Knowing your long-term care history
Elizabeth Leis Newman
We are creatures who live in the moment, especially this time of year, when it feels like downtime is spent running from a holiday party to wrapping presents to readying the house for guests.
When it comes to long-term care news, I suspect there will be a few themes, like the push to reduce antipsychotics, that will stay with you into 2014 (and if you're really lucky, you'll get to discuss those with family members around the holidays). But in these hurly-burly times, I know many of you — like myself — read a story about a piece of legislation, a study, or quality measurements and that then let it slip through the corner of your mind.
This is partially why I found myself thinking this past week about forgetfulness, and remembering one's history. I went to see an excellent revival of a 1985 play, The Normal Heart, at Chicago's Timeline Theater; it also happens to be coming to HBO in 2014. It's a more or less autobiographical story about Larry Kramer's founding of the Gay Men's Health Crisis and the infighting, tragedy and response to gross government indifference that followed.
For those of you who see it, when one doctor barks that all healthcare is political, I suspect, like me, you'll think, “Preach.”
Still, one shouldn't compare the early AIDS crisis of the 1980s to the 2013 long-term care mess anymore than saying that LeadingAge and Gay Men's Health Crisis are similar because they both have nonprofit status. But there is a common thread I think is worth noting, which is an examination and understanding of history. Kramer castigated what he called the “post-AIDS generation” in a 2006 interview, saying that the younger, healthier members “don't want to know the history.”
How many of you think the same thing about younger executives when you realize that they were in playpens when the Nursing Home Reform Act, or OBRA ‘87, was passed? Or, on the flip side, how many of you under 40 have thought to ask older administrators what nursing homes were like in the '70s or '80s?
More grimly, how many lawsuits have you read about, or experienced, that felt like déjà vu? How much would have been gained, or how many decisions are to be changed, when there's an examination of the path to a tragedy?
History matters. Taking a resident history is considered a vital part of the admission process. One would expect you to know if a resident is widowed, or if he's had diabetes for a decade. But staff also should have a basic understanding of local and national history: A resident with dementia might remember the John F. Kennedy assassination as happening in present time, and be as scared as he was on Nov. 23, 1963. Another resident might still blame herself for throwing her gay son out of the house in 1980, and making funeral arrangements for him three years later. Another could think of the Sept. 11 attacks every time he sees a plane, or become agitated when one of his grandchildren gets on a plane.
You don't need to hire history majors, but think of ways to acknowledge the past, whether it's mentioning events in conversation, having lunch-and-learns around specific topics, or including a line about “This week in local history, this happened” in your weekly emails. As William Faulkner said, “The past is never dead. It's not even past.”
Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.