Yesterday our group ventured over to Charles Morris Nursing and Rehabilitation Center, which is part of the Jewish Association on Aging. This home was chosen to be our urban comparison to rural homes. However, we interviewed them first because they were the quickest to respond. At the home we met with Sharyn Rubin, Director of Resident and Community Services. Sharyn was our main source of information and shared her thoughts on community, dignity, family, etc.
Community
Sharyn believes that community amongst residents depends on if they long-term or short-term Charles Morris residents. Long term residents understand the fact that they have to be there and are engaged in daily life in the home. Short term residents are very “I” centered, working hard in rehab, and hoping to move out soon. Sharyn said that living in a care facility is an adjustment. “It is like a kid’s first day of kindergarten, they say they have no friends and don’t know anyone. It takes a while for that kid to run from mom to school when being dropped off”. So Sharyn usually tells family members to give their loved ones time and they’ll come around.
When asked about social cliques, Sharyn said that bullying in facilities is usually a big issue. However, she doesn’t see that happen here. Nor does she see cliques forming. Occasionally roommates don’t get along and efforts are made to fix that quickly. Considering that Charles Morris is affiliated with the Jewish community, we asked if religion was a diving factor in the community (as the facility is open to anyone). Sharyn said that is not an issue and in fact, religion is a source for community building. For instance, on holidays, the religious aspects are played out to the fullest. This could be anything from having services to kosher meals. Sharyn said that those who don’t keep kosher or attend service aren’t offended, they just don’t opt in. And those who do follow these beliefs are happy. This is the easiest way to please the community at large. Additionally, I should note that other holidays outside of Judaism are acknowledged.
When looking into the community between staff and administrators and patients, this too thrives. There is a “Guardian Angel” program, where staff adopt a new resident and visit with them on their first few days in Charles Morris. They take residents to the kitchen or social spaces to help them get acclimated to their new surroundings. Additionally, Sharyn noted that sometimes programs aren’t needed and these things come naturally. For instance, the housekeepers have a very close relationship with residents. Often times, they will fix a residents hair or buy them gifts and other necessary items.
Sharyn also noted the outside community as extremely influential within the home. Charles Morris has a strong volunteer base and many volunteers “adopt” patients. Additionally, Sharyn pointed out the various donations from the community, which make Charles Morris a nicer place to live. For example, an Eagle Scout built a gazebo outside of the center, which Sharyn claims “we live in that gazebo during summer months”. Another community member donated a jukebox and while in the craft room, we saw bags of donated scarves.
Sharyn also noted that the Pittsburgh community in general is a huge advantage to Charles Morris. Through the community, Charles Morris is able to work in coalition with other homes in a program called “Agewell PGH”. This service provides a call line for people across the country to talk to a central person regarding the needs of their elderly loved ones. Additionally, having the universities and their researchers was cited as a major advantage. By working with them, Charles Morris was able to implement a study on medication use in the elderly. The study showed overuse and drug reactions amongst elderly people who live independently (outside of facilities). This question showed that Charles Morris felt that belonging to the Pittsburgh community was truly and advantage. This makes me wonder how the other homes we hope to interview feel about being rural.
Finally, community is found by residents taking up individual roles in Charles Morris. One man on a motorized wheelchair meets with Sharyn every day at 1:00pm to distribute the mail. Other women work in the gift shop. Sharyn says that often setting up this type of participation is more work, however it gives people a purpose.
Dignity
According to Sharyn, dignity is a huge issue in the home. She said employees of Charles Morris are trained to provide dignity to residents in everything they do and to realize that Charles Morris is these people’s home.
A major issue surrounding dignity is the problem of people soiling themselves. In care facilities, only certain workers are trained and legally allowed to assist residents to the rest room. Hence, when a bell is rung, meaning that a resident needs assistance, a specific person must answer this call. Sharyn admits that sometimes with an emergency happening in another room or other extenuating circumstances, residents have soiled themselves. Sharyn shared a story with us about a man who called her and left her a voice-mail saying that since nobody came quick enough, “he was forced to soil himself”. Even talking to us, you could see Sharyn’s guilt and how upset she was about this. However, she stated, we are constantly overstaffed with trained people and sometimes these things still happen.
Finally, Sharyn mentioned that dignity is built into some of the amenities the facility offers. For instance there is a manicurist and a beauty parlor. While showing us the beauty parlor, Sharyn said “(The beautician) is more effective than the Doctors”. “People will come out of the hospital without washing their hair or showering and she makes them look and feel like new”. Additionally, Sharyn stated that the beautician really cares about the residents and gives them a great source of interaction. Sharyn also mentioned that building dignity into the facility is continuing in the form of meal service. Right now, meals are served at a set time and if a resident is asleep or busy, their meal may be lukewarm or of a lesser quality than those that were served on time. She states that this often leads to an invasion of a resident’s privacy and lifestyle as they are woken up earlier than they prefer for meals, etc. However, Charles Morris recently received a grant to build a resident centered food facility that functions similar to a restaurant. When it is opened next year, residents can pick what they want off a menu and it will be made for them fresh. This will be available for all meals each day.
Family
When asked about family visiting their loved ones in the facility, Sharyn said “It depends”. She stated that a family can live down the street from the facility and not come in to see their loved ones because it hurts too much or perhaps they were never that close in the first place. However, she cited one man who came in monthly to see his mother even though he lived in Miami, Florida. Sharyn said he came even more frequently during the end of his mother’s life. As we were given a tour around the facility, Sharyn pointed out a cot that she hadn’t put away yet, from a family member staying the night with their loved one.
Physical Space
Sharyn pointed out several issues in the physical space of the Charles Morris facility that she thought could be improved. This was something our group had never really considered, but after hearing her talk, I believe this is a great aspect that our deliverable could be based on. First Sharyn pointed out the long hallways throughout the building. She also mentioned that the activities rooms are spread out and not central to the building. Additionally, the nursing unit is not in the middle of each floor. She also stated several things that would need to change in the future. There is an increasing interest in a pool and a gym, something Sharyn believes is a shift in interests between generations. Also, she would like to see kitchens in each unit. Finally, she stated general lifestyle thoughts, such as the fact that married couples cannot live together because roommates are chosen on the same-sex basis.
Final Thoughts
I really enjoyed Sharyn’s thoughts on physical spaces and I was surprised that this is something our group didn’t consider before. I personally, would love to move forward with research and a deliverable in this area because I think it relates to all our other concerns within care facilities. For example, if we re-designed the layout of one unit and put the nursing center in the middle, dignity issues could be solved as there would be a faster response rate to bathroom calls. Other health issues could be easily addressed as well. Furthermore, the community could be strengthened if social areas were put in the center of the layout and if the commute to these areas was shortened with smaller hallways or a more open floor-plan.
Emily Sale
Design and Policy 