Helping the Home Help Your Loved One

C. Gourgey Ph.D.

You are in a tough spot. You have made the difficult decision to place your loved one in a nursing home. It was certainly not what you would have chosen, and you experience many conflicted emotions: anxiety, guilt, and sometimes more often than you can tolerate, anger. It is hard not to feel anger. In the nursing home your loved one simply cannot get the care that he or she received at home. Most nursing homes are understaffed. An aide might have to care for a dozen or more residents. At home your loved one was the sole focus of attention. That is never the case in a nursing home.

What do you do if you feel that your loved one’s care is not up to standard? What can you do if it seems that your friend or family member is being neglected or even harmed? The most natural reaction is to become enraged. When that happens, a common impulse is to express that rage directly to the staff members who are caring for your loved one: the nurses and nurses’ aides.

However, in the nursing home, direct expressions of anger do not work.

We cannot control people with the intensity of our emotions. We may think that if we express ourselves strongly enough we can make people do what we want. But more often than not, it works against us.

It is easy to forget that on the other side of the conversation is another human being, with needs and flaws similar to our own. We expect professionalism, and perhaps even perfection. Sometimes we do meet staff members who understand our anger, who appreciate what it must feel like to see someone we love suffering in an institution, neglected or in pain. They do not take our anger personally and do not hold it against us. However, to respond to an upset family member with such compassion requires experience, maturity, and self-discipline. We cannot assume that all staff members possess such qualities. Many do not.

More often than not, a person whose job performance is questioned is likely to become defensive. Everyone needs a positive self-image. People want to feel proud of the job they do, especially if their goal is helping others. Some egos are more sensitive than others, but everybody has one. The individual is indeed rare who will not be triggered by another’s anger regardless of its intensity. Strong expressions of anger, raising your voice, using abusive language, make others more worried about defending themselves than about helping you. It is not in your interest to make adversaries of people whom you need on your side.

Venting anger may make you feel good for the moment, but the long-term consequences can be disastrous. Beyond alienating the staff, which is bad enough, if your anger reaches the level of verbal abuse you can be barred from visiting the home. If you feel tempted to react in anger, it might be best to leave the room and take a few deep breaths before returning.

None of this means, however, that you must tolerate an unacceptable situation. When provocative situations arise, it is important to realize that you do have options. Feelings of powerlessness lead to desperation, and desperation soon can become uncontrollable rage. But you are not powerless. You can do much to help yourself when facing a tough situation at the home.

For specific strategies that you can use please see my brochure, “How to Be Your Own Advocate.” It covers the basic structure of the nursing home, how to approach the staff, and whom you can call upon for help. I will just add a few additional observations here.

When approaching a staff member, instead of immediately becoming confrontational I find it useful to tell the person that I need her help in solving my problem. This is respectful, and it encourages the other person to want to be helpful. It is always best to begin by assuming the other’s good will. If the assumption turns out to be false, there are always other measures you can take. But there is no point in ruining what good will might exist by creating an adversary relationship. If such a relationship cannot be avoided, then let the other person create it. That will only strengthen your position.

Once you have the staff member’s attention, analyze the situation rationally. Know the details, including dates, times, places, and names, and know your rights. Being calm and well prepared will bring you respect and increase your chances of getting a serious response. Most important, do not fail to ask the “Two Magic Questions”:

What specific steps will you take to resolve this problem?

When can I follow this up with you?

This advice is simple and I have given it many times, but it is still remarkable how easy it is to forget when in the heat of battle. Expressions of raw emotion are easily dismissed. If you just blast your frustration, the staff member can simply say, “Yes, that’s terrible,” or “I’ll look into it.” Such responses are meaningless. What you need is a commitment to a set of specific actions, and a time when you can check whether those actions have been taken. This is very difficult to achieve once the conversation becomes dominated by emotion. The short-term gratification of emotional release may cost you the chance of obtaining any realistic plan to help your loved one.

The temptation to try to control others through the intensity of one’s feelings is difficult to resist. In practice, however, it is ineffective. You will also feel less need for it if you know you are not powerless. You have two powerful motivators on your side: the sincere desire of many nursing home personnel to do the best they can for the residents, as well as every nursing home’s fear of acquiring a bad image. Ultimately, if it gets to that point, every nursing home is answerable to the Department of Health. They know this. You should too.

You will never get everything you want in a nursing home. Most nursing homes are underfunded and understaffed, and the situation is getting worse. You need to be willing to live with imperfection; nevertheless, you need not accept substandard care. There are sticks available, but it’s smart to use the carrots first. You can motivate the staff to want to help you. That’s the best way to get the best help. Also be a visible presence at the home, so that they know someone is watching. Give yourself time to get acquainted with the strange terrain of the nursing home. With persistence and patience, you will learn how to survive.