They are operating as they did 20 years ago “when everything has changed”
Portuguese nurse Carmen Garcia, author of a book that means to get the country talking about old people, warns that nursing homes are operating as they did 20 years ago and as such are not working.
This is the gist of a long interview with Lusa today in which Nurse Garcia defends the establishment of district teams of Social Security to provide training to start ringing the changes.
“The Last Loneliness” (A Última Solidão), is being published on World Elderly Day on Friday.
Carmen Garcia tells Lusa that 20 years ago “people lived fewer years, with a lower average life expectancy, less comorbidities, less polymedicated”. The average age of entry into a nursing home was around 70; today it easily exceeds 80.
“We continue to offer the same services, the same type of organisation and it doesn’t work,” she explains, arguing that it is necessary to “urgently think about dividing up care homes”.
This division would consist of having a specific model for more independent residents, who need less supervision and less health care, in parallel with other homes, closer to a long-term care unit, for residents with serious dependencies, who need to be mobilised more frequently, where there would be nursing 24 hours a day.
“The homes for more independent people have to provide a much more integrated response in the community, much more dynamic, with much more cognitive stimulation, while the other homes, for more dependent people, have to provide a response much closer to that of a health unit”, she said.
Nurse Garcia proposes that the departments of Social Security and Health should rethink the structures of support for the elderly and also believes they should consider the possibility of old people staying in their own homes and increasing the amount of support given to families.
Equally, a mechanism could be created so that an elderly person is adopted: “As there are social security nannies for children, there could be this for the elderly. People who are unemployed could become carers…”
From Carmen’s experience, current residential homes for the elderly “are a hybrid” that don’t know how to respond to the needs of those who seek them, and “are not sufficient to respond to the most dependent people”, while illegal care homes “grow like mushrooms”.
She also criticises Social Security inspections with prior warning; homes that have only two assistants for 60 patients at night, and the lack of training of staff.
As she explained “restraints are the first ball out of the bag” when an old man is more agitated and removes the probe that is feeding him, for example – when this could easily be solved with gloves that prevent fine motor skills but allow the person to be mobile.
She recalled what she witnessed in a social home in the Alentejo, where at night there was only one auxiliary, who resorted to the use of an anti-psychotic to calm the patients.
She told Lusa there is a “constant infantilisation of the elderly”, in fact a whole process of depersonalisation as soon as they walk through the door of a care home.
She therefore proposes that Social Security create a district team to provide training in nursing homes, pointing out that “most of the things that are done badly in nursing homes are not because of a lack of will on the part of those who are there, they are because of total ignorance”.
“This could be so simple, review the basics, review positioning, tube feeding, dementia, urinary catheters”..
Nurse Garcia also suggests that a platform be created – similar to what already happens in Health – in which nursing home professionals and relatives of patients can signal abnormal situations to Social Security, and that the Socialist Party’s proposal to create protection commissions for the elderly, like those that already exist for children, be reconsidered.
“I would really like us to look at the internal organisation of nursing homes, to divide things up, to think about ratios, to provide better health care to people who are more dependent, with more nurses, to prevent people from being immobilised, to prevent those horrible bedsores that are a problem in nursing homes,” she stresses, arguing that the Recovery and Resilience Programme (PRR – the EU bazooka post-pandemic recovery funds) should be used to build more responses in this antiquated sector, and inject useful money into nursing homes.