Once the decision is made to move a family member into a long-term care facility (LTCF), and there are about 3 million Americans who have made that decision, maintenance of the many dimensions of health becomes job one. Each patient brings their own unique set of health issues in with them, and then faces not only adjustments to their lifestyle but also the realization that they are no longer independent. For many, this tectonic shift in their routines and independence can causes an equally seismic change in their health. On the outside they must adjust to all-new circumstances, new people and places, and new rules. On the inside, they must adapt to a new thinking and new microbes. All this can be stressful both to the psyche and the immune system.
Because immune systems are often compromised before admittance, controlling the spread of infectious disease is a major challenge confronting long-term care facilities. Of the approximately three million patients in nursing homes, skilled nursing facilities, chronic care facilities, and assisted-living and residential care facilities (altogether known as LTCFs), about half contract some form of infectious disease each year. About fifteen percent will die. In addition to urinary tract infections, skin infections, respiratory tract infections, vaginal infections, and odontogenic (tooth) infections, institutions can often harbor hard-to-treat bacteria, viruses, and pathogens collectively labeled Hospital Acquired Infections (HAIs).
To prevent infectious diseases of all kinds, LTCFs, like hospitals, must adhere to strict sanitation protocols – for hand-washing, alcohol rubs after contact, cleaning uniforms, and the routine use of antimicrobial agents.
Senile dementia and Alzheimer´s disease may be more slowly acting but these two diseases affect over half the patients of LTCFs, and are often the cause for placement. Patients with these conditions must be housed in “memory care” units that are specifically designed for safety. The cost of care in these units, and the costs for housing in specialized Alzheimer´s wings with registered nurses on-duty twenty-fours, are more than twice the cost of basic care.
On the lighter side, Mark Twain famously noted that “Age is an issue of mind over matter. If you don´t mind… it doesn´t matter.” But in reality, the statistics are staggering. An estimated 80 to 90 percent of patients in long-term care facilities suffer some form of mental disorder. Subtracting the 50% with Dementia or Alzheimer’s disease, translates to somewhere between 30 to 40 percent diagnosed with depression or other mental illnesses. Most often, patients have varying but progressive combinations of both. Treatment typically consists of administering several medications daily: anti-psychotics, anti-depressants, mood stabilizers, stimulants, antibiotics, and hypnotics, each with its own set of side effects. When several drugs are given in combination, as is standard procedure, their side effects can be synergistic and unpredictable. Psychiatric counseling is rare.
The patients who survive and adapt best in LTCF’s are those with a flexible and positive outlook based in the belief that they can overcome most any obstacle. (Also, those who refuse medications?) Vaccinations can be helpful against a few of the most common ailments but the best preventative is more holistic and less clinical. Basic health practices against the spread of contagious disease can vastly improve overall health in long-term care facilities, but the will to survive and belief in one´s own power can also be a great deterrent. Although there is no clinical study to prove it, maintaining a positive, social, and purposeful attitude tends to provide patients in long-term care far better prospects than the best set of vaccinations.
Western medicine and the better long-term care facilities are now beginning to acknowledge the power of the mind-body continuum. The Placebo Effect, that 30% of medical conditions can be cured by believing in the curative powers of just about anything, has been documented for centuries.
“Eventually it became clear that our emotions, attitudes, and thoughts profoundly affect our bodies, sometimes to the degree of life or death. Soon mind-body effects were recognized to have positive as well as negative impacts on the body. This realization came largely from research on the placebo effect—the beneficial results of suggestion, expectation, and positive thinking.”
― Larry Dossey, Reinventing Medicine: Beyond Mind-Body to a New Era of Healing
Rather than believe in pharmacology, doctor visits, or rhinoceros horn powders we should be teaching everyone of all ages to believe in the power of their belief in healing themselves and staying healthy. Laughter can be the best medicine, and a sense of purpose, caring for others, and belief in your own survival can be critical, too. Those who combine these essentials with regular exercise, something with effort, and a consistently cheerful approach to everything fare far better than those who don´t.
The Preventative Medicine of Empowering Patients
To help understand the dynamics of what goes on in long-term care, let´s look at all the types of assistance that a facility provides their patients (from the National Care Planning Council):
- Using the bathroom
- Helping with incontinence
- Managing Pain
- Preventing unsafe behavior
- Preventing wandering
- Providing comfort and assurance
- Providing physical or occupational therapy
- Attending to medical needs
- Answering the phone
- Meeting doctors’ appointments
- Providing meals
- Maintaining the household
- Shopping and running errands
- Providing transportation
- Administering medications
- Managing money
- Paying bills
- Doing the laundry
- Attending to personal hygiene
- Helping with personal grooming
- Writing letters or notes
- Making repairs to the home
- Maintaining a yard
- Removing snow
Although some 60% of us will need some assistance doing some of these things at one point in our lives, we don´t want to feel helpless while we´re receiving help. We also want to believe that things will change for the better, that we will recover functions and go back to doing all the things we did before. Yet, accepting the fact that we now must have ongoing help and that things may not ever be the same are realizations that can be devastating.
Find a facility that places value on empowering their patients, and trains their their staff to consistently notice the patient´s positives and give compliments. Unless the facility provides a happy, purposeful environment with activities and social functions to replace all those lost functions patients can feel striped of their humanity. Mild cognitive impairmet (MCI), dementia, and Alzheimer´s, prevalent in at least half LTCF patients can also be debilitating, causing feelings of frustration and anger. All this and a sense of helplessness can creep into lives at any facility, cause more mental health problems, and weaken immune systems.
Consistently good attitudes are the best preventatives. They strengthen immune systems and decrease the risk of disease. The power of positive thinking, or Placebo Effect, has been clinically proven to cure health problems 30% of the time. Facilities can provide long lists of assistances for all the basics, provide some structure for socialization and activity, and encouragement. But ultimately, patients must provide their own faith in their own future well-being. Laughter, purpose, good cheer, meaning, and a strong will to survive are the best medicines.
In other words: “There is a fountain of youth; It is your mind, your talents, the creativity you bring to your life and the lives of people you love. When you tap into this source, you will truly have defeated age.” – Sophia Loren