Why Are We in Long Term Care?

Author: Michael Wasserman MD

Originally published: Thursday, August 20, 2015

“Why are we in long-term care?” That was the question posed by Dr. Jeff Burl at the core curriculum on medical direction course at AMDA—The Society for Post-Acute and Long-Term Care Medicine. His answer, “For our residents,” rang so true to me. Those of us in the field of geriatrics are dedicated to serving our patients. Not only have we taken an oath, but it is in our hearts. When it comes to caring for people in nursing homes, residents’ rights are often at the forefront of any discussion. The Centers for Medicare & Medicaid Services recently proposed strengthening these rights. Respecting the rights of those who live in a nursing home should be of paramount importance to anyone who works in the long-term care arena.

When I took my medical ethics course in medical school many years ago, I learned about the concept of patient autonomy, which is basically the right to make one’s own decisions. I have often found it interesting that many people question decisions made by older adults if they do not conform to what others think. If you are young and you make a stupid decision, no one is prepared to put you in a nursing home. If you are old, that is another story.

One of the most challenging circumstances that I have encountered over the years is when older adults are becoming unsafe in their own homes. These people often stubbornly insist that they want to remain in their homes, while their families become increasingly worried about their well-being. I have had families attempt to force their loved ones into a higher level of care, despite the fact that these loved ones were cognitively intact. When our children become adults and embark out on their own, there is nothing that we can do when they make decisions with which we disagree. However, those very same children may try to impose their will on us when we make decisions with which they do not agree.

That brings me back to the concept of residents’ rights. You have ended up in a nursing home for any number of reasons. This is now your home. What are your rights? What if you are a night owl and like to sleep in? What if you like to surf the Internet looking at pornography sites? What if you take lots of supplements and eat a gluten-free diet? Historically, nursing facilities were modeled after hospitals; and in the setting of an acute illness, an individual’s rights are often not made a focus of the nursing staff. While there may be a medical component to the care delivered in a nursing home, the key focus is on their basic care.

As physicians, we are focused on improving the health and well-being of our patients. By the time that our patients are in nursing homes, their physical health and well-being may be problematic. However, their emotional health and well-being can still be paramount. It behooves us to pay attention to the little things that matter to our patients. There is a reason that the facility calls them residents rather than patients. That reason is to remind us that they have the right to live their lives based on their own wishes and autonomy. The fact that they are frail and vulnerable should not detract from that right.

This brings me back to Dr. Burl’s question: Why are we in long-term care? Those of us who deliver care to older adults in nursing facilities are dedicated to ensuring the dignity and autonomy of our patients. It is often easy to forget about this when families or facility staff treat the frail older residents like children. We have an opportunity to be teachers and leaders in our nursing homes. After all, we practice in nursing homes for the residents.