The limitations of care homes in treating older adults with dementia


When an older adult is struggling to live independently and look after themselves, families will naturally look into solutions to provide for these deficiencies. One common solution is having either a relative or paid caregiver visit a client’s home regularly throughout the week. During these visits, helpers can render assistance with cooking, cleaning, grocery shopping, medication management, and other daily tasks.

However, over time as the client becomes more impaired, they will usually require more intensive, round-the-clock care. This is especially the case in clients with dementia or other medical conditions.

At this point, the two most common options are for the client to be moved into a care home, or for visiting caregivers to provide fulltime in-home assistance. The former option has traditionally been the most common choice in caring for seniors. However, such facilities may impose profound limitations on a client’s quality of life.

Quality of life in senior care homes

Among the elderly, and particularly among those with dementia, depression is a major problem.1 When people experience a loss of independence and physical ability, in addition to the confusion and distress of memory impairment, it is common for them to become depressed.

While depression among older adults is by no means a problem exclusive to care homes, the institutionalized environment may exacerbate this issue. One reason is that people with dementia want to connect with others in a meaningful way and engage with them socially, which can be difficult to facilitate in a care home due to the staff supervision required for such programs.2

A challenging dynamic between staff and patients entails a difference in understanding what constitutes good quality of life. Staff tend to gauge their patients relative to their level of dependency and physical ability, and so focus their efforts on providing patients support in these areas almost exclusively. Residents, on the other hand, rate their quality of life based on less directly tangible aspects, like their levels of anxiety and depression.3

It therefore follows that residents perceive themselves as having a better quality of life when they have positive relationships, good communication, and active involvement in care planning from staff.4

Unfortunately, this kind of personal relationship with caregivers that seems to most meaningfully benefit seniors is difficult to achieve in care homes, largely due to the high workloads as well as the pressure staff feel to prioritize the physical health needs of residents.

Medical care in care homes

One major medical issue in care homes is the spread of viruses such as influenza.5 Even in the cleanest and most well-kept facilities, having a large number of older people living together (many of whom have lowered immune systems), will inevitably lead to the proliferation of various communicable illnesses.

You can see similar problems in hospital-acquired infections, like MRSA, or in the fast spread of viruses in children's playgroups and pre-schools. So, the problem is hardly limited to the elderly; any concentrated, prolonged gathering of individuals will invite the spread of contagions. Rather, influenza is a particularly dangerous scourge among older adults, and can be potentially deadly.6

A typical care home patient takes an average of eight different medications7, which require careful management throughout the day. Unfortunately, there is a prevalence of medication errors in care homes7 where people are given the incorrect medication or the wrong dose for their needs. This is believed to be due to two key issues:

  1. Doctors prescribing medication often do not know the patients personally and may not be fully aware of their medical history.

  2. Dispensing staff are overworked, with high levels of stress and intense time pressures making it difficult to exercise due diligence in double-checking the medication they are giving out.

Remaining active in care homes

To stay mentally and physically healthy, it is important for older people to remain active. This means both performing exercise and physical activity, as well as experiencing entertainment activities is important. Social interaction, playing board games or completing puzzles, listening to or performing music, and pursuing personal hobbies are great ways of staying active. Such activities are important not only to keep people busy (preventing boredom and depression), but they are particularly vital for lowering the risk and slowing the onset of dementia, along with other degenerative diseases.8

It is difficult for older adults to get sufficient exercise in care homes, as there is often not access to the equipment, classes, and support that is required for them to do so safely. While there are indeed programs in some care homes to give residents twice-weekly sessions with a physiotherapist, these occasional sessions may not provide enough stimulation to effectively reduce depression.9

In terms of social activities, seniors living in care homes often lack stimulation, especially those with dementia. Once again, staff and family members tend to think of the most important activities as being those which promote physical health. The clients themselves, on the other hand, most highly valued interacting with family members and friends, listening to music and pursuing hobbies, and reminiscing about their life experiences with others.10 Unfortunately, the institutionalized approach to care espoused by most care homes has proven inadequate to the task of providing these stimuli.

Ways to improve the care home experience

Sometimes it is necessary for an older adult to be placed in a care home, as family members may not have the resources, the living space, or the knowledge to care for the client themselves. Similarly, providing care at home for patients with dementia is extremely challenging, and not something that all families are equipped to handle well. In this case, there are steps that families can take to provide a better experience for their loved ones residing in care facilities, such as visiting regularly, advocating for their individual, and participating directly in care activities.11

The notion of person-centered care is becoming more widely recognized in care homes, which promotes the valuing of people with dementia through acknowledgement of their individual differences, preferences, and interests.12 Such approaches can help to provide an improved quality of life for the older adult as they are cared for.

If you are looking for an appropriate care solution for a senior in your life, and would like to learn about alternatives to institutional care homes, then visit us at https://www.burdhomehealth.com to find out more about home health care options.

References

1 https://www.bmj.com/content/319/7211/676

2 https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/improving-quality-of-life-for-people-with-dementia-in-care-homes-making-psychosocial-interventions-work/D735835380CC9DE588AFB1EDF6A59429

3 https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/quality-of-life-of-people-with-dementia-in-residential-care-homes/B3ED49D72E73F43A589EE6EECBB355E7

4 https://academic.oup.com/gerontologist/article/45/suppl_1/133/553781

5 https://www.bmj.com/content/333/7581/1241.short

6 https://www.jstor.org/stable/30143093?seq=1#page_scan_tab_contents

7 https://qualitysafety.bmj.com/content/18/5/341.short

8 https://www.alz.org/alzheimers-dementia/research_progress/prevention

9 https://www.sciencedirect.com/science/article/pii/S0140673613606492

10 https://www.tandfonline.com/doi/abs/10.1080/13607860802343019

11 https://books.google.de/books?hl=de&lr=&id=RdwPBQAAQBAJ

12 https://books.google.de/books?hl=de&lr=&id=Z8CpCgAAQBAJ

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