. Each video session takes us to actual settings in Biblical lands with Ray’s teaching illuminating, life-changing “faith lessons.”
Prayer Meetings
The impact that the Church has in the secular community, including the nursing home arena, would be greatly enhanced if we worked together on a harmonious, multi-denominational basis. For this reason, and to this end, we promote and facilitate interdenominational, community-based prayer meetings, prayer retreats and ministry leaders’ prayer groups.
For more information concerning any of these activities of our ministry, please contact us today.
The Leadership of Christian Concourse
Jerry and Dar Johnson – Jerry is the founder, president and Director of Ministry of Christian Concourse; an ordained minister in association with the Evangelical Church Alliance; and a former Associate Minister with Churchland Christian Fellowship. He is the pastor of Good Shepherd Community Chapel in Portsmouth, VA. He received a bachelor’s degree in Religious Studies from St. Leo College. Dar is his dear wife, trusted counselor, administrator, assistant and co-worker in the ministry. As members of Hampton Roads Activity Professionals Association we provide a liaison between the Christian community and this organization of area activity directors.
Larry McAdoo – Board member and secretary of Christian Concourse; retired Chaplain, U. S. Navy; ordained with Christian Churches/Churches of Christ. Larry received a bachelor’s degree in Bible/Ministry from Manhattan Bible College in Manhattan, Kansas and a Master of Divinity from Lincoln Christian Seminary, Lincoln, Illinois. He ministers in local facilities with a true pastor’s heart of faithfulness and compassion.
Bob Walker, Sr. – Board member and treasurer of Christian Concourse; received a bachelor’s degree in Business Administration from Northwestern University, Chicago, Illinois; commissioned missionary from Tabernacle Church of Norfolk, VA. Bob is a retired missionary to the military and a faithful community activist for revival within the interdenominational Church.
Our Support
Everything this ministry does and all the materials we publish are provided without charge. The people to whom we minister in nursing homes cannot support us. We do not ask poets to pay us for sharing their work and we do not require others to pay us to read their poems. Our Bible study system, in its entirety, is available without charge on our website. We rely completely on the support of Christian friends who see the value of what we do and are willing to help us financially.
By God’s Grace, the positive difference this ministry makes in the lives of others is significant and real…and eternal! Our expenses are real, too. In addition to our personal support, paper, ink, the raw materials for CD duplication, printing and office equipment, phone and internet service, and vehicle maintenance are all costly. The demand for our materials is increasing exponentially as more learn of the resources we provide. Our production to meet these demands is directly proportional to the financial sustenance we receive. We invite you to prayerfully consider supporting this Christian labor of love.
Christian Concourse Ministries, Inc., is a non-profit corporation registered with the State of Virginia and classified as a 501-C3 tax-exempt charity with the IRS. Your monetary gifts and the fair-market value of goods donated are tax- deductible. References and our financial statement are available upon request.
We sincerely pray that this humble handbook will minister to you. And, we pray that it will aid you in some way to be a greater blessing to the precious care facility residents to whom you minister.
For more information or to get involved in this exciting field of ministry contact us today: Leave your message, comment, or request in our guestbook.
Or phone us at: (757)714-3133
Back to Handbook Table of Contents
Section 3
About This Handbook
The Purpose of This Handbook
In the broadest terms, the goal of The Nursing Home Ministry of Christian Concourse is to encourage and assist the interdenominational Christian community to work together to meet all the volunteer needs of every care facility in their geographic area. This handbook has been assembled to aid us in that purpose. Here, you will find tools to advance you and your church group in ministry to residents of care facilities. These tools include general information about care facility ministry, scriptures related to this mission field, forms, programs, suggestions and detailed instructions for many nursing home activities. As the simple product of our experience and what we have gleaned from others, we do not consider this work exhaustive nor authoritative beyond the value it may prove to be to you and your fellowship. In other words, this is not all there is to it, nor are our suggestions and ideas here the only way to do it.
With this manual, we are not trying to rigidly impose on anyone our way of going about the task of ministering in nursing homes. Stated simply, in the use of these tools, we hope and pray the quality of your service in this ministry will be enhanced and expanded, and that your service will be kept from becoming stale and dull to you and the residents. If, even in a small way, you feel this to be the case, we will consider that a great blessing.
We encourage you to adapt these ideas and suggestions to your own way of doing things. Proceed prayerfully and sincerely, absolutely. And, have fun! If you do not find delight in your efforts, how can you expect the residents to? So, be creative . . . and enjoy yourself! We hope it is obvious to all that we are doing just that!
The Scope of This Handbook
Geographic Area
The material used in this handbook draws from years of experience of many care facility ministers and staff working within the United States and Canada. But, through our website, we are finding that almost all of the features in this manual are helpful in any country that uses facilities for long- term care. We have supplied earlier editions all over the United States, of course, and to England, New Zealand, Australia, South Africa, Italy, and Canada.
The Interdenominational Christian Community
Whether you live in a large city or a small town, we believe Christian unity to be the only practical way the Church can satisfy the volunteer needs of all the residents in our local facilities. It is our conviction that it would please God greatly were all Christians willing to cooperate in their ministry efforts to the care center population. In spite of any personal convictions and doctrinal understandings that differ among Christians, the love of Jesus Christ will bind us together in our purpose to serve His saints, our elders, in the care facilities nearby. In the name of Jesus Christ, we encourage all Christian volunteers to work together for that purpose, in that spirit. And, with this thought in mind, we include here a poem that frames a picture of what can happen if we refuse to cooperate with each other for the cause of Christ.
The Cold Within
A Poem On Accord In The Body Of Christ
Six humans trapped by happenstance, in bleak and bitter cold;
Each one possessed a stick of wood, or so the story’s told.
Their dying fire in need of logs, the first man held his back,
For of the faces round the fire, he noticed one was black.
The next man looking cross the way, saw no one of his church,
And couldn’t bring himself to give the fire his stick of birch.
The third one sat in tattered clothes, he gave his coat a
hitch;
Why should his log be put to use to warm the idle rich?
The rich man just sat back and thought of the wealth he had in
store,
And how to keep what he had earned from the lazy, shiftless poor.
The black man’s face bespoke revenge as the fire passed from
his sight.
For all he saw in his stick of wood was a chance to spite the white.
The last man of this forlorn group did naught except for gain,
Giving only to those who gave was how he played the game.
Their logs held tight in death’s still hand was proof of human
sin:
They didn’t die from the cold without - they died from the cold within.
by James Patrick Kenny.
Let us say again: If Christians who worship in a given geographic community will work together, interdenominationally and inter-racially, this field of ministry responsibility for the Church will be abundantly satisfied! We hope and pray that you, the reader will join with us to promote this concept.
“Care Facilities”
As we use the term in this handbook, a “care facility” refers to any institution that provides professional care (on any scale short of a hospice or hospital) to individuals, whether it be a for-profit or non-profit operation, privately run or corporately controlled, large or small, religion-sponsored or secularly managed, long-term care or acute care. (It should be mentioned that the terms, “care center” and “nursing home” are often used interchangeably with “care facility.”) In all cases, we work through a relationship with a staff member of the facility who is preferably a professional activity director. We provide and promote Christian ministry and volunteer service to care facilities without regard to race, religion, creed, or social status. In the ministry of Christian Concourse, we render support and service to the following types of care facilities:
Nursing Homes A generic term sometimes used to refer to all care facilities. Technically, it is divided into these two levels of care:
Skilled Nursing Facilities
Intermediate Care Facilities
Assisted Living Homes
Retirement Communities
Adult Family Homes
Adult Day-Health Care Centers
Multi-Level Care Complexes
For a description of each type of care facility listed here, refer to the next section of this handbook, “A Profile Of The Care Facility Industry.”
Long-Term In-Home Care
In the United States, the elderly who are given care at home constitute the vast majority of those who receive long-term care, and this number is increasing (see Section 4, “Overview”). Though there would obviously be many similarities, this handbook does not specifically address the unique considerations for the needs of these individuals. In most cases, they are cared for by loved ones, and we know they can usually benefit from outside support. Where applicable, in your judgment, in a home-care setting we certainly invite you to use this resource if you are ministering as a caregiver, a friend, or a volunteer. (See “Copyright Information About this Handbook,” below.)
The Volunteer Needs of Care Facility Residents
Because nursing, food services, and building maintenance generally require professionally trained and/or licensed specialists, the volunteer needs of care facilities are usually focused on leisure activity programs. However, the long-term care industry is slowly responding to the importance of the emotional, social and spiritual well-being of their residents, and they are utilizing trained activity professionals to assist them in this dimension of care for their residents. It is the responsibility of these activity professionals to know their clients, document their activity capabilities and needs, and provide an adequate, customized answer to those needs for each individual resident. From a practical point of view, it is nearly impossible for the owners of a facility to provide adequate staffing to help the activity professional in such a monumental task. Therefore, volunteerism plays a vital role in meeting the activity needs of care facility residents. This manual attempts to address most of these wholesome volunteer needs identified by activity directors of care facilities. Within the genre of “activities,” the list of tasks that could be or need to be done on a volunteer basis in a care facility is really quite long! Such simple things as reading the newspaper or picking up a pair of socks at a local store become very important in a nursing home. For a list of the types of things you can do in care facilities, please refer to Section 11, “Games and Activities” later in this handbook.
Copyright Information About This Handbook
This handbook is copyrighted by Christian Concourse Ministries, Inc. All rights are reserved as provided by applicable United States and international laws. We have loaned this handbook to you, your church or care facility for the benefit of the residents of care facilities and it remains the property of Christian Concourse Ministries, Inc. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the explicit, written permission of Christian Concourse Ministries, Inc.
The sole exception to the above reservation is as follows: for the purpose that it would help you in your service to care facility residents or those receiving “long-term care” at home, we gladly give the local church, care facility or individual to whom this handbook was lent, permission to photocopy or copy into your computer system the descriptions, guidelines, lists, samples and forms herein on the four conditions that [1] they will not be used in any for-profit activity, [2] that the provided text will not be altered in any way, that [3] the copyright statement at the bottom of each page will be legibly included with each copy of each page without exception or alteration, and that [4] there is no copyright by another individual indicated with a particular article or piece in the text.
In the event that you feel you can improve on our ideas, we encourage you to do so. We would deeply appreciate a copy of your work with your permission to include it, with proper credits, in our next edition.
Christian Concourse Ministries, Inc. offers this handbook to you for you to use at your discretion and we take no responsibility for the results of your efforts, though we are deeply grateful for your interest in assisting the staff and residents of care facilities and we hope this handbook will be helpful to you. No part of this manual is to be construed as an endorsement of any given facility, local church or ministry by Christian Concourse. We work as hard as we can to keep the material in this handbook up to date, accurate and helpful, but we acknowledge that it may be flawed and incomplete. No harm or damage due to our mistake or omission is intentional; neither do we take responsibility for the correctness or incorrectness of this information.
Back to Handbook Table of Contents
How to Use This Handbook
We encourage you to read this handbook from cover to cover.
Where we provide material for you to copy, please do so within the scope of our permission in the preceding segment, “Copyright Information About This Handbook.” In that case, reproduce freely and generously. Where bulletins, forms and lists are included, make the copies, collate, staple, fold and cut them as necessary into your own booklets. Be as creative as you can with colors and paper quality.
Please distribute copies of these materials to volunteers and residents as you deem necessary and/or helpful to enhance your service in this field of ministry.
Back to Handbook Table of Contents
Section 4
Profile of the Care Facility Industry
Overview
The commercial industry of long-term care, as it has developed in our western culture, is unique in the history of the world. At no other time, nor in any other place, has institutionalized care been seen on the scale of what we have today. In localities where nursing homes numbered five or six just a few decades ago, today there are fifteen or twenty. Nationwide, in nursing homes alone, there are 1.5 million residents living in 16,000 facilities (CMS OSCAR Data Survey, December 2003, from the website of the American Health Care Association). As “in-home care” becomes more and more popular (and subsidized by insurance and Federal programs), the percentage of elderly and handicapped who are able to stay in their own residence will significantly increase; but, because of the “baby boomer” phenomenon, the total number of individuals who live in long-term care facilities (especially “retirement communities”) will probably increase in the foreseeable future. Today, about seven million people over the age of 65 need long-term care. By 2005, that number will increase to nine million. By 2020, twelve million older Americans will need long-term care. Most will be cared for at home; family and friends are the sole caregivers for 70 percent of the elderly who need “long- term care.” But, a study by the U. S. Department of Health and Human Services says that people who live to the age of sixty-five will have a 40 percent chance of entering a nursing home. (www.medicare.gov/LongTermCare, February, 2004) This suggests that at least 10% of our elderly who are cared for at home will eventually reach a stage of needing institutional care.
Nearly one of every two women and one of four men over age 65 will enter a long-term care facility at some time in their lives. More than a third of all nursing facility stays last more than a year, and many last three years or more. About 10 percent of the people who enter nursing homes will stay there five-plus years. ( www.nolo.com/lawcenter, J. L. Matthews)
In addition to the numbers, the nature of long-term care has changed too. Fifty years ago there were two basic types of facilities: “old folks’ homes” and “convalescent homes.” Both often looked and smelled more like insane asylums than homes. As described later in this section, today there are different levels of adult care such as “nursing” care facilities, assisted living facilities, retirement homes, adult family homes, adult day-health care centers, and multi-level care complexes. Through education, community involvement and responsible regulation, these long-term care facilities are generally more clean, pleasant, and professionally managed than their predecessors.
Until recently, as the type and number of facilities has increased, so has the number of residents increased in the average facility. Where nursing homes might have housed 20 patients in old, three- story converted homes 70 years ago, today, 120 residents live in sprawling, well maintained commercial buildings designed particularly for that purpose.
We see at least five major factors in the United States affecting the population of care facilities.
Factors In Care Facility Population
1. Modern medicine is more successful in treating major illness and injury. Therefore, more people are surviving serious trauma and disease.
2. The average life-span is increasing. People are just naturally living longer than in past centuries. By the year 2020, more than 200,000 living Americans will be over the age of 100.
3. Due to the “baby boomer” phenomenon, the proportion of elderly people in the general population is increasing. Over fifty percent of our population is 50 years old or older.
4. Since 1964, Medicare and Medicaid have dramatically increased funding available for long- term care.
5. In increasing numbers, disabled people have no family or friends who are able to care for them.
Types of Facilities
The “care facility industry” is the focus of the ministry of Christian Concourse. Though the type of ministry that we do is often referred to as “nursing home ministry,” the type of facilities to which we go are actually very diverse. It is safe to say, in all cases (except Adult Day-Health Care Centers) they provide residence and care for the elderly and/or the infirm. The following list is our attempt to identify in laymen’s terms these different types of homes. [As mentioned in our discussion on the scope of this handbook, please note that the material in this manual does not address the special volunteer needs of hospitals or hospice institutions]
Augmented by our own observations, resources for this information are New LifeStyles Guide to Senior Residences and Care Options (listed in our Bibliography section) and the Federal Health Care Financing Administration.
Nursing Homes – A nursing home is a residence that provides room, meals, recreational activities, help with daily living, and protective supervision to residents. Generally, nursing home residents have physical or mental impairments which keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing (services that can only be administered by a trained professional).
Occasionally called convalescent centers, “nursing homes” is a term often used in general reference to long-term care facilities. Its proper technical use would be to identify facilities which provide some level of 24-hour, professional nursing services to residents. Nursing homes often serve residents needing short-term rehabilitation after accidents or illnesses. Though the same facility may house both levels, they are officially divided into two types based on the degree of nursing care they offer:
Skilled Nursing Facilities (SNF) – provide around-the-clock nursing supervision. Many of their residents are completely or partially confined to their bed, and they are often incontinent. Medical treatment is provided under the supervision of licensed nursing professionals. At least one registered nurse must be on duty during the day. An SNF may include a special unit for residents suffering with Alzheimer’s disease and other forms of dementia.
Intermediate Care Facilities (ICF) – residents are able to get out of bed and move about with or without assistance from staff personnel (whether ambulatory – able to walk – or in a wheelchair). These residents may be incontinent and will require intermittent professional care. An ICF may include a special unit for residents suffering with Alzheimer’s disease and other forms of dementia.
Assisted Living Homes – provide an option for full-time, long-term care on a level between ICF nursing homes and retirement communities. They offer assistance with medications, bathing, dressing and usually serve full meals. These homes may include a special unit for residents suffering from Alzheimer’s disease and other forms of dementia.
Retirement Communities – offer retired and elderly individuals the option of living in a community with other seniors in a fairly independent atmosphere. Residents of retirement communities are usually offered organized social programs, meal service, transportation, recreation, and assistance for shopping needs and medical services. Very often, the larger of such facilities will include an “assisted living” section on their premises.
Adult Family Homes (or Residential Care Facilities, or Adult Care Residences) – actual homes usually in residential areas having four or more beds providing care for a small group of seniors and/or mentally or physically challenged persons. Residents may be ambulatory or non- ambulatory and will be supplied room and board as well as supervision and assistance with daily activities such as bathing and dressing. Residents may suffer from Alzheimer’s disease and other forms of dementia. Programs are designed to help the residents be as independent as they can be. Such facilities are staffed around the clock.
Adult Day-Health Care Centers – weekday, daytime-only facilities for seniors and disabled individuals who generally live with relatives or friends during non-working hours. Staff- supervised group activities of a recreational nature are provided throughout the day. Snacks and lunch are usually served. Programs vary widely, but services may also include nursing and rehabilitation.
Multi-Level Care Complexes (or Continuing Care Retirement Communities, CCRC’s) – offer a variety of independent and retirement living options, coupled with full medical and nursing services designed to accommodate the contingencies of progressive aging disabilities. CCRC’s are usually equipped to be self-contained communities that offer a full range of activities, recreational opportunities and services for the active resident.
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Section 5
Rights of a Nursing Home Resident
Rights
Though people may live in an “institution,” or a care facility, they are no less citizens of this great nation. As citizens, they have the same basic civil rights that you do. And, beyond these rights, the national and state governments have legislated some further “rights” that apply specifically to nursing homes that house residents who receive financial assistance from Medicare or Medicaid (according to the latest figures, of 16,000 facilities, only 3% are not Medicare or Medicaid certified). The following description of these rights is provided through the auspices of the United States Department of Health and Human Services and is prepared by the Centers for Medicare & Medicaid Services (CMS). CMS and States oversee the quality of nursing homes. State and Federal Government agencies certify nursing homes. The nursing home must provide the resident with a written description of his or her legal rights.
Disclaimer: The material in this section is provided only to inform and educate our readers. This material is not and should not be considered legal opinions or advice. You do not and cannot have any client-attorney relationship with Christian Concourse or any of its employees. You should not take legal action based upon advice you perceive as legal found in A Handbook for Nursing Home Ministry. You are advised to seek professional counsel before taking any legal action based upon information found herein.
At a minimum, Federal law specifies that a resident in a nursing home has rights which include:
● Freedom from Discrimination: Nursing homes do not have to accept all applicants, but they must comply with Civil Rights laws that do not allow discrimination based on race, color, national origin, disability, age, or religion under certain conditions.
● Respect: The right to be treated with dignity and respect. As long as it fits a resident’s care plan, they have the right to make their own schedule, including when they go to bed, rise in the morning, and eat meals. They have the right to choose the activities they want to go to.
● Freedom from Abuse and Neglect: The right to be free from verbal, sexual, physical, and mental abuse, and involuntary seclusion by anyone. This includes, but is not limited to nursing home staff, other residents, consultants, volunteers, staff from other agencies, family members or legal guardians, friends, or other individuals. If abuse or neglect (neglect means the resident’s needs are not met) is suspected, report this to the nursing home, your family, your local Long-Term Care Ombudsman, or State Survey Agency. It may be appropriate to report the incident of abuse to local law enforcement or the Medicaid Fraud Control Unit (their telephone number should be posted in the nursing home).
● Freedom from Restraints: Physical restraints are any manual method or physical or mechanical device, material, or equipment attached to or near the body so that a resident can’t remove the restraint easily. They prevent freedom of movement or normal access to one’s own body. A chemical restraint is a drug used to limit freedom of movement and is not needed to treat medical symptoms. It is against the law for a nursing home to use physical or chemical restraints, unless it is necessary to treat medical symptoms. Restraints may not be used to punish nor for the convenience of the nursing home staff. The resident has the right to refuse restraint use except if they are at risk of harming themselves or others.
● Information on Services and Fees: The nursing home resident must be informed in writing about services and fees before they move into the nursing home. The nursing home cannot require a minimum entrance fee as a condition of resistance.
● Money: The residents have the right to manage their own money or to choose someone they trust to do this for them. If the nursing home is asked by residents to manage their personal funds, they must sign a written statement that allows the nursing home to do this for them. However, the nursing home must allow the residents access to their bank accounts, cash, and other financial records. The nursing home must protect residents’ funds from any loss by buying a bond or providing other similar protections.
● Privacy, Property, and Living Arrangements: The right to privacy, and to keep and use personal belongings and property as long as they don’t interfere with the rights, health, or safety of others. Nursing home staff should never open a resident’s mail unless the resident allows it. The resident has the right to use a telephone and talk privately. The nursing home must protect the residents’ property from theft. This may include a safe in the facility or cabinets with locked doors in resident rooms. When a married couple lives in the same nursing home, they are entitled to share a room if they so desire.
HIPAA: Congress called on the Department of Health and Human Services to issue patient privacy protections as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA included provisions designed to encourage electronic transactions and also required new safeguards to protect the security and confidentiality of health information. The final regulation covers health insurance companies, health care billing companies and health care providers including nursing homes.
Each nursing home is responsible to implement their own plans for observing privacy regulations. And, they may provide residents with even greater rights and protections of their health information and their privacy in general. As a volunteer, you should consult with the appropriate staff of the nursing home to determine how they expect you to help them abide by these rules. In all cases, please show the utmost respect for the personal privacy and personal property of the residents of the facility in which you volunteer. As a ministry, it is the policy of Christian Concourse not to take photographs, audio recordings, or video recordings of care facility residents without a signed permission slip from the resident(s) and without the full knowledge and consent of the facility. For a sample of a permission slip see Section 13, “Tools.”
● Medical Care: The resident has the right to be informed about their medical condition, medications, and to see their own doctor. They also have the right to refuse medications and treatments (but this could be harmful to their health). They have the right to take part in developing their plan of care. They have the right to look at their medical records and reports when they ask to do so.
● Visitors: The right to spend private time with visitors at any reasonable hour. The nursing home must permit family to visit at any time, as long as the resident wishes to see them. Conversely, the residents don’t have to see any visitor they don’t wish to see. Any person who gives help with health or legal services may see them at any reasonable time. This includes the resident’s doctor, representative from the health department, and their Long-Term Care Ombudsman, among others.
● Social Services: The nursing home must provide the residents with any needed social services, including counseling, help solving problems with other residents, help in contacting legal and financial professionals, and discharge planning.
● Leaving the Nursing Home: Living in a nursing home is the resident’s choice. They can choose to move to another place. However, the nursing home may have a policy that requires the resident to tell them before they plan to leave. If they don’t, they may have to pay them an extra fee. If a resident is going to another nursing home, they should make sure that there is a bed available for them.
If the resident’s health allows and their doctor agrees, they can spend time away from the nursing home visiting friends or family during the day or overnight. The nursing home staff should be informed a few days ahead of time if the resident wants to do this so medication and care instructions can be prepared.
Caution: If a resident’s nursing home care is covered by certain health insurance, they may not be able to leave for visits without losing their coverage.
● Complaints: The right to make a complaint to the staff of the nursing home, or any other person, without fear of punishment. The nursing home must resolve the issue promptly.
● Protection Against Unfair Transfer or Discharge: A nursing home resident cannot be sent to another nursing home, or made to leave the nursing home unless:
• It is necessary for their welfare, health, or safety of themselves or
others,
• Their health has declined to the point that the nursing home can not meet
their care needs,
• Their health has improved to the point that nursing home care is no longer
necessary,
• The nursing home has not been paid for services received by the resident, or
• The nursing home closes.
Except in emergencies, nursing homes must give a 30-day written notice of their plan to discharge or transfer a resident. Residents have the right to appeal a transfer to another facility.
A nursing home cannot make someone leave if they are waiting to get Medicaid. The nursing home should work with other state agencies to get payment if a family member or other individual is holding the resident’s money.
● Family and Friends: Family members and legal guardians may meet with the families of other residents and may participate in family councils. By law, nursing homes must develop a plan of care (care plan) for each resident. A good care plan can help make sure that the resident is getting the care they need and help make their stay more pleasant. Health assessments (a review of someone’s health condition) must be done within 14 days of admission. A resident should expect to get a health assessment at least every 90 days after their first review, and possibly more often if their medical status changes. The resident has the right to take part in this process, and family members can help with the care plan with the resident’s permission. If a relative is the legal guardian, he or she has the right to look at all medical records about the resident and has the right to make important decisions on their behalf.
Family and friends can help make sure the resident gets good quality care. They can visit and get to know the staff and the nursing home’s rules.
Family Members Note
Some states enforce the Nursing Home Reform Amendments better than others. Therefore, family members and friends of nursing home residents still have an important role to play in protecting their loved one’s rights. This fact underlines the need for caring, committed Christian volunteers to help fill the gap in personal love and attention to nursing home residents. It is estimated that, on a national average, 60% of the residents in nursing homes never have a visitor who comes to see just them!
Become familiar with both the Federal Nursing Home Reform Amendments outlined above and your state’s law. Nursing homes must post and make available a copy of the rights of nursing home residents.
Report violations. If you observe or experience a violation of a nursing home resident’s rights, report it to the nursing home. Use the facility’s grievance procedures. If you are not satisfied, then, report the violation to the local long-term care ombudsman. Nursing homes must post and make available the name and telephone number of the ombudsman.
Follow up to make sure that action is being taken and the facility is correcting the violation.
Keep informed of movements within your state to introduce legislation that would change nursing home laws or regulations. By making your views known before legislation is voted on, you can help protect the rights of long-term care residents.
Ombudsmen: Who They Are and How They Can Help
Thanks to Prof. Tom McCormick of Toronto, Canada for his research on this topic. Taken from material he presented to the national Christian Fellowship of Care Center Ministries, March 2004; to contact Mr. McCormick, leave a note in our guestbook.
Resource: http://www.carescout.com/resources/nursing_home/ombudsman.htm“Every state has an ombudsman program that, for free, acts as an advocate on behalf of nursing home residents. Each state designates individuals to serve as long-term care ‘ombudsmen.’ Nationwide, there are more than 500 local ombudsman programs.
“An ombudsman is responsible for receiving and resolving complaints affecting residents in nursing homes throughout the state. If you have a legitimate complaint about you or your loved one’s nursing home that the administrator of a facility has not resolved to your satisfaction, you may wish to contact the Ombudsman office for help. It is part of an ombudsman’s job to help you resolve your nursing home problems and complaints.”
The telephone numbers for the Ombudsman in each State are given at the website listed above.
For more information about the rights of nursing home residents, contact:
National Training Project
AARP Foundation
601 E Street, NW
Washington, DC 20049
National Citizens’ Coalition for Nursing Home Reform
1424 16th St., NW, Suite 202
Washington, DC 20036
or call: (202)332-2275
Prevention of Abuse in Care Facilities
Alarming things happen when scores of strangers are placed in a close living environment, often against their will. Sometimes, unfortunately, what occurs to a care facility resident is abusive and wrong. But, as Christian volunteers we must remember that the circumstances and events leading up to any questionable observations made in a facility are mostly unknown to us. Also, the underlying reasons why a given individual is in a care facility are often very complex and hard to understand from the limited viewpoint of a volunteer. Therefore, we must be careful not to quickly assume the role of judge and jury over decisions and actions made by professional social workers, facility staff and family members. Try to maintain the attitude that you are there to be a blessing, an encouragement, a peacemaker to the residents, their families and all who care for them. There are almost always two sides to a story, if not more — and there are probably parts of that story that are none of our business!
The Federal definition of abuse is: “Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.” (Centers for Medicare & Medicaid Services, 42 CFR 488.301).
Abuse can happen at any care facility. No matter how refined the setting, no matter how professional the staff, abuse may occur. And, abuse can happen to anyone: man or woman, young or old, nice or grouchy, lucid or suffering dementia. And all of us are capable of being abusive, however so slightly, but still abusive. ANY ABUSE OF A CARE FACILITY RESIDENT IS TOO MUCH ABUSE!!! Therefore, we feel it is appropriate to, at least, provide some very general information on this highly explosive issue in long-term care. Our intention here is not to create controversy or lay blame. Neither do we deal comprehensively with the subject, but we hope these ideas will help all involved to think positively in the direction of preventing elder abuse.
Indicators of Abuse in a Care Facility:
Resource: http://www.carescout.com/resources/nursing_home/ombudsman.htm
Unexplained or unexpected death.
Rapid weight loss.
Development of bedsores (“pressure sores” or “decubitus ulcers”).
Heavy medication and sedation is used in place of adequate nursing staff and supervision.
Caretaker cannot adequately explain condition.
Injury resulting from restraining a resident.
The occurrence of a broken bone.
Suddenly and unexpectedly emotionally upset or agitated or withdrawn and non-communicative resident.
Reasons a Resident May Not Mention Their Abuse:
The following is adapted from material compiled by Marci Stocks on her website, Elderly Place (http://www.geocities.com/~elderly-place/ ).
May be too frightened to tell their caregiver.
May be frightened because of threats from the abuser.
May think that this abuse is “normal.”
May not even be aware that they are being abused.
May think that they deserved to be “punished.”
Warning Signs From the Resident
Loved one may report abuse.
Loved one may be afraid of staff; may pull away when certain staff is approaching.
Loved one may have lost his appetite.
Unusual or unexplained marks on the body.
Warning Signs From the Abuser
Caregivers not called when loved one is taken to the emergency room.
Unexplained marks or bruises.
Staff not telling caregivers what has been happening.
Constant emergency room visits without explanations.
Staff not calling caregiver when an “accident” occurs.
Some Reasons Abuse May Occur in a Facility Caregiver’s burnout.
Overworked staff, long shift hours.
Untrained staff.
Staff underpaid or not enough benefits.
Staff may be frustrated with aggressive or rebellious clients.
Staff in a hurry to leave after a long day.
Preventative Measures for Family Members
Find out how much training the staff has received. If your loved one has dementia, make sure that the staff is properly trained to deal with challenging behaviors. If the staff has not received specific training, ask how well they are qualified, such as how much experience have they had working with Alzheimer’s patients.
Visit your loved one often and ask how they are doing. Find out what workers they like best and what workers they like least. Some residents will have a bond with certain workers while, at the same time, they may not care for other workers. If this is the case, find out why.
Preventative Measures for the Staff
Take your profession seriously enough to seek out proper training. If you are unfamiliar with certain behaviors, receive training so that you will know how to deal with particular situations. Facilities usually train their employees, especially so in long-term care facilities.
Learn about the elderly, especially if the individual has a dementing disease such as Alzheimer’s Disease. Behaviors associated with these diseases can often be difficult to deal with. If you have never worked with a person afflicted with a disease like Alzheimer’s, you may feel overwhelmed. Be professional, get yourself informed.
If you are not sure how to deal with a particular situation, ask for help. Think of it as a learning experience. If it should happen again, you will then know what to do.
Back to Handbook Table of Contents
Section 6
Profile of the Care Facility Population
Beyond the need for more intense medical care and generally advanced age, it is important not to oversimplify or stereotype the kind of person you will find living in a care facility: they are as diverse as the general population.
Health
In each type of facility, you will find residents with varying degrees of illness and dementia. Depending on the purpose of the care facility, there will be a higher or lower proportion of individuals with serious health problems, but we stress that you will meet people just like you in all of them. (We should note that “adult family homes” often house three or four retarded individuals who are given the greatest degree possible of self-sufficiency in a “home” environment.) In every case, although they may be in wheel chairs or rolling recliners, and though they may be very worn and look very tired, and though they may be very sick or confused, each resident in a care facility has desires and feelings just like you – if anything, they may be even a little more sensitive and hungry for friendship than you are! Pay attention to them and get to know them – they are very human.
Disclaimer: Christian Concourse Ministries, Inc. provides this information solely as a general reference for your convenience. This material may not apply to your physical or emotional situation and it is not intended to provide guidelines for diagnosis or treatment. If you have questions about a specific health condition please consult a professional medical provider.
Physical Illness
All of us get sick, so we all can identify with the negative feelings of being ill. As you interact with residents in care facilities you will encounter numberless types of physical sicknesses. Obviously, we cannot list them all, but, there are some special diseases we will mention here due to their unique relationship with the aging process.
This material taken from the web site of the National Institute on Aging, U. S. Department of Health and Human Services ( http://www.nih.gov/nia/health/ )
Alcohol Abuse
Anyone at any age can have a drinking problem. Alcohol slows down brain activity. Because alcohol affects alertness, judgment, coordination, and reaction time – drinking increases the risk of falls and accidents. Some research has shown that it takes less alcohol to affect older people than younger ones. Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach. Alcohol’s effects can make some medical problems hard to diagnose. For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack. It also can cause forgetfulness and confusion, which are symptoms of Alzheimer’s disease.
Arthritis
Arthritis causes pain and loss of movement. It can affect joints in any part of the body. Arthritis is usually chronic, meaning it can occur over a long period of time. The more serious forms can cause swelling, warmth, redness, and pain. The three most common kinds of arthritis in older people are osteoarthritis, rheumatoid arthritis, and gout. Treatments for arthritis work to reduce pain and swelling, keep joints moving safely, and avoid further damage to joints. Treatments include medicines, special exercise, use of heat or cold, weight control, and surgery.
Constipation
Constipation is a symptom, not a disease. It is defined as having fewer bowel movements than usual, with a long or hard passing of stools. Older people are more likely than younger people to have constipation. But experts agree that older people often worry too much about having a bowel movement every day. There is no right number of daily or weekly bowel movements. “Regularity” may mean bowel movements twice a day for some people or just twice a week for others. Doctors do not always know what causes this problem. Eating a poor diet, drinking too little, or misusing laxatives can be causes. Some medicines can lead to constipation. These include some antidepressants, antacids containing aluminum or calcium, antihistamines, diuretics, and antiparkinsonism drugs.
High Blood Pressure
You may be surprised if your doctor says you have high blood pressure (HBP) because it does not cause symptoms and you can have it even though you feel fine. But HBP is a serious condition that can lead to stroke, heart disease, kidney failure, and other health problems. The good news is that there are simple ways to control it. If you have mild HBP, your doctor may suggest that you lose weight and keep it off, eat less salt, cut down on alcohol, and get more exercise. You may bring your blood pressure down simply by following this advice. Even if medicine is needed, these daily habits may help it work better. Some people think that when their blood pressure comes down, they no longer need treatment. If your doctor has prescribed medicine, you may have to take it for the rest of your life. Later on, though, you may be able to take less of it.
Hyperthermia: A Hot Weather Hazard
Warm weather and outdoor activity generally go hand in hand. However, it is important for older people to take action to avoid the severe health problems often caused by hot weather. “Hyperthermia” is the general name given to a variety of heat-related illnesses. The two most common forms of hyperthermia are heat exhaustion and heat stroke. Of the two, heat stroke is especially dangerous and requires immediate medical attention. Heat-related illnesses can become serious if preventative steps are not taken. Many people die of heat stroke each year; most are over 50 years of age. With good, sound judgment and knowledge of preventive measures the summer can remain safe and enjoyable for everyone.
Osteoporosis: The Bone Thinner
Osteoporosis is a disease that thins and weakens bones to the point where they break easily– especially bones in the hip, spine, and wrist. Osteoporosis is called the “silent disease” because you may not notice any symptoms. People can lose bone over many years but not know they have osteoporosis until a bone breaks. About 25 million Americans have osteoporosis– 80 percent are women. Osteoporosis is preventable. A diet that is rich in calcium and vitamin D and a lifestyle that includes regular weight-bearing exercise are the best ways to prevent osteoporosis.
Prostate Problems
Found in men, the prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). Prostate problems are common in men 50 and older. Most can be treated successfully. A urologist (a specialist in diseases of the urinary system) is the kind of doctor most qualified to diagnose and treat many prostate problems.
Stroke
Thanks to new tests that help predict stroke, treatments that help control high blood pressure, and good health habits that many Americans are practicing, the death rate from stroke is down as much as 50 percent since 1970. Still, stroke is the third leading cause of death in the United States and the leading cause of disability among adults.
A stroke is a sudden partial loss of brain function usually caused by a clot that stops the flow of blood to an area of the brain. Without oxygen and important nutrients, the affected brain cells are either damaged or die within a few minutes.
While cell damage can be repaired and the lost function regained, the death of brain cells is permanent. Most strokes are caused by a blood clot or narrowing of a blood vessel (artery) leading to the brain. Other strokes are caused by a hemorrhage (bleeding) from an artery.
A stroke was once viewed as a single damaging attack, but we now know it develops over many years. The risk factors or conditions that may lead to stroke include high blood pressure, smoking, heart disease, and diabetes. The risk of stroke increases with age and is higher in African Americans and Hispanics than in whites.
Mental Illness
Here we list some of the mental diseases that attack care facility residents. Of course, the most well- know is Alzheimer’s. Following this basic description of Alzheimer’s is a list of other dementing illnesses. For more information on how to interface with a resident suffering with some form of dementia, please refer to our material under “Mental Impairment - Dementia” in the section entitled “How to Volunteer in a Local Care Facility.”
Alzheimer’s Disease
Adapted from material compiled by Marci Stocks on her website, Elderly Place - http://www.geocities.com/~elderly-place/ .
Below, are listed the Stages of Alzheimer’s Disease. Some reading material may break down AD into 3 stages, while others break it into 4 stages. Both philosophies are correct. Please keep in mind that someone may progress at a slower rate while someone else may progress quite rapidly.
Stage 1
The first stage consists of the 2-4 years leading up to and including the actual diagnosis of Alzheimer’s Disease. Typical characteristics of Stage 1 are:
Recent Memory Loss (or short-term memory loss) begins to affect job
performances.
Confusion in natural environment – gets lost in a known environment.
Mood and personality changes.
Poor judgment; makes bad decisions.
Daily tasks such as cleaning, dressing takes longer.
Trouble handling money and/or paying bills.
Losing items such as keys, purse, wallet in unusual places.
Your loved one doesn’t seem interested in life anymore.
Stage 2
The second stage is approximately 2-10 years after diagnosis. This is the longest stage characterized by:
Memory loss increases.
Confusion on a regular basis.
Problems recognizing family and/or friends.
Repeats statements over and over.
Difficult speaking and organizing thoughts- cannot get the words out.
Makes up stories; may feel paranoid.
Reading and writing problems.
May be suspicious, irritable, teary/sad.
Hallucinate.
Major or constant weight loss or gain.
Stage 3
The third stage is also known as the “Terminal Stage.” This stage lasts approximately 1-3 years and the following symptoms are increasingly evident:
Cannot recognize family/friends.
Weight loss while eating good, well balanced meals.
Cannot communicate with words.
Bowel/bladder movement problems.
May have seizures.
Difficulty swallowing.
Little ambition for self care.
Alzheimer-like Diseases
There are several dementing diseases that are often confused with Alzheimer’s Disease. Here we have listed just a few along with some key similarities of that to Alzheimer’s Disease. Please keep in mind that we have only picked “key” similarities. They are not defined thoroughly.
Multi-infarct Dementia (MID)
MID is a breakdown of mental capabilities caused by multiple strokes (infarcts) in the brain. Symptoms include:
Impaired thinking.
Personality changes.
Changes in judgment.
Memory Impairment.
Pick’s Disease (PD)
PD is characterized by personality disturbances and behavioral changes. It is a rare progressive disease that affects certain areas of the brain. Symptoms include:
Speech impediments.
Repetition of words.
Confusion of surroundings.
Changes in behavior or personality.
Huntington’s Disease (HD)
HD is an inherited degenerative brain disorder. Symptoms include:
Irregular involuntary movements of the limbs or facial muscles.
Personality changes.
Memory disturbances.
Speech impediments (i.e. slurring of words).
Parkinson’s Disease (PD)
PD attacks certain nerve cells, causing difficulties in walking, balancing, and speaking. Symptoms include:
Tremors.
Walking difficulties.
Balance difficulties.
Speech impediments.
Diffuse Lewy Body Disease
This particular disease is a combination of the symptoms of Alzheimer’s Disease and Parkinson’s Disease. It is often mistaken for Alzheimer’s Disease. Symptoms include:
Gradual memory loss.
Mood or behavior changes.
Walking difficulties.
Balancing difficulties.
Age
Most people who need long-term care are elderly, but this is not always the case. There are many residents in nursing homes and assisted living homes who are in their thirties and forties, some even in their twenties. In fact, one facility in Norfolk, Virginia, Lake Taylor, has a children’s department. Adult family homes often house individuals in their twenties or thirties. Retirement communities, on the other hand, are almost entirely populated with senior citizens, since they cater to those old enough to have retired from their occupation or profession.
According to the most recent data published by the American Health Care Association, among the residents of nursing homes in 1999, 10% are under 65; 12% are between 65 and 74; 32% are between 75 and 84; and 46% are 85 and older.
The Changes That Come With Age
As the human body ages it experiences certain predictable changes. But these changes are not restricted solely to the physical person. The intangible parts of us go through changes also. By being aware of these changes, as Christian volunteers, our ministry to elders can be more effective, more appropriate and more relevant to their specific needs. In the following paragraphs we note several of these changes. Some are the result of a disease and should not be considered as part of the “normal” aging process.
Note: This material on the changes associated with aging is taken from a presentation given to a national meeting of the Christian Fellowship of Care Center Ministries in March, 2004, by Paul Falkowski, Executive Director of Desert Ministries, Inc. in Omaha, Nebraska. Website: www.desertministries.org .
Changes in the Senses
[Schieber, F. (1992). Aging and the Senses. In: Handbook of Mental Health and Aging. Second Ed. Academic Press. 10, 251-306.]
Vision
•Light entering the eye becomes scattered (astigmatism).
•Less light gets in the eye due to reduction of the diameter of the pupil (senile miosis).
•The lens has trouble focusing on near objects (presbyopia).
•The rods and cones of the retina deteriorate causing loss of night vision, onset of tunnel vision and eventual blindness (retinitis pigmentosa).
•Loss of contrast sensitivity making it difficult to recognize faces and objects.
•Color sensitivity decreases significantly after the age of 70, especially the recognition of blues, greens and violets.
To compensate for some of these eye limitations here are some suggestions you might consider:
•Be sure there is adequate lighting.
•Avoid high gloss surfaces and printed materials that give off a glare.
•Use bold, large, plain san serif fonts for text in printed materials.Example: This is readable text.
(Arial Unicode MS, bold, 18 pt.)
(For more guidelines on this refer to The American Printing House for the Blind -- http://www.aph.org )•Avoid quick movements when speaking.
•Do not use presentation materials that have fine visual details.
•Be aware that the older we get the more difficult it is to see blues, greens and violets. [Owsley, C. & Sloane, M. (1990). Vision in Aging. In: Nebes, Robert D. (ED); Corkin, S. (Ed); Handbook of Neuropsychology, New York, NY, US: Elsevier Science. Vol. 4. pp. 229-249.]
Hearing
Structures in the middle ear become calcified. Auditory canal blocked with increased secretion of ear wax. Auditory nerve cells and inner ear structures show decline with age. Sound localization decreases with age - the ability to tell where a sound came from. Elderly have difficulty hearing higher frequencies (e.g.: consonants, d, k, p, s, t, etc.). Men are more likely to have hearing loss than women.
We list here some considerations for the volunteer concerning the hearing of seniors:
•Some believe that hearing loss can lead to clinical depression!
•Rooms with a
lot of echo or speakers with a lot of reverberation added will hinder elders’
hearing.
•Background noise - chatter, machinery, ice machines, air conditioners,
etc. – will hinder speech recognition.
•Adjust recorded and live music to
emphasize higher frequency sounds.
•The faster you talk, the less likely the
elderly will get your message.
•Speaking louder will not help if you are talking
too fast.
•Speak clearly, slowly and distinctly.
Taste
Interacts with smell: loss of taste may be closely tied to loss of smell. There is disagreement among researchers as to whether the number of taste buds declines with age. Taste sensitivity may be more associated with tobacco use and medications, especially treatments for hypertension.
Smell
There is a rapid decline of the olfactory process with age. Institutionalized elderly tested poorly for the sense of smell compared to non-institutionalized.
Note: Try experimenting with recipes to bring out “the flavor” of a food to offset this loss of smell and taste. Consult a dietitian.
Touch
The skin becomes less elastic with age. The ability to tell what an object is just by touch alone declines with age. Sensitivity to pain and temperature generally does not change with age. The importance of touch remains into old age, even though there is a decline in the structure of the skin and nerve pathways.
Changes in Memory
[Conway, A., Engle, R. (1994). Working Memory and Retrieval: A Resource-Dependent Inhibition Model. In: Journal of Experimental Psychology: General. 123, 4, pp. 354-373.]
There is some decline in memory but, overall, it is normally not significant. Generally, younger people test better for memory, but this may be due to slower processing time than of memory itself. We repeat: severe memory loss is not normative with aging. We encourage you to stimulate the memory of your senior friends through memorization of Bible passages, hymns, poetry, etc. See Section 11, Games and Activities.
The enemies of memory include: The natural tendency to accept the erroneous, self-fulfilling stereotype of “I’m old, therefore, I’m forgetful.” Some diseases listed previously under “Mental Illness” affect our memory. Poor diet, lack of exercise, lack of mental stimulation and depression adversely affect our memory.
Changes in Personality
[Helson, R., & Stewart, A., (1994). Personality Change in Adulthood. In: Can Personality Change? Heatherton, T., & Weinberger, J., (Eds.) American Psychology Association, pp. 201-225. Also, see: Costa, P & McCrae, R., (2000), Revised NEO Personality Inventory.]
In some ways, our personality remains the same as we age and in other ways our personality changes. If we are cranky when we are young, without an unusual change of heart, we will probably be cranky when we grow old. Some researchers, therefore, identify traits that do not change after the age of 30 (e.g.: anxiety, anger, depression, assertiveness, positive emotions, openness, actions, agreeableness, trust, modesty, order, self-discipline, etc.). On the other hand, other parts of our personality probably change with time: our values, creativity, relationships and self-image. At any length, it is important to remember that we are not rigidly locked into our ways. We can change.
Changes in Intelligence
[Cavanaugh, J. (2002). Intelligence. In: Adult Development and Aging. Fourth Ed., Wadsworth Publishing Co., 8, pp. 253-296.]
There are two types of intelligence:
Fluid – the ability to think on your feet, allowing you to draw inferences
and respond.
Crystallized – knowledge acquired across your life time, your
library of experiences and education.
The effects of aging are minimal on intelligence, but there is a correlation between intelligence in later life and certain factors. “Loss” of intelligence is slowed by the following:
Complexity of career. Lengthy marriage to a well-educated and intelligent spouse. Exposure to stimulating environments. Flexible attitudes at mid-life. Self-motivated individuals protecting themselves from “worthlessness.”
These factors press us as volunteers ministering to the elderly to be sensitive to the level of a person’s education. We should keep in mind the potential of the elderly to be a valuable resource for mentoring, teaching, etc. It is important to remember that the elderly are intelligent. They can learn new skills. This fact holds valuable implications for the programs and the events we seek to involve them in.
Changes in Wisdom
[Baltes, P., Smith, J., Staudinger, U., & Sowarka, D. (1990). Wisdom: One Facet of Successful Aging? In: Late Life Potential. Perlmutter, M., (Ed.) pp. 64-69.]
Wisdom is defined as: the culmination of all life experiences and intelligence giving the ability to make “good judgments and good advice about difficult but uncertain matters of life.” This faculty that we call “wisdom” increases with age. As Paul Falkowski says, the “hardware” may be breaking down, but the “software” can compensate for those limitations. “In the task of reviewing one’s life, the elderly show a greater understanding of life’s uncertainties than younger adults” (Baltes, et al. 1990). Obviously, not all old people are wise, but a careful observation should show a disproportionately large number of elderly among the wise. The implications of this fact are important: We should involve older people in mentoring at-risk youth and other difficult family situations; we should tap their experience in the work place; and we should include the enrichment of relationships with older people in our personal lives!
Gender
By any casual observation, the population of care facilities is substantially more female than male. But, it should be stressed that, contrary to popular stereotypes, we see a large number of men in every facility. According to studies published by the American Health Care Association, about 33% of nursing home residents are male, and 67% are female. This is important to remember as you formulate the types of activities you help with in the facility. Men like to do “men” things. Consider sports interests, workshop skills and masculine hobbies as you look for ways to relate to elderly men. And, of course, accommodate the ladies with appropriate activities that would spark memories of their former favorite pastime.
Race and Culture
The racial and cultural diversity of care facilities usually reflects that of the community around it. As a volunteer, you will probably have the opportunity to minister to individuals from all the races and many cultural backgrounds. It has been our experience that some of our most rewarding relationships in care facilities have been with residents of a different race from ours.
Color and cultural differences among the people who live in nursing homes should not be a factor in our availability or our attitude as volunteers. You may disagree about many things, you may have differing preferences on any number of issues with a care facility resident, but your job is to show them the love of Jesus. Accepting them as someone He loves and died for does not compromise your convictions. In fact, this is the perfect environment to practice our Master’s teaching to love our neighbor as we would love ourselves. Be tolerant and try to understand someone who is different from you — “Do unto others as you would have them do unto you.”
The January 18th, 1999 selection from Our Daily Bread is a wonderful exhortation on the bigotry that is inclined to rear its awful head in all of us. We have copied it here for your reflection.
“Sin of the Skin”
Do not hold the faith of our Lord Jesus Christ, the Lord of glory, with partiality. James 2:1
Most people hate to be accused of racism. But racial bias is all too prevalent. Even Christians have had a long history of ethnic prejudice. In the first century, Jewish believers were reluctant to accept their Gentile brothers. A few centuries later, Gentile believers were reluctant to accept their Jewish brothers. In recent years, racial discrimination has been a dominant issue.
Prejudice can run so deep that it sometimes takes a tragedy to make a person see how wrong it is to discriminate on the basis of physical differences. Several years ago I read about a bigoted truck driver who had no use for African-Americans. But one early morning, his tanker truck flipped over and burst into flames. A week later, he was lying in a hospital bed and looking into the face of a black man who had saved his life. He learned that the man had used his own coat and bare hands to smother the flames that had turned the trucker into a human torch. He wept as he thanked the man for his act of unselfish heroism.
We shouldn’t need a tragedy to open our eyes. We need only look to Calvary. There our Lord gave His life for people of every language, race, and nation. The universal scope of His sacrifice shows His love for every human being.
Have mercy on us, Lord, if we have fanned the fire of prejudice that You died to put out. –MRD II
Join hands, then, brothers of the faith,
What e’er your race may be;
Who
serves my Father as a son
Is surely kin to me. – Oxenham
Prejudice is a lazy man’s substitute for thinking.
Read Ephesians 2:11-22
Our Daily Bread, Copyright © 1998 by RBC Ministries, Grand Rapids, MI. Reprinted by permission.
Religion
The Spirituality of Seniors
Humans, universally, have a spiritual nature which demands fulfillment. This desire for spiritual fulfillment is often heightened in advanced years. What matters most in the later stage of our existence on earth is one’s sense of what life is about, coming to terms with who one is on the inside. (Lifespan Development, Holt, Rinehart and Winston, 1983. Jeffrey Turner. P.451)
Thus, when considering the health of our seniors, we should include their “spiritual well-being.” Those who care for the elderly are focused on relieving their declining physical conditions. Often, the mental and emotional problems that are associated with aging are easily monitored and treated with drugs. But there is also a great need to address the spiritual health of care facility residents. As in the physical body, the spiritual body needs food and nurture to grow and remain strong. Indicators of the spiritual well-being of any individual, young or old, cannot be observed directly with the five senses. Rather, we study the spirit’s indicators, the reflections of it in people’s meanings, ultimate concerns, and faith orientations. All of these spiritual indicators in turn give rise to and influence thoughts, beliefs, and actions. It is in this essence of our being, this core of who we are, that we seek “spiritual well-being” regardless of our physical and mental condition. (Spiritual Well- being Defined by Rev. J. W. Ellor. From the website of The San Francisco Ministry to Nursing Homes, www.sfmnh.org.)
Faith
Approaching the later years of life, we begin to see, with growing certainty, the unavoidable reality of death. Again, this fact naturally presses us to seek the internal fulfillment of spiritual well-being. Christians have often found just such a blossoming fulfillment in God through faith in the person and work of Jesus Christ as He is revealed in Holy Scriptures. Accepting this God-given gift of faith in Christ brings us His sovereign promise of joyful life beyond the grave. We find substance in our faith through the presence of His Holy Spirit in our hearts. And we find vital encouragement for our faith in the faith we see in the lives of fellow believers around us. This is the testimony of the writer of this handbook. And, this is the Gospel that elderly Christians love to share and love to hear again and again because it is more and more the reality of their experience.
This faith, so very priceless to Christian residents, is fed through Bible reading, prayer and discussion of faith issues. Our faith is strengthened when we are reminded of the power and the faithfulness of God. Our faith is strengthened by sharing and listening to others share their faith and hope in Jesus Christ. The Old, Old Story really never gets old – our faith is strengthened each time someone rehearses the Gospel of Jesus Christ with us.
Therefore, as Christian volunteers who conduct and facilitate such religious activities in care facilities, we must keep in mind the importance of our task. We are a vital resource to the facility for addressing this important dimension of the health of their residents.
To achieve this goal best, we must perform our service in a way that demonstrates our respect for the residents as human beings, as fellow creations of God. We must use wisdom so as not to offend and frustrate residents who do not share our enthusiasm for our faith. We are there as invited guests. Our audience is not captive. If they ask us to leave and not come back, we will be obliged to do so.
As we have stated, the intangible qualities of faith, religion, prayer, church and spirituality are interwoven into the fabric of physical, emotional and social well-being. And scientists are documenting that these intangible qualities predictably produce tangible results.
Research shows that religious affiliation and frequent attendance at services are associated with lower death rates, though many experts attribute this partly to the strong social network and healthy behaviors encouraged by religious communities. (Ladies Home Journal; Dec 01, 1997; Frishman, Ronny; Bussani, Tracy)
Jeff Levin, Ph. D., senior research fellow at the privately funded National Institute for Healthcare Research has discovered scores of medical studies on the effects of religion on health. Most of these scientific studies support the concept that religious interaction and prayer has a positive physical influence on adherents.
Some highlights from these studies:
--A 1995 study at Dartmouth-Hitchcock Medical Center: one of the best predictors of survival among 232 heart-surgery patients was the degree to which the patients said they drew comfort and strength from religious faith. Those who did not had more than three times the death rate of those who did.
--A survey of 30 years of research on blood pressure showed that churchgoers have lower blood pressure than non-churchgoers--5 mm lower, according to Larson, even when adjusted to account for smoking and other risk factors.
--Other studies have shown that men and women who attend church regularly have half the risk of dying from coronary-artery disease as those who rarely go to church. Again, smoking and socioeconomic factors were taken into account.
--A 1996 National Institute on Aging study of 4,000 elderly living at home in North Carolina found that those who attend religious services are less depressed and physically healthier than those who don’t attend or who worship at home.
--In a study of 30 female patients recovering from hip fractures those who regarded God as a source of strength and comfort and who attended religious services were able to walk farther upon discharge and had lower rates of depression than those who had little faith.
--Numerous studies have found lower rates of depression and anxiety-related illness among the religiously committed. Non-church-goers have been found to have a suicide rate four times higher than church regulars. (Time; Jun 24, 1996; “Faith and Healing,” CLAUDIA WALLIS)
The Christian Attitude
Our point in quoting the above studies is to underline the empirical observations by secular scientists – that there is a connection to physical and psychological well-being and the exercise of one’s faith. As Christians, though, we must be careful in what we are promoting when we say “prayer and religion works.” We do not, in this handbook, advocate the notion that prayer invokes some impersonal “force” which unalterably solves all our problems and woes like some magic potion. Rather, consider the following five passages of scripture:
Go to now, ye that say, Today or tomorrow we will go into such a city, and continue there a year, and buy and sell, and get gain: [14] Whereas ye know not what shall be on the morrow. For what is your life? It is even a vapour, that appeareth for a little time, and then vanisheth away. [15] For that ye ought to say, If the Lord will, we shall live, and do this, or that. [16] But now ye rejoice in your boastings: all such rejoicing is evil. James 4:13-16
And this is the confidence that we have in him, that, if we ask any thing according to his will, he heareth us... 1 John 5:14
Thy kingdom come. Thy will be done in earth, as it is in heaven. Matthew 6:10
And he went a little farther, and fell on his face, and prayed, saying, O my Father, if it be possible, let this cup pass from me: nevertheless not as I will, but as thou wilt. Matthew 26:39
He went away again the second time, and prayed, saying, O my Father, if this cup may not pass away from me, except I drink it, thy will be done. Matthew 26:42
Christian prayer should be seen as illustrated by the act of a humble child innocently asking their father for something. The loving, generous father knows if granting the request is in the best interest of all concerned. We should pray for our specific needs and for those whose needs have touched our hearts...by all means! But we must do so humbly, readily acknowledging the answer of God to be a function of not just His almighty power, but also of His will and His all-knowing wisdom.
God answers prayer! We are admonished by His written Word to pray; even to pray boldly. But we come to Him as His children in simple faith, not with demanding arrogance as though we were His boss.
Oh, so many of those we minister to in care centers know well the blessing in submissive praye