Wednesday, July 16, 2014

Are Nursing Homes Like Third World Countries? (Part 1)

I was reading Chasing Chaos: My Decade In And Out of Humanitarian Aid, by Jessica Alexander, the other day.  She lived and worked in some of the places you hear about on the news:  Rwanda, Darfur, Sri Lanka, Sierra Leone, Haiti, New York City…  (Yes, New York City is its own country – just ask anyone from western New York).  In her book, Ms. Alexander was sorting out her feelings about her humanitarian aid career compared to what she knew from the statistics and actually observed in the field.  Sometimes they don’t all jive.  Sometimes the big picture gets lost in the day-to-day, and sometimes it is the other way around.  

The humanitarian aid industry usually comes into the picture after a crisis:  hurricane, war, tsunami, or earthquake.  The people doing the humanitarian aid have their own way of doing things which is almost never the way the locals did it themselves, be it housing, nutrition, infrastructure or health care.  By definition, humanitarian aid is a disruption in the re-establishment of the local economy.  If you give things away, the local vendors can’t compete.  If you hire people to do things (so they can buy things from the local vendors), those jobs you created will disappear when you leave.   That is if you CAN leave, because sometimes the crisis created by the departure of the aid industry can be almost as traumatic as the crisis that brought them there in the first place.  There are always trade-offs.

In long term care, we have the parallel issue of sorting out our feelings, understanding and observations about what we do as activity professionals.  Someone ends up in assisted living or a nursing home as a result of a crisis.  It may have come on gradually, but that individual can no longer deal with life on their own.  Our long-term care facilities and communities have their own ways of doing things, which no matter how “home-like” we try to make them, are still different than what the residents were used to.  They go from a private home or apartment to some level of group setting.  Solitary or family meals become group dining.  Instead of running their own lives, there are administrators, financial officers, social workers, housekeepers, maintenance staff, and care providers who must now be dealt with.  And don’t forget wheelchairs and bed alarms, schedules and strange roommates.  

Now, don’t get me wrong.  A lot of families spend a lot of money for the privilege of sending their offspring to experience college dormitory life – which, other than the health part, is not so different than long-term care.  But a college student will eventually, we hope, emerge from the dormitory to re-engage in what we call the “normal” life.    For most seniors, leaving assisted living or the nursing home without major home care assistance is the prescription for a new crisis:   falls, fire, self-neglect, malnutrition.  There are always trade-offs.

The activity professional is in a strategic place in both the big picture and the day-to-day.  We are the ones who are charged with knowing our residents individually and figuring out how to make it possible for each of them to enjoy the highest quality of life possible under the circumstances.  We plan day-to-day, but we also look at the long-term patterns.  When one approach doesn’t work, we look for something else.  Ideas are our currency.  Some we come up with on our own, but others come from the residents themselves, the residents who are creating their own new economy.

© Donna Stuart, February 13, 2014*


Alexander, Jessica. Chasing Chaos: My Decade In And Out of Humanitarian Aid. New York: Broadway Books, 2013.

This article first appeared on the Metrolina Activity Professionals Association Facebook page on 2/13/2014.

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