Sue Ellen Clark
Guide, 2022 Pioneering a New Culture of Aging Conference
A good night’s sleep is fundamental to health and being human. However, lack of quality sleep is the number one problem that no one is talking about in long-term care. If you are not convinced, just ask yourself how important sleep is to you. It is really important! Poor sleep patterns are among the most common difficulties elders experience and are associated with many negative outcomes. We carefully review the quality measures of falls, infections, pressure areas, and the like, but do little if anything in assessing the sleep that elders receive. There are many things that happen in a traditional nursing home that create bad sleep including age related changes, environmental factors, behavioral issues, care practices, diagnoses, polypharmacy, inactivity, and the unbending institutional structure.
Prior to moving in to a care community, an elder had expressed night time and morning routines, but shortly after their arrival those preferences get squeezed out for the sake of efficiency. The elder becomes lost in the regimented routines, and falls prey to the tasks that need to be done. Just think about the schedules that typically exist in traditional long-term care settings. The day is akin to a one size fits all, assembly line approach.
If you have never stayed overnight in a long-term care bedroom, please consider doing so. No, not for your own self-glorification but for the sake of upending the institutional regime. It will serve as a disturbing motivator for change. One time, I stayed overnight at a community where I worked as winter weather was bearing down on the region. Upon entering my assigned room, it was unusually cold and smelled like my grandmother’s old chest freezer, the one found in her basement. There was no shower to bathe myself, only a shallow sink that overflowed if the water ran for more than 30 seconds. I crawled into bed and experienced sleeping among the tentacles of bedrails for the first time. The pillow was a crunchy, plastic substance, and the mattress made squeaky noises each time I flinched. A badly stained chair, whose expiration date was long overdue, wafted an undetectable stench. Throughout my five-hour existence in the room, I could hear team members chatting in the hall, and elders on all sides of my room with their televisions at full volume. I thought to myself that if a CNA came in to reposition me every two hours on top of all this, I would surely go out of my mind. I raced to get out of bed and out of that room as early as possible the next morning to end the misery.
Throughout that ordeal, my mind kept turning to the fact that this is the environment in which so many elders live. It did not represent anything close to what I experience at home every night. I felt guilty as I could easily walk away, go home, tell a good story about it, and chalk it up to ‘taking one for the team.’ But the elders could not do that. This is their daily life and existence. Everyone has preferences and styles that vary enormously related to sleep. Everyone needs productive, meaningful sleep. That does not change as one gets older but only becomes more essential. Elders in long-term care have the very basic right to sleep and wake in a way that is needful for them. For elders in traditionally run nursing homes, achieving that can be much more challenging and elusive.
Part of the theme for this year’s conference is shaping the future. That means creating sleep and wake routines to resemble what elders did in their homes. Elders’ lives should not be so upended once they move into care communities that they have to give up what is important to them. The succumbing to the institution does nothing more than underestimate the very existence of being human. Now is the time to create what we would want for our families and ourselves when we need long-term care and support services. The new model in long-term care must support normal, restful sleep and natural waking for good health and well-being. In that, we start to change the future of elder care.