The Care Project: Long-Term Care |
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Posted on November 09 2009 under Community
Monkey Biz is working on The Care Project because of the countless stories of care that many of us do not see or recognize. Throughout the series, we will explore people and organizations in Hamilton who are caring for each other in different ways, and we will address the question: How do we recognize, honour, celebrate and support the care that is happening in our community? By Jeanette Eby Sharon Kaasalainen is a registered nurse, a career scientist for the Ontario Ministry of Health and Long Term Care, and an assistant professor for McMaster University’s School of Nursing. Before working at McMaster, Dr. Kaasalainen worked as a registered nurse in Wentworth Lodge, which is a long-term care facility located in Dundas. Monkeybiz asked Dr. Kaasalainen to help us better understand long-term care based on her experience. Long-term care (LTC) is a term used to describe a combination of medical, nursing, recreational, custodial and community services that support people who have chronic care needs, including the elderly who can no longer live independently. The long-term care model we will focus on here is the nursing home. LTC’s model of care is very different than hospital or community living. “The residents become your family and vice-versa,” said Kaasalainen. In a long-term care facility, there are different caregiving roles: Registered Nurses (RNs) have more of a supervisory role; Registered Practical Nurses (RPNs) administer medication and provide other types of care; and personal support workers (PSWs) do most of the hands-on physical care tasks. People also work in recreational and therapeutic roles. To Kaasalainen, care is holistic. It goes beyond the physical tasks to the social, psychological, financial and spiritual aspects of their lives. It is important to see the person as a whole, and get to know where they came from. People living with dementia have a whole history behind them that needs to be explored. Listening is a central part of care, many residents simply want to be heard. “Care is about letting them make choices rather than myself making choices for them.” Long-term care facilities are 90 per cent run by nurses. Medical director oversees operations, but there is little physician involvement with the residents. This can present a challenge, since physicians are required to make prescriptions and medical decisions. Nurse practitioners are helping to bridge the gap and Kaasalainen’s current research at McMaster focuses on the role nurse practitioners play in palliative and long-term care, particularly in pain management. A nurse practitioner has at least a master’s degree in nursing, and can perform examinations, order medications and diagnostic procedures, and educate staff and families in collaboration with physicians. A new wave of nurse practitioners is now working throughout the long-term care model, which will improve the situation a lot, she said. A long-term caregiver has many roles to play. They can work as an advocate for people who can’t speak up for themselves. They get to know people as individuals and can share their needs with others. Also, many people die while living in LTC. Part of the role of a nurse is being with them through the whole grieving process. When staff members have relationships with the residents, they go through their own grieving as well, said Kaasalainen. Caring in a holistic way is not easy, as we have heard from other participants in The Care Project. LTC facilities are more understaffed than other places, and the care relationships that develop can be physically and emotionally overwhelming. Many residents have families, but the families need support as well. Spousal burnout is very common. Care workers can become self-protective, because they feel quite vulnerable to care a lot. It is also very hard to “leave your work at work” when you have developed close relationships with the residents. In terms of how the broader community can contribute, Kaasalainen said that the community needs to recognize the vulnerability of people in LTC, and their need for support. Any care facility for the elderly requires volunteers. People just want to be listened to, and volunteering your time can involve as much as sitting and chatting with a senior. “Residents value those conversations,” said Kaasalainen. Kaasalainen always enjoyed being with older people. Her first exposure was through her relationship with her grandparents. When she went on to university and studied nursing, experiencing the different kind of work she could do, she realized that her heart was with older adults. “There are certain residents with whom you develop a long-term relationship. That is the caring ethic, building these relationships. If you are there, you know them until they die.” |
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