Don't Sweat the Small Stuff When It Comes to Nursing Home Care

When I went to visit my cousin, Joyce, in Ft. Wayne, Indiana last fall, we went to the nursing home to see her mother. The minute we got there Joyce saw that her mother was dressed in a sweat suit. She had specifically asked the staff to use the sweats only at night - as pajamas.

Joyce was appalled. Her mother never would have worn a sweat suit during the daytime. Joyce immediately went to the administrator's office and complained vociferously. The administrator was a little annoyed but managed not to show it.

This was just one more in a long list of items Joyce had complained about. But the truth was that her mother, who had dementia, didn't mind the sweats at all. The issue was just a matter of Joyce's personal preference and her mother's previous personal preference; it wasn't doing any harm.

Sometimes there's friction between family members and nursing home staff. Sometimes complaints are warranted and must be registered. But other times, as long as no harm is being done and the resident isn't complaining, it's best for the family to avoid protesting.

It's wise to save complaints for significant problems. In other words, pick your battles. Don't sweat the "small stuff". The staff members at most nursing homes are incredibly busy and they're doing the very best they can to provide high quality care to every resident - including your loved one.

Before complaining ask yourself if the issue is bothering your loved one or is something potentially harmful. If not, let it go. If you criticize the staff for every little thing, pretty soon your objections will begin to cause friction, which isn't helpful for anyone.

Here are just a few of many examples of "small stuff" and "big stuff:"

"Small Stuff"

1. How the Resident Is Dressed: This would include things such as occasionally dressing the resident in someone else's clothes (unless it becomes habitual) or dressing the person in clothes you don't think go together well. Sure, you don't like seeing Uncle Frank in his roommate's sweater and you certainly don't like for him to be wearing colors that clash, but if Uncle Frank isn't complaining about it, neither should you. As mentioned below, the important thing is for the clothing to be clean.

2. How Hair Is Styled: The staff may style ladies' hair in a new way--a way the woman wouldn't have previously liked. As with dress, however, if the resident isn't complaining (and doesn't look horrid), go along with it. In the final analysis it doesn't matter that much. The thing that matters is that residents' hair is washed regularly.

3. Activities You Consider Beneath the Resident's Dignity: This could include games such as bingo or balloon volleyball. You may object to these, especially if your parent or spouse is highly educated and was a scholar, businessman, or had another "serious" profession. But "serious" people may now enjoy participating in activities they never would have before. Look to see if the person is having fun. If so, let it be. Activities can be very therapeutic.

4. Teasing the Resident or Showing Physical Affection: This depends on the nature of the teasing. If it's truly making fun of the resident, hurting his or her feelings, that's grounds for complaining. But if it's good natured and the resident obviously enjoys it, then don't object - even if your loved one didn't previously enjoy being teased. A related issue is if staff members express physical affection to a person who wasn't previously openly demonstrative. Again, keep any displeasure to yourself if the resident clearly likes it. As is the case with activities, touch can be extremely therapeutic.

Significant Issues:

1. Clinical Care: Any notable problems with clinical care should be immediately brought to the attention of the administrator or director of nursing. These might include not following the doctor's orders, violations of universal precautions (for example, stirring liquid medications with a bare finger - which I've actually seen), not assisting residents who need help with eating, or leaving wheel-chair bound residents (or any resident for that matter) in bed all day.

2. Safety: Issues such as leaving a medication cart unattended or leaving the call system button away from the resident's reach. For residents with dementia, additional issues apply such as having the unit properly secured or allowing a resident to have sharp, potentially harmful objects.

3. Personal hygiene: Matters such as not changing incontinent residents in a timely fashion, not keeping bedding clean, putting dirty clothes on the resident, not providing regular showers or not shaving male residents who need help with that on a regular basis.

Something family members need to realize is that people can change when they move to a long-term care facility. They now spend nearly all of their time being cared for by the staff, and may begin to enjoy things they never before liked. And they may come to accept things about which they previously would have been displeased.

Keep in mind that in some respects the staff members may now know better than the family what a given resident may or may not like. So don't sweat the small stuff. It will make things easier for everyone - you, the resident and the staff. Save your complaints for problems that really matter. It will improve your quality of life and make interactions between you and the staff much smoother.

Marie Marley is the author of the award-winning "Come Back Early Today: A Memoir of Love, Alzheimer's and Joy" and co-author (with neurologist Daniel C. Potts, MD, FAAN) of "Finding Joy in Alzheimer's: New Hope for Caregivers." Her website ( contains a wealth of information for Alzheimer's caregivers.

This article first appeared on the Alzheimer's Reading Room.