Relocating is generally a stressful experience for many people, and not just the aged. In many ways, aged people feel the stress of transferring from their existing residences to new residential facilities such as loss of social bonds, breakdown of personal routine, loss of personal space and generally the discomfort arising from the need to rebuild one’s life. Relocation is more difficult for the aged than that of younger people. This paper examines the issues that surround relocating to aged care facilities from the point of view of the patient and nurses.
Challenges related to Aged Care
Entry Conditions
It is impossible to develop a consistent profile relating to the physical and psychological condition of the aged when they start seeking admission to aged care facilities. They have such a diversity of backgrounds that it is impossible to put a finger on the common elements defining their lives (Cheek, 2005). They come from different academic backgrounds, varying financial capacities, different physical wellness conditions, and they possess very different worldviews. This makes it extremely complicated for an aged care facility to take decisions based on the profile of the people they will admit to their facilities (Cheek, 2005).
On the other hand, the aged go through a difficult time evaluating the few options available for aged care in cases where they have the capacity to participate in the decision. However, there are certain conditions such as lifelong disability or terminal illnesses that may dictate the suitability of a certain aged care facility. However, most aged people tend to suffer from chronic pain. Therefore, the presence of pain is not a very important way of distinguishing among those who need special care (Better Health Channel, 2011).
Relationship between Personal Loss and Aged Care
Personal loss refers to a prolonged permanent loss of function leading to the need for care. Personal loss often triggers the decision to make the move to aged care facilities. Yeboah (2009) identified several types of personal losses that lead to the eventual decision to move into an aged care facility. Physical loss is the basic type of loss behind many of the decisions to move to aged care facilities. The aged lose their ability to care for themselves because of physical loss. In many cases, age affects their capacity to handle basic tasks on their own such as washing up, cooking , eating, and in some cases, getting into and out of bed (Yeboah, 2009).
Other types of loss include loss of a caregiver to death, marriage, divorce, or rapid loss of capacity to care for oneself. In some cases, a spouse may choose to move into an aged care institution to join their spouse or to get complimentary care for their spouses. The aged tend to have more pronounced symptoms to common ailments such as the common cold (Helme & Gibson, 2001). This makes it important for them to be in environments where they can get professional help as needed.
The Trauma of Transfer
The three main stakeholders in the relocation process include the aged being the beneficiaries of the process, their relatives, or benefactors that support them, and the nurses in the new residence. Each of them goes through different stages in the process of transitioning. The aged find the transition to aged care very stressful (Ellis, 2010). The specific stresses they suffer include dependency, confusion, anxiety, depression and withdrawal, and the aggravation of existing health conditions due to psychological factors (Ellis, 2010). The main emotions that relatives and benefactors go through include feelings of “relief, guilt, sadness, failure, abandonment, and loss” (Ellis, 2010, p. 7).
It is confusing for them too because they wonder whether this is the best way to take care of their loved one. Some feel that the care given in the aged care facilities is inadequate (Ellis, 2010). It is clear that this process evokes mixed emotions among the people involved (Chater & Tsai, 2008). While it may entail a simple process of moving personal items from a home to an aged care facility, the emotional and psychological effects are serious for the people involved (National Health Priority Action Council, 2006). Members of staff at the facility tend to be better prepared to accept new patients. This comes from the fact that it is their primary duty to take care of the aged; hence, it is easier for them to adjust to the arrival of new members.
Some Difficulties in Aged Care Facilities
Most aged care facilities present serious problems to the aged living there. Dinkelmann (2008) identified the most disturbing traits of facilities for the aged, such as widespread depression, institutionalization, labelling according to illness, and prevalence of silence and passivity (Dinkelmann, 2008). This situation arises from the conceptualization of the aged care facility as a hospital and not a social place.
The result is that programs tend to come up to deal with issues from a clinical angle without sufficient regard to the social needs of the senior citizens housed there (Virir, 2009). This approach, makes the aged become morbid, bored and withdrawn from the social life of the immediate community. It is true that the aged often suffer from physical ailments and diverse body pains, but there is still need to regard them as people with feelings, desires and capacity to interact socially (Dewar, 2007). Social involvement reduces their care needs because it helps them to meet the social needs that otherwise carers need to provide (Jacobs, Rapoport, & Jonsson, 2009). This shows that there are benefits that the aged can give each other provided that they have the structures to support their activities.
Staffing in Aged Facilities
It is interesting to note that many students studying nursing do not look forward to practicing in an aged care facility. The current courses on offer do not take into account the need to train nursing students on gerontology (Abbey, et al., 2006). The education content provided is not specific to the elderly, but is generic and hence requires personal application to work in an aged care facility (Abbey, et al., 2006). This explains the reason why many aged people do not receive appropriate health care despite their higher need for medical care. The impact of this to the aged living in an aged care facility is that it reduces their capacity to trust the institutions to take care of them. Caregivers, usually volunteers, or family members, also go through a lot of stress as they try to find the best way to take care of the aged, without any kind of training on their part. This serious gap requires urgent action.
Treatment and Interventions
Since 1996, the Australian government has been promoting the concept of aging-in-place (Commonwealth Department of Health and Aging, 2002). The idea behind this initiative is to reduce the impact of transferring the person requiring care to a new facility from their usual surroundings. It came from the realization that the transfer from familiar surroundings proved too stressful for many aged people. In some cases, relocation of aged couples ended up becoming permanent separation if the two people had different care needs provided in separate facilities (Commonwealth Department of Health and Aging, 2002). Aging in place seeks to provide the opportunity for people to age within familiar surroundings and to receive all the care they need from that location. The program does away with many of the stresses associated with relocation for both the aged and the nurses. In this situation, the main intervention is for nurses to tailor the care they provide to aged under their care.
The application of taking care of the aged that is similar to aging-in-place is a combination of institutional and residential aged care (Webber, Bowers, & McKenzie-Green, 2010). Residential care can take place with some degree of participation in a home for the aged. The nurses attend to the unique needs of the aged provided they can participate in the activities there. Once a person becomes too old to participate actively in the activities at the home, then they benefit from full time residential home care. This approach reduces the costs incurred in full time residential home care and it avails the benefits of a communal home for the aged such as social interaction (Webber, Bowers, & McKenzie-Green, 2010).
The nurses in this case must ensure that the aged under their care have opportunities to interact and that they have the support they need for meaningful interaction with each other. It is also the nurses’ role to ensure that family members know how to take care of the aged while at home, and what to do in case of any sudden complications.
Another concept gaining currency in the debate of care for the aged is the emergence of retirement villages (Buys, Miller, & Barnett, 2006). These are resort-like places where people past their active stages of life choose to go and wind down. They still depend on nurses to take care of them. The attraction of retirement villages is that they fulfill the needs of the aging population better than conventional living. These villages are much less stressful, and people living there understand each other’s need for support (Buys, Miller, & Barnett, 2006).
It is potentially more stimulating than residential care or institutional care approaches to caring for the aged because of the natural setting and the capacity to develop a personal routine not based on aggregated needs. The role of nurses in these situations is to ensure that the aged can function normally as part of this community. The aged must have a means of contacting the nurse in case of an emergency. In addition, neighbors in these retirement villages should know whom to call in case one of them develops complications.
Finally, nurses have the duty of encouraging family members to maintain communication, both with their aged relative at the aged care facility and with the staff at the facility (Bauer & Nay, 2008). The family knows the needs of the member at the facility better and can communicate those needs to the institution. In addition, communication ensures that social ties remain strong, which improves the quality of life for the member housed at the facility.
References
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