By Geri Waters:

As a former head of nursing for several senior care facilities and a state ombudsman over senior care facilities, I’ve had the opportunity to see senior care in the home and in institutions of all sizes with various amenities, budgets, and staff programs.  Each combination varies depending upon the administrative influence all the way down to those at a patient care level.

Most programs are well supervised and most staff personnel put forth a tremendous effort to care for their patients.  Sure, there are a few ringers but for the most part, they don’t last and most people know who they are in very short order.  There are also a few facilities that are so driven by profit motives that patient care isn’t a top priority, especially if it conflicts with the potential for profit.

The biggest factor in the quality of patient care

With few exceptions, the number one influence on the quality of patient care, whether by homecare staff, assisted living/residence management, or nursing home staff, is the level of family interaction and interest from the patient’s family and friends.

How often the senior client/patients’ family sees the family, how active they are in the senior’s life, the more the family asks questions, talk and interact with the staff, and generally watch and keep watching the level of care, all makes a huge difference in the level of care that the senior receives.  

Most management personnel will tell you that there isn’t any difference the quality of care that they give and for the most part, that is what they intend and what they perceive about the quality of their own care.  When it comes to a minimum expectation or even a reasonable expectation, they may indeed be correct.  There might not be any differences.

However, evaluating “care” is extremely subjective and the difference between tolerable care, acceptable care, and exceptional care is hard to measure and of course, it depends on whose standards you go by.  What I am talking about, is patient care that is exceptional, relative to the other patients in the same situation.  

How long does the staff spend with each patient?  If there is a special need, which patients get the attention the fastest?  How much time does staff spend talking to each patient?  These are all questions which relate to care but when asked relative to each patient under the same care, can differentiate between received care.

There are several reasons in my opinion why this is, even in the most honest and well-intentioned care programs:

1) Staff get to know more than just the patient. By building a relationship of sorts with the family, staff seem to have a better attitude and a higher degree of responsibility to the patient. There is also an affinity that is built between the patient and the staff because personal communication is enhanced when the staff knows the family to which the patient is referring. A sense of familiarity is developed and that always facilitates increased personal care.

2) There is the case of course that staff is often over-worked and must make care decisions/choices. The human tendency is for making the choices for care of patients whose families are involved because it reduces the risk of having to deal with an unhappy family member who thinks that care is lacking.

3) Involved families also communicate more with the senior adult. Lack of care is one topic that involved families will not only notice and ask about, but are more willing to confront the situation.

4) One little understood fact is that seniors who have actively involved families have a greater sense of personal self-worth and are generally happier and have higher expectations. This leads to a greater expectation of care from responsible staff members. A patient who sees themselves as worth of quality care is going to expect it and demand it where the patient with a lower self concept is more likely to be compliant or accepting of lower standards of care. Bottom line, you pretty much get what you expect and what you are willing to demand.