Well this is encouraging. On Friday the Centers for Medicare and Medicaid Services - the federal agency that sets quality standards for nursing homes – issued new guidelines for nursing home surveyors that emphasize the importance of “resident quality of life” and “homelike environments.” CMS says the goal is to get nursing homes to focus on resident-centered care. It’s about time, don’t you think? And just what have they been focusing on prior to this decision? Profit margins?

Last fall my father had to spend several weeks in the nursing home that is part of his Florida continuing care retirement community. He had fallen in his apartment, received treatment at a local hospital and then was discharged to the nursing home for rehabilitation and physical therapy. To be blunt, initially it was a terrible experience. When we arrived at the nursing home, they assigned my father to a room and then left us to fend for ourselves for what felt like an eternity. How wonderful it would have been to have someone – a nurse, an administrator, anyone -  take a few minutes to welcome him, explain his daily schedule, meal options, etc. Yes, I understand that he was just one of many patients they had to deal with. But a little warmth and time spent in his admission would have gone so far in starting things off on the right track. Instead I left the nursing home that afternoon with a knot in my stomach, with no confidence in the care he would receive. It certainly did not feel like a “homelike environment.”

One of the other points in Friday’s CMS report is that nursing homes should start to pay “close attention to resident’s preference for his or her own daily schedule.” I know this will be a difficult task, but how wonderful it will be for the residents in nursing homes that can fulfill this suggestion. My father prefers to eat his dinner later in the evening, 6:30 at the earliest. While he was in the nursing home, he had to eat at 5pm. That may seem like a minor issue, but to anyone who has dealt with a family member in this situation, you know that it has a big impact on their attitude and sense of dignity. One of the things that upset my father the most while he was in the nursing home was that he was dependent on the nurses and CNAs just to use the bathroom. He would have to ring the call bell and then wait, and wait, and wait, for someone to come into his room to help him up to the bathroom. As you can imagine, at 84-years-old, this was often an urgent issue for him.  But most of the nursing staff seemed to exhibit total disregard for this.

I believe that part of the problem initially was that my father was placed on a floor where most of the other residents were much more incapacitated that he was. So I think the staff was a bit slack – it is tempting to not be “resident-centered” if the resident doesn’t know the difference, and can’t even articulate any frustration. He was also placed in a corner room at the end of the hall, a bit of the “out of site, out of mind” phenomena. After my sister and I raised a fuss, he was transferred to a different floor and that’s when things turned around. He was surrounded  by more active residents, and more engaged staff members. I recall the dining supervisor found out that he had been asking for honey to go with his hot tea (which was usually served lukewarm, by the way). Just when he had given up on ever getting honey, she arrived with several small packets  delivered personally to his room. A small gesture that made a big impression.

I’m sure there are nursing homes in Florida and the rest of the country that already focus on “resident-centered care” and “homelike environments.” But there are far too many that don’t. This won’t happen overnight. But I have hope that these new survey guidelines will at least get these important issues on the table and create greater accountability for nursing homes. If you’d like to learn more about the CMS guidelines, visit http://www.cms.hhs.gov/transmittals/downloads/R48SOMA.pdf

For a searchable database of nursing home in Florida, visit Florida Senior Living Advisor.

I’m starting to think that the next hit reality TV show should be shot in a senior living facility. Judging from what I have seen at my father’s Florida continuing care retirement community, there is plenty of material. Who sat with with whom at dinner? Who said they’d call, but didn’t. Who is most likely to flirt with the new – and rare – single men who move in? The drama is endless. And I have to believe that it is not just amusing to those of us on the outside, but it is actually mentally stiumulating to those involved.

Prior to moving into his senior living facility more than a year ago, my father had spent about four years living all alone in a traditional apartment building, filled primarily with people much younger than him who were busy with their own lives. I suspect he would go days without interacting with anyone else, especially in the cold winter months when he would not venture out. Imagine eating every meal alone? It took me a while to realize that this social isolation was having a very negative effect on his mental and physical health. He, of course, denied it, trying to take pride in his belief that he didn’t “need” to be around people as much as most. How wrong he was.

Within a week or so of moving into his Florida continuing care retirement community, I could sense renewed energy in his voice. He started making friends and I could tell he was amused by the “soap opera-like” drama among residents. Within the first month, he met a female resident that he really clicked with. Here we are nearly a year later and they are still going strong, sharing meals, long walks and participating in the facility’s organized activities together. His attitude and energy are far better than when he first moved in. At times he does sound a bit disgusted by some of the gossip and nosy-ness that he thinks some of the residents exhibit. But while he may never be able to admit it, I think he does realize it is better than the alternative – living all alone.