Nursing Home Procedures You Should Question
Faced with that difficult decision whether to place a family member in a nursing home, we rely on a good deal of trust: trust that the doctors and nurses will make the best treatment decisions. But when should we question these professionals’ treatment decisions? Finally some nursing care guidelines come from the Society for Post-Acute and Long-Term Care Medicine (AMDA).
AMDA has joined an initiative called “Choosing Wisely.” Their goal is to initiate and promote conversations between clinicians and families to choose care that:
- is supported by evidence
- is not duplicative of previous tests or procedures
- causes no harm
- is necessary
AMDA partnered with “Choose Wisely” to design a set of guidelines for long-term care patients [PDF]. These guidelines set forth ten specific tests or procedures that you should discuss with the doctor before giving consent.
One procedure you should question is placement of an indwelling urinary catheter. Some circumstances do require a catheter, such as urinary retention, outlet obstruction, or to help in the healing of serious sacral or perineal wounds when there is incontinence. To manage general cases of urinary incontinence, however, nursing homes should not use catheters. That’s because they are the most common source of bacteremia, which can lead to several life-threatening conditions. But many facilities don’t have enough nursing staff to adequately toilet patients, so they resort to placing catheters to ease demands on the staff.
A second nursing care guideline concerns the placement of feeding tubes. The medical literature shows that nutrition delivered by a percutaneous feeding tube (through the skin into the stomach) does not prolong life or add to the quality of life in patients with advanced dementia. When a patient’s health declines to the point where caregivers consider artificial nutrition, it is often a sign of significant and irreversible decline. It may seem contrary to common sense, but tube feedings do not improve patients’ comfort or reduce their suffering. In fact, these feedings may cause fluid overload, diarrhea, and abdominal pain. They may also increase the risk of aspiration, which introduces harmful matter to the lungs. The best intervention with a patient who is not eating is to offer assistance with eating.
These “Choose Wisely” guidelines are a welcome list of topics to begin a conversation with your healthcare provider to help ensure that your family member is receiving the best and most effective care.