|Debbie Hommel's A.D. Tips
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by Debbie Hommel, BA, ACC, CTRS, Executive Director of DH Special Services
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Debbie Hommel, BA, ACC,
CTRS, is the Executive
Director of DH Special
Services. She is a Certified
Activity Consultant on State
and National level, with over
twenty-seven years of
experience in providing direct
care and consultation to long
term care, medical day care,
assisted living, and ICF/MR
facilities throughout New
Jersey, New York, Maryland,
and Pennsylvania. She is an
experienced trainer and
conducting a variety of
seminars throughout the
Tri-State area for the Activity
and allied healthcare
professional. Debbie Hommel
is an active member of Activity
Professional Associations on
State and National levels. She
is ACC certified through the
NCCAP. She is a founding
member of the New Jersey
Association, serving terms as
Vice President and President.
She received the Weidner
Lifetime Achievement Award
in 1994 and the Monmouth &
Ocean County Activity
Achievement Award in 1999.
Let Debbie answer your
Visit DEAR DEBBIE:
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and your Department.
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Sticks and Stones can Break your Bones
but Words Can Never Hurt you - Or not?
By Debbie Hommel, ACC/MC/EDU, CTRS
“After we toilet the feeders, we need to transport them back to the locked unit because
they might elope.” I cringe as I overhear this statement. They were just words. They
were said in a matter of fact manner, in a normal tone of voice, and without malice. Why
did they bother me so much? Fifteen years ago, those words would have gone
unnoticed and the conversation would be one many the staff had about taking care of
the residents. Today, those words and many more are being banished from our day to
day conversation and being replaced with more respectful conversation.
Why is there an interest in changing the language of long term care? Language is
mankind’s means of communication. We communicate verbally and non verbally
through our words, gestures, tone of voice and more. We persuade, inform and relate
our thoughts and feelings through communication. Words can hurt or comfort; instill or
destroy hope and alter a person’s attitude for better or worse. We often don’t realize the
impact of our words, until it is too late. My question to you is – how would you feel if you
“had to be toileted and living on a locked wing”. Personally, I would feel disconnected
and controlled – with or without dementia.
Nursing homes are rooted in institutional care: large buildings, based on rules and
guidelines. Caregivers knew what was best and residents were managed for safety
and efficiency. Residents were labeled as a means to define care needs. We did “for”
them, we made their decisions and we controlled their day. Sounds a bit harsh, but it
was done in a caring way for the most part.
Nursing homes are moving away from this institutional, medical model to person
centered, person directed care homes. We do not want to be “home-like” but home. In
order to create “home”, we need to consider how we communicate to each other within
our home. We are not toileted in our home and we do not transport ourselves from one
room to the next. One way to re-define the “home” in the nursing home is to adopt new
language within our care settings. I am reminded of the following saying:
“Watch your thoughts, for they become words.
Watch your words, for they become actions.
Watch your actions, for they become habits.
Watch your habits, for they become character.
Watch your character, for it becomes your destiny.”
It may seem superficial to substitute one word for another but if communication defines
a relationship, the words we use contribute to the relationship in a positive or negative
way. The following is a listing of institutional words and potential alternatives you can
use in your home:
Transport – Transporting implies boxes, tractor trailers and non-personal things.
Transporting people suggests “herding” and minimal choice in where the people are
going. Consider escorting or assisting residents to and from their chosen destination.
Toilet – A toilet is a noun and when used as a verb (“I have to toilet my residents”), it
creates an image of complete dependency of the individual. The nursing home
resident may be dependent and but they are still a person that needs assistance.
Feeders – Feeders are fish who suck the algae on the sides of fish tanks. To label
residents in this manner is one of the most undignified and demeaning terms used in
long term care. All labels associated with care should be discontinued. We label
boxes, containers or jars – not people. Residents who need assistance in dining is
Elope or escape – Eloping and escaping means running away and avoiding restraint.
These words contribute to the caregiver attitude of control and lack of resident choice.
When residents leave the building, it may be unescorted exiting or maybe they just want
to take a walk.
Locked unit – Prisoners are locked up. Most individuals when locked up focus on
getting free. Memory units often have secure entries and should be called “secure”.
Better yet, give the memory unit a name like “Magnolia Gardens” or “Main Street” and
everyone will know this is a special, safe place for those with memory loss.
“Change has a considerable psychological impact on the human mind. To the fearful it
is threatening because it means that things may get worse. To the hopeful it is
encouraging because things may get better. To the confident it is inspiring because the
challenge exists to make things better.”
~King Whitney, Jr.