How to choose a Nursing Home : An Insider View

Cleanliness: When you visit, cleanliness will be one of the very first things that you notice. If the residency does not appear to be taken care of, this could indicate the residents are being neglected as well.

The appearance of residents: Are the people who live there dressed and groomed or do they look as though no one cares if they are reasonably neat and clean? Are their rooms tidy and clean? Is their clothing fresh and clean or dirty and foul? Did you notice an overall stench at the home?

Pain management: As you walk through the home pay attention to the conversations between residents or between residents and caregivers. Note if you hear anyone say he/she is hurting, as it is pertinent that nursing home residents are receiving prompt and accurate care.

Medication: While it is important for nursing home residents to receive proper medication and treatment, it is equally important that they are not being overmedicated. See if the facility has an antipsychotic medication policy for residents who suffer from schizophrenia and bipolar disorder, as these are just a few of the issues faced in nursing homes today. These medications should not be used to subdue patients, however. They are only used when medically necessary.

Nutrition: To determine if your loved one will receive nutritious food and beverages, request a meal during your visit (at your expense). Also look at residents’ plates after they have been served, observing their expressions as they eat and notice if they did not finish their meal. If you did not enjoy your meal, think of the residents who dine at the facility every day, as they do not have access to alternative options. Also, ask if snacks are served between meal times and if residents have choices in times to eat and foods that they prefer.

Assure patient safety in the heat

There is good evidence that dehydration in the summer months causes a significant increase in the incidence of urinary tract infection (UTI) and other severe infections associated with it. Jennie Wilson, the member of the Infection Prevention Society, provides these key facts to help you prevent your patients from becoming dehydrated.

Keep drinking

Adults need to take in a minimum of 1.5 liters of fluid every day. This is equivalent to at least 8 large cups or mugs of fluid.  Make sure that drinks are offered to patients enough times during the day to enable them to drink this amount of fluids

Older people are more vulnerable to dehydration

The loss of thirst reflex decreases in muscle mass in which to store fluids, and reduced kidney function combine to make older people at much greater risk of dehydration. They need to be reminded to drink and advised of the importance of drinking enough to keep them healthy

Any fluid is good fluid

The most important thing is to consume sufficient fluids; it does not matter what form this takes. Use fluid-rich foods such as jelly, ice cream, yogurt to supplement fluids in drinks

Assistance to drink

Think about the design of cups or mugs used to serve drinks. Are these appropriate and pleasant for patients to hold and drink from?  Remember that some older patients may need someone to help them drink and a member of staff will need to be allocated to support them

Support people worried about incontinence

One reason older people do not drink enough is that they are worried about being able to get to the toilet in time or about getting up in the night to use the toilet. Make sure that they know how important it is that they drink enough during the day. If they are in hospital or care, ensure they are reassured that they can ask for help to get to the toilet

Look out for signs of dehydration

Some of the more obvious signs are a dry skin or mouth, dark-colored urine, or complaining of a headache.  Also look out for confusion or drowsiness as these can also be important indicators that a patient is becoming dehydrated

Choice and drinks preferences

Exploring preferences of your residents and extending the choice of drink to include theirs can make a big difference. Introduce an anonymous form to help residents select what they enjoy drinking the most

Introduce protected drinks time

A structured approach to ensuring all residents are offered drinks means no confusion as to who has or hasn’t had a drink most recently

Provide additional drinks before and after meals

Some people may not manage to drink with their meal or may not want to. Building in extra time for hydration around the meal means that the need for drinking won’t get lost when the focus is on food

These principles are not only important for patients in the hospital, but also for the frail elderly in their own home or in residential care

Cerebral Palsy

What is Cerebral palsy?

Cerebral palsy is primarily a disorder of movement and posture. It is defined as an umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development. It may be stated as a static encephalopathy in which, even though the primary lesion, anomaly or injury is static, the clinical pattern of presentation may change with time due to growth and developmental plasticity and maturation of the central nervous system.

What are the Various types of Cerebral palsy?

There are several different types of cerebral palsy:

Spastic cerebral palsy

This is the most common type of cerebral palsy. Spasticity means stiffness or tightness of muscles. The muscles are stiff because the messages to the muscles are relayed incorrectly from the damaged parts of the brain. When people without cerebral palsy perform a movement, groups of muscles contract whilst the opposite groups of muscles relax or shorten in order to perform the movement. In children with spastic cerebral palsy, both groups of muscles may contract together, making the movement difficult.

Dyskinetic cerebral palsy

This refers to the type of cerebral palsy with abnormal involuntary movements. It is divided into two types of movement problems, called dystonia and athetosis.

• Dystonia – this is the term used for sustained muscle contractions that frequently cause twisting or repetitive movements, or abnormal postures.

• Athetosis – this is the word used for the uncontrolled extra movements that occur particularly in the arms, hands and feet, and around the mouth. The lack of control is often most noticeable when the child starts to move – for example, when the child attempts to grasp a toy or a spoon. In addition, children with athetoid cerebral palsy often feel floppy when carried.

Ataxic cerebral palsy

This is the least common type of cerebral palsy. Ataxic (or ataxia) is the word used for unsteady shaky movements or tremor. Children with ataxia also have problems with balance.

Mixed types

Many children do not have just one type, but a mixture of several of these movement patterns. Some of these concepts are difficult to understand. Please discuss them further with your therapist or doctor.

Which part of the body is affected?

Again, this varies greatly from one child to another. Certain words are used to describe the parts affected:

Hemiplegia – the leg and arm on one side of the body are affected (also described as hemiparesis). Diplegia – both legs are predominantly affected. Children with diplegia usually also have some difficulties with their arm and hand movements.

Quadriplegia – both arms and both legs, and the trunk are affected (also described as quadriparesis). The muscles of the face, mouth, and throat can also be involved.

What are the causes of cerebral palsy?

Cerebral palsy occurs in about two in every thousand children. There are many different causes. A problem with the brain can occur:

1. If the brain does not grow or form properly. The result is that children may have brain malformations.

2. In the early months of pregnancy – for example, if the mother is exposed to certain infections such as Rubella (German Measles), or Cytomegalovirus (CMV).

3. During labor or at birth – for example, if the baby does not receive enough oxygen.

4. In the period shortly after birth – for example, when an infant develops a severe infection, such as meningitis, in the first few days or weeks of life.

5. In children having accidents in the early years of life, causing permanent brain injury. These children are also considered to have cerebral palsy.