Nursing Homes


Useful Citations on Communication Barriers in Nursing Homes

Communication barriers and misunderstandings within nursing homes can result in a host of problems for patients. Misunderstandings due to language or cultural difference can result in elderly patients experiencing more hospitalizations, inappropriate treatment, and unnecessary pain.  Barriers in communication within the home can result in discomfort, incorrect medications, and even injury.  The following resources are meant to inform administrators, nurses and nursing home staff of the possible problems and solutions faced in nursing homes, with the intention of improving communication and overall care of nursing home residents.

Breaking Language Barriers—One Nursing Home’s Language Bank Program.;col1
This article describes a long-term care facility in New York that has taken a new approach to communicating with residents whose first and sometimes only language is something other than English.  Staff members were asked which foreign languages they speak, and their language and work schedule was made available to patients.  This allowed patients to communicate in their own language instead of relying on pointing at picture boards, and greatly improved patient care and comfort.

Minorities Less Likely to Choose Hospice Care.
The Washington Post, November 18, 2007.  LexisNexis
This article gives several possible reasons why minorities are less likely to choose hospice care, including distrust of the medical system and a strong belief in trying to stay alive as long as possible, even if that involves additional pain and hospitalization.  Not knowing what hospice care involves, worrying about the cost, and language barriers also contribute to fewer minorities choosing hospice care.

The lived experiences of Korean immigrant caregivers after nursing home placement of their non-English-language speaking elderly relative with dementia
This study describes the experiences of Korean immigrant caregivers who placed non-English-language speaking (NELS) elderly relatives with dementia in American nursing homes. Two underlying themes emerged: Korean way of thinking and beliefs about dementia. In relation to caregivers’ experiences regarding nursing home placement, six major themes emerged: (1) I never thought about a nursing home; (2) Nursing home staff cannot communicate with Korean American residents; (3) If I think in a Korean way or If I compare with a Korean situation …; (4) My care recipient maintains Korean culture; (5) Nursing home services are better than expected but …; and (6) My care recipient is more vulnerable because of dementia. This study provides valuable knowledge to aid understanding the experiences of Korean immigrant caregivers after nursing home placement of their relatives with dementia.

Language needs and service provision for older persons from culturally and linguistically diverse backgrounds in south-east Melbourne residential care facilities
The objectives of this study were to provide up-to-date figures on the language needs of older persons from culturally and linguistically diverse backgrounds in local residential care facilities and to investigate the extent to which these needs are catered for by the provision of language-relevant services.
A questionnaire sent to 189 registered aged care facilities found that 19% of residents either preferred or needed to speak one of 40 different non-English languages. While over half of the facilities had at least one staff member who conversed with residents in their preferred language, residents speaking nine non-English languages were never spoken to in their original tongue. Almost one-quarter of the facilities did not provide any language-relevant services.

Ethnic Residents in Nursing Homes: A Staff Perspective
The numbers of the aged from non-English speaking backgrounds are increasing at a proportionately greater rate than are the numbers of other aged Australians. Little attention has been directed at identifying difficulties encountered when providing them with residential care. A survey of 163 directors of nursing (DONs) in Sydney nursing homes and interviews with thirty two DONs investigated their experiences with ethnic patients. Tensions were identified in the areas of placement in a home, settling in, nursing care, patients’ relationships with their families and staff, and staff-family interactions. Some implications of these findings for social workers involved in placement are discussed.

This grouping of slides illustrates a study on the quality of care stroke victims received based on race.  It found that minorities received less care or no care in some nursing home facilities compared with white patients.

Feds Investigate U. Med Center’s Service for Non-English Speakers.
By Kristen Stewart, The Salt Lake Tribune.
The University of Utah Health and Science Center was accused of not providing interpretation services or adequate care to minorities.  The Center responded by saying they do have interpretation services, and are continually trying to improve the resources available to patients.  They also maintain that new regulations without increased funding has made it difficult to afford more interpretation services.

Speaking Their Language Aids Dementia Patients
Elderly dementia patients from non-English-speaking backgrounds communicated more with others and took fewer psychiatric medications when living in ethno-specific nursing homes, a Monash University study has found. The study revealed that Italian-speaking residents in mainstream facilities had a significantly higher rate of prescription of daytime tranquillizers than those in Italian-specific facilities.

Improving Nursing Home Communication:  An Intervention to Reduce Elderspeak
Kristine Williams, Susan Kemper, Mary Lee Hummert
This study focuses on nurse use of “elderspeak” with nursing home residents.  Elderspeak involves using smaller, simpler sentences (baby talk to the elderly). The study found that this limits social interaction overall mental health.  Reducing elderspeak results in more respect being shown to the patients, and increased mental stimulation and interaction between nurses and residents.

Nursing Homes—How to Compare. nursing-home.htm
This article describes why it is important to shop around for nursing homes, provides a list of things to consider when choosing a nursing home and advice on how to help your parents with the transition into a nursing home.

Nurse-elderly patient communication in home care and institutional care: an explorative study.
Caris-Verhallen WM, Kerkstra A, van der Heijden PG, Bensing JM.
This study explores communication patterns between nurses and elderly patients in two different care settings. Nurse-patient encounters were videotaped and analyzed and categorized into socio-emotional communication and task-related communication.  It was found that task-related communication rates were higher in home care settings compared with a home for the elderly.

Scales Help Diagnose Pain of Elderly Nursing Home Residents
Kamel HK, Phlavan M & al.
To study the effect of utilizing a combination of three easily-administered pain assessment instruments on the frequency of diagnosing pain among elderly nursing home residents, a cross-sectional study was conducted at two academic skilled nursing facilities.  The study involved medical records abstracting and patient interviews. Pain was assessed in 150 (49%) subjects using the question “Do you have pain?” (Group 1). In the remaining 155 (51%) subjects (Group 2), pain was assessed using three pain assessment instruments: the visual analog scale, the behavior (faces) scale, and the pain descriptive scale. Using the three pain assessment scales greatly increased the frequency of diagnosing pain among the oldest residents. The frequency of diagnosing pain among cognitively impaired residents showed a similar. These data indicate that using three easily-administered pain assessment scales increased the frequency of diagnosing pain among nursing home residents.

A Cooperative Communication Intervention for Nursing Home Staff and Family Members of Residents
Karl Pillemer, PhD, J. Jill Suitor, PhD, Charles R. Henderson, Jr., MA, Rhoda Meador, MS, Leslie Schultz, Julie Robison, PhD, and Carol Hegeman, MS
This article reports on a randomized, controlled study of Partners in Caregiving, an intervention designed to increase cooperation and effective communication between family members and nursing home staff.  The staff members participated in training that emphasized listening/empathy skills, feedback, and “I-messages”.  The study found that Partners in Caregiving appears to be an effective way of lowering family and staff member stress, while improving staff-family communication.

Partners in Caregiving in a Special Care Environment: Cooperative Communication Between Staff and Families on Dementia Units
Julie Robison, PhD, Leslie Curry, PhD, Cynthia Gruman, PhD, Martha Porter, Charles R. Henderson, Jr., MA and Karl Pillemer, PhD
This article reports the results of an evaluation of Partners in Caregiving designed to improve communication and cooperation between staff and families of residents in nursing home dementia programs. Project staff conducted training sessions on communication and conflict-resolution techniques with two groups at the intervention sites: staff and residents’ family members, followed by a joint meeting with facility administrators. Families, staff, residents, and facility programs in the intervention facilities all demonstrated positive outcomes from program participation. Families experienced significant improvement in communicating with staff and in staff behaviors toward them, and spouses of residents increased their care involvement. Behavioral symptoms decreased for residents, and facilities implemented more family-focused programs.

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