Nursing Homes And The Lutheran Home For

The Aging Essay, Research Paper

Nursing Homes and The Lutheran Home for the Aging

Recently, I had the pleasure of having a personal tour of the Lutheran

Home for the Aging located in Wauwatosa, Wisconsin. I chose this area of study

because it happened to be convenient in location for me as well as easily

accessible to a source of an interviewee that I felt comfortable with and who is

also very comfortable with myself. I find it much easier to conduct an

interview and get more relevant information from a source that I’ve already had

former contact with and also established a friendship with. I interviewed, age

48, who was a social worker at the Lutheran Home for the Aging for 12 years

until she changed career paths that would benefit herself more as well as her

family. graduated from the University of with a Social Work degree and is

presently pursing a two year Dental Hygiene degree(Associate Degree). She

explained to me that at the time she was hired at the nursing home it was not

necessary for social workers to have to take a test in order to obtain a license

and a position in the social work field, a position that she held for twelve

years explained to me how she was “Grandfathered” into her social worker

position and did not have to take a test for a license until it was required

after years of responsible and professional work in the Home for the Aging.

The Lutheran Home for the Aging was founded in 1906 by John C. Koch,

with the motivation and desire to promote residential care for his fellow aging

Lutheran constituents. Along with the supportive interests of other Lutherans,

he purchased approximately eight acres of land. A large house on the property

served as the Home’s first building and within a year of its founding, it had

reached a capacity of twenty members. Today the same desire and motivation has

increased the residential population to 313 members, age 65 and over. The

founders of the Home did more than provide a place to live for the Aging. They

founded a tradition of excellence and quality care that continues even to this

day. The mission of the home is to “take a leadership role in resident

satisfaction by providing superior services in a Christian atmosphere that meet

or exceed the expectations of each resident and his or her family” (”Lutheran

Home for the Aging” 1). Through the years, with renovations and expansions, the

facility has evolved into a nursing facility providing skilled nursing care and

related therapeutic care to all the residents 24 hours a day. The Lutheran Home

for the Aging is a non-profit organization and is a recognized service

organization of the Missouri Synod Lutheran Church. The Home is governed by The

Board of Directors, which consists of men and women from various congregations

located throughout the Milwaukee area. They constantly review and evaluate the

quality of care in relationship to the purpose of the Home and are also in

control of delegating a responsible and competent administrator who is the

leader and manager of the Home.

There is a full array of highly trained and competent staff that keep

the Lutheran Home for the Aging running smoothly and up to standard. As I

researched what quality nursing homes should offer to those in need of a variety

of daily and sometimes complex assistance, I was surprised that this Home for

the Aging met most, if not all the criteria of a “model” nursing home. Some of

the services offered include personal , dietary, therapeutic, social,

recreational and nursing services. There are also meals, laundry facilities,

housekeeping, and 24-hour medical services provided by professional nursing care

and attending physicians. In addition, as most non-profit organizations homes,

there are religious services and counseling programs provided. Some of the

daily responsibilities and individual aspects of the diverse staff include the

following:

? The activities coordinator is a trained therapist or someone designated to

help and assist residents’ individual needs and create programs that provide

recreation, entertainment and therapy for the residents.

? The social service staff consists of social workers, counselors, and , in

some nursing homes, a psychologist who assist in coping of the emotional and

psychological aspects of aging, the transitional problems that may arise when

first entering an aging home, and daily problems and frustrations.

? A food service director oversees nursing homes’ daily meal program. Many

homes including the Lutheran Home for the Aging, have a Dietitian that meet the

individual daily requirements of each resident, whether therapeutic diet or

normal, and try to ensure that meals are appetizing also.

? The Pastoral care staff consists of ordained, professional, or lay persons

trained to meet the spiritual needs of residents through worship, study, and

counseling. At the Lutheran Home for the Aging there is a Chaplain on hand that

conducts Sunday services, Bible classes, and directs a support group for family

members that meets and discusses the difficulties of adjusting to the separation

of their loved ones from the family.

? Volunteers and members of the community assist the staff by spending many

hours interacting with the residents and helping them as well as the staff

perform their daily activities. There are often groups that are well known for

their participation with the people at the Aging Home and continually come back

year after year to help and visit the new friends they have met through their

volunteer work.

Some original and surprising activities and therapies were discovered

during my research that not only entertain residents, but also rehabilitates

those with disabilities or mental deficiencies. Some therapies I found

interesting were the Pet, Music and Art therapies that are common in Aging Homes.

The Music therapy consists of a musician that sings with the residents several

times daily for entertainment purposes and is found also to be a good source of

rehabilitation for those who have slower motor skills, the easily confused

(cognitively deficient), and people that have trouble remembering things

(Alzheimer’s patients). Art therapy gives the elderly a chance to paint, do

craft work, woodworking, and explore dance and drama if interested. Pet therapy

consists of either “live- in” pets or a hired person that brings animals in to

enhance the feeling of companionship among the residents. The Lutheran Home for

the Aging has a cat, iguana, several parakeets, and a Golden Retriever named

Pawlet that s hare the home with the residents. There is also an

Intergenerational Program that involves the Child Day Care facility located

within the Home for the Aging. The child day care was built in 1991 and consists

mainly of employees children, but is also open to the public when space is

available. The children learn to benefit from the social interaction with the

residents and are included in some of the therapies and activities such as going

to the zoo, baseball games, movies , malls, and even Bible study once a week.

The residents have the opportunity to have the delightful presence of the

children and be involved in their care also by reading to them and participating

in activities especially designed for the children.

Many nursing homes, including the Lutheran Home for the Aging , are non-

profit organizations which have long been recognized as having a tradition of

serving the needs of older persons. Non- profit organizations are usually

community-based agencies and sponsored by religious organizations and fraternal

groups. As mentioned earlier, theses homes are governed by a volunteer board of

trustees who are committed to caring for the needs of older people. An important

aspect of non- profit organizations is that any income generated is put back

into the facility to either improve or expand the services they provide. As in

the case of the Lutheran Home for the Aging, the generated income from resident

pay and contributions has been used in expansion of the Home, the building of

the Child Day Care, and the coordination of special activities for the residents.

The main concern in non – profit organization is the continuum of care that

offers many options to the elderly residents of the facilities. The range of

offerings can include those who need somewhat simple care to those who need a

high level of care.

The nursing care facilities consist mainly of long- term facilities that

integrate custodial care with nursing, psychological, social, and rehabilitative

services on a continuing basis. At the time of admission, each individual’s

potential and problems are evaluated and their care and treatment is designed to

their individual needs. Regardless of the care needed and the advancements made

in therapies, nursing homes enable residents to capitalize on their strengths

and compensate for their weaknesses in an atmosphere designed to look as home-

like as possible. Nursing care facilities are licensed by the state and are

overlooked by the federal government. An interesting program that I found at the

Lutheran Home for the Aging was the Interdisciplinary Team or often called

Resident Care Management in other nursing homes. This team consists of a social

worker, nurse, dietitian, physical and speech therapist, recreational therapist,

a resident and their family. This team reviews the residents’ status

to ensure that all the needs are being met and treatment is not lacking in any

way in any area. This work load can be very large for a social worker,

especially. As in case load, she reviewed between 96 -100 people monthly and had

to use very professional judgments in each case because of strict regulation of

the State. In nursing homes, there is a State Yearly Review in which the State

picks residents names at random and does their own evaluation of the patients as

well as of the nursing home. There are numerous interviews with residents, staff,

and even family to ensure the Nursing Home is living up to standard. If problems

are found, the facility can face financial penalties or even lose its license

unless the situation is corrected in an allotted time period.

As can be expected with all the care and rehabilitative efforts needed

by many in nursing homes just to maintain daily comfort in their lives, comes an

incredible expense to the resident or their families. In many nursing homes,

residents are required to have a need for professional medical staff and cannot

accept applicants whose basic need is custodial care or who are developmentally

disabled. Thus, payment sources must be reviewed before initial entry is

considered. I found that the costs of living in nursing homes can be incredibly

expensive, especially if the resident is in need of daily therapy and medical

attention, which increases the amount each resident pays as medical attention is

needed more often. The average daily rates can be from $90 to $140 for only

their bed – stay, not including any special treatments that are often required

by many. Costs may exceed over $4,500 monthly and from $35,000 to $45,000

yearly. There are not a lot of sources for covering such large expenses and thos

e that are offered are limited to financial need of the patient. There are three

basic methods of funding long- term care in nursing facilities that require

patients to need medical assistance. The “Private Pay” method is for residents

who are financially able and pay a daily rate from their private funds. As

mentioned before, the rate is based upon care needed and is determined prior to

admission. Another method may be through Medicare which will help pay for a

portion of an individual’s care when certain criteria are met. Some of these

requirements may include that the resident requires skilled care on a daily

basis by nursing and therapy which can only be provided in a skilled nursing

facility. Medicare will pay up to 100 days of 100% coverage in the nursing home

as long as the patient is making advancements in treatments and therapy. As soon

as the patient is at a “plateau” in their medical condition, Medicare is no

longer provided. It should be mentioned that Medicare is a federal program “that

un derwrites health insurance for persons 65 and older and some persons with

disability and also covers limited home health and hospice care” (Sager 459).

Another popular payment method may include Medicaid which is a “joint federal

and state program that helps hose with disabilities pay for nursing home care

and health care at home after they can no longer afford the expenses

themselves” (460). There are other payment methods, such as nursing home

insurance, offered to the elderly, but are rare in comparison to the payment

methods mentioned above. The role of the social worker is included in helping

the assistance of some residents find or obtain payment methods that may benefit

themselves. For instance, if a patient has no family it is the job of the

social worker to have to go and fill out the Medical Assistance papers at

designated buildings so that the residents are eligible for financial assistance

towards their stay at the nursing home. They are also responsible for

coordinating and participating in

discharge planning when a resident may return home to live in the community.

Social workers set up health care, physical therapies, or occupational

assistance for the patients if needed. They sometimes refer residents that need

psychological or psychiatric counseling to outside agencies and monitor the

results.

I found it interesting while when interviewing of the Lutheran Home for

the Aging, how much she had related the role of her work as a social worker to

what we had learned in class about the Code of Ethics. When I first asked her

for a brief description of her duties as a social worker there, she said,” I

was an advocate for Resident Rights. It was my job to protect the individual

rights of each citizen, protect their worth and dignity, and make sure they

weren’t taken advantage of.” I told her that it sounded like she was reading the

same book I had and giving me the answers I wanted to hear. Some other things

that amazed me in the professionalism of social workers to their job of working

with people and maintaining the best interest of the client became evident for

the first time during this research project. All the things I learned in class

seemed to come together after just researching one institution. Another aspect

of social work that Mrs. Hippler stressed was the importance of documentatio n

for everything . She stated, “If it isn’t written down, it didn’t happen.” This

is especially important if there is a legal problem with a resident or if the

State Review Board would like to see certain charts and documentation on a

certain patient. Also mentioned was the importance of confidentiality and the

need to provide accessible resources, especially to those in nursing homes who

cannot always care for themselves.

There are many nursing homes today that do not always meet the needs of

the residents that occupy them and often violate many ethical standards of

proper living for people. Some homes have been found to exploit people

financially, ignore proper medical care, and engage in a variety of residential

abuses. After my research, I truly believe what separates “good” nursing homes

from those who are involved in unethical practices is based upon individual

morals, community involvement, and religious guidance. At the Lutheran Home for

the Aging, I found the staff to be incredibly friendly and competent in the

performance of their job detail. I was also impressed by the professionalism of

the social worker I interviewed in regard to her job and the stress and

frustration that comes with it. The nursing home was very involved with the

community for rehabilitative purposes for the residents, and provided a learning

experience for a wide range of volunteers that take time out of their lives to

help others. The

Home has been a clinical site for interns in therapy and social services as

well. Although the institution is based upon the ” spirit of Christian caring,”

the Home for the Aging does not discriminate from other races. There is a

Chaplain available to the residents and staff for counseling and spiritual

support. Bible classes are offered as well as Sunday Lutheran services, weekly

communion, and monthly Catholic services.

I came across a good quote that would serve as an example of the unique

characteristics and motivation needed in order to maintain professional

excellence in non – profit and religious – based nursing homes. This was from a

pamphlet that stated:

“The Lutheran Home for the Aging has been blessed from its inception with

insightful leadership, a committed staff, and a supportive Christian community.

By the grace of God, we look to the continued dedication of those resources to

the tasks ahead” (”Lutheran Home for the Aging” 8).

BIBLIOGRAPHY

Applegate, William B. “Journal of the American Geriatrics Society.” Online.

Internet. Available http://www.wwilkins.com/wavcat-

bin/journals_ops/ID0856948/0002-8614/prod.

“Code of Ethics.” Online. Internet. Available

http://www.umanitoba.ca/faculties/?tml#Ethical Duties and Obligations.

Lutheran Home for the Aging. Wauwatosa: Lutheran Home for the Aging, 1996.

“Long-Term Care and Nursing Homes.” Online. Internet. Available

http://freenet.uchsc.edu/2000/senior/nurshome/menu.html.

“Nursing Home, Home Health and Hospice.” Online. Internet. Available

http://www.math.utah.edu/~c-pkse/medfile/hhh.html.

“Nursing Homes and Long Term Care Facilities.” Online. Internet. Available

http://www.medaccess.com/locator/nursehome/nsgh01.htm.

Sager, M. Measurement of Activities of Daily Living in Hospitalized Elderly: A

Comparison of Self-report and Performance-based measures. Wisconsin:

Geriatric Society, 1992. 457-462.

“Senior Care Insurance, Medicare, Medicaid.” Online. Internet. Available

http://seniors-site.com/ads/medicare.html.

Lutheran Home for the Aging:

“A warm, caring place

where life always has

quality, value and

dignity.”