Nursing Homes In The Good Old Days

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Nursing homes often receive criticism in the media. Unfortunately, sometimes, this is well deserved.

We need to address these issues and make positive changes. However, I think it’s also essential to look at how far nursing homes have come over the past few decades.

I started as a candy striper (teen volunteers who wore red and white striped pinafores) in a nursing home when I was 14 years old. Later, I worked as a nursing assistant during the late 1970s and early 1980s as part of my journey to becoming an RN. Today, I want to share some of my memories from those good old days.

As you read about my experiences, there might be times when you shake your head and chuckle. At other times, you’ll probably feel horrified.

I suspect these stories will spark memories for some of you, too. If so, I welcome you to share your stories with my readers. Simply leave a note in the comment section.

Uniforms

Nursing staff wore all-white uniforms and white oxford shoes. If a female nurse chose to wear a dress, she also wore white pantyhose.

And then there was the infamous nurse’s cap. These went out of fashion when people realized how infrequently nurses washed their caps. Part of the problem was the fact that it was difficult to get a cap back into its proper shape after washing it.

Besides, you didn’t want to go out and buy just any new nurse’s cap at a uniform shop. That’s because nurses took great pride in wearing the unique cap bestowed upon them by the nursing school they attended.

While employees in many nursing homes today wear scrubs, a lot of facilities allow staff to wear street clothes. This provides a more home-like environment for their residents.

Smoking

A large percentage of nursing home employees smoked back in those days. At the facilities where I worked, they had to smoke in the staff lounge. Most nursing homes only had one break room, so it always exposed nonsmokers to second-hand smoke. I’ve also heard of healthcare facilities where employees smoked at the nurses’ desk.

Residents also smoked in nursing homes. In fact, at one facility where I worked, they even smoked in their beds if they wished.

We had large aprons (similar to what you wear when getting an x-ray at the dentist) that we draped over the resident while they smoked. This way, if any ashes fell, they wouldn’t set the bed linens on fire.

Over the years, we’ve realized the dangers of smoking and especially the risks of exposure to second-hand smoke. We developed laws and policies to protect nursing home residents and employees. In fact, in the community where I now live, the law forbids anyone to smoke in or around public buildings.

Documentation

There was no such thing as a care plan back when I started working as a CNA. All we had was something called a Kardex. This was a big binder containing a single paper card for each resident.

The card included general information like their diagnosis, medications, and very basic notes about the care they needed. Nurses wrote everything in pencil so it could be erased and rewritten as needed.

Computers didn’t exist at the nursing home. Each resident had a chart consisting of a thick binder kept on a rack behind the nurses’ desk.

For some unknown reason, I remember nurses didn’t allow CNAs to look at residents’ charts. However, as I think about it, the often unattended nurse’s desk allowed absolutely anyone to peek inside a chart.

All nursing notes were handwritten in the resident’s chart. We charted in blue or black ink for the day shift, green for the evening shift, and red for the night shift. I also remember using a rubber stamp that said, “Resident appears to be sleeping.” to save time when charting during the night shift.

Today, each resident has a detailed, individualized plan of care. The vast majority of medical records are computerized, and we carefully protect health information under HIPAA regulations.

Medications

Pills came in individual bottles similar to those you receive at a pharmacy. Nurses set up each resident’s pills in tiny paper cups before each med pass.

After placing the cups on a tray, the nurse carried them into each of the residents’ rooms as she (nearly all nurses were women) passed meds. Handwritten paper med cards told the nurse which resident received each medication.

These days, a variety of high-tech medication systems assure that medication administration is efficient and accurate. Equally important, medications are monitored and reassessed frequently. This ensures that residents only receive medications that are truly necessary, and adverse side effects are minimized.

Restraints

I hesitated to include this topic because it sounds so archaic by today’s standards. However, I think it’s important to know that this was the reality back in those days. We believed we were doing the right thing to keep our residents safe.

At one nursing home where I worked, a full 50% of our residents wore restraints when they went to bed at night. If we were concerned about a resident in a wheelchair wandering to where they might not be safe, we simply tied their wheelchair to the handrail in the hallway by using a bedsheet.

Thankfully, nursing homes rarely use physical restraints nowadays. In fact, research found that some restraints (such as side rails) place residents at even greater risk of harm.

Chemical restraints were common in those days, too. Residents with any behavioral issues often received older antipsychotic medications like Mellaril or Thorazine. Sadly, these frequently resulted in nasty side effects, such as involuntary movements that didn’t go away even after discontinuing the medications.

Fortunately, there’s been a real push over the past few years to reduce the use of antipsychotics and other psychotropic medications in nursing homes. We’re finding that many other approaches work much better without the risk of those terrible side effects.

Skin Care

I still have vivid pictures in my mind of some horrific pressure ulcers I saw in nursing homes. The only devices I remember being available to prevent pressure sores were egg crate mattress toppers and heel/elbow booties. Sometimes, we later learned that these devices made the problem worse instead of better.

To protect the skin on areas especially susceptible to pressure sores, we applied a thick ointment called Bag Balm. According to the label on the tin, this product was meant for use on cows’ udders to protect them from irritation. (I’m told that a form of this product has since become available as a skin moisturizer for humans.)

Today, pressure ulcers are almost entirely preventable in nursing homes. We have access to lots of different products and devices that protect residents’ skin.

Medical Equipment

Equipment to help transfer residents was nearly non-existent. This created back-breaking work for the CNAs. I remember we had one Hoyer lift we could use if a resident was completely dependent in their mobility.

Otherwise, we had to transfer residents with the help of two or sometimes three people. With a very large resident, we hoped to find a male nursing assistant (called “orderlies” in those days) on duty who could help with transfers.

We didn’t have high-tech automatic machines to check vital signs at the nursing home. In fact, we used glass thermometers to check residents’ temperatures. The oral thermometers had a blue dot at the end, and the rectal thermometers had a red dot. After use, thermometers were soaked in a disinfectant solution and then redistributed.

There was no such thing as individual glucose monitors for diabetics in the nursing home. Instead, we used something called Clinitest tablets. This involved collecting a urine sample from the resident and placing it in a test tube.

We then added a Clinitest tablet and watched for the urine to change color. A color chart estimated how much glucose the urine contained. While this seemed to be the best technique available at the time, obviously it was a far cry from the vastly more accurate equipment available for diabetic monitoring today.

Incontinence Products

We didn’t have disposable incontinence products (such as Depends) available in nursing homes back then. During the day, residents wore cloth “diapers” covered by rubber pants. At night, they slept on what was essentially a plastic drawsheet covered with an absorbent padding of cloth fabric. If a resident was incontinent of BM, we had to rinse out the cloth in a hopper before sending it to the laundry for washing.

One nursing home where I worked had a policy that residents’ family members had to pick up all of their personal laundry and wash it themselves. The facility only laundered towels and bed linens. So if a resident soiled their clothing, we had to rinse it out by hand and hang it on racks to dry until the family could pick it up.

Today, a wide variety of high-quality disposable incontinence products are available. But even more important, we don’t accept incontinence as a normal part of aging. Instead, we look for the cause of the incontinence and try to find ways to reduce or reverse it.

Training

In this article, I sometimes refer to nursing assistants as CNAs. In reality, however, nursing assistants didn’t need to be certified back in the 1970s.

I started working as a nursing assistant at age 16. There was no formal orientation back then. I simply followed an older CNA around for a few days, and then I was on my own.

Today, the federal government requires a minimum of 75 hours of training for a CNA to work in a Medicare & Medicaid funded facility. This includes both classroom and clinical instruction.

Passing a competency exam is also necessary to become certified. Additionally, keeping one’s certification requires ongoing continuing education.

Meals

Residents who had a lot of difficulty with swallowing often received a pureed diet. I remember this meant blobs of bland-colored food plopped onto a plate. There seemed to be no attempt at making the pureed food look attractive or enticing.

Worse yet, it was common to feed residents liquified pureed food by using a large syringe. Now I cringe to think of how many residents might have aspirated (inhaled food into their lungs) due to this technique.

Nowadays, the dietary staff uses lots of different tools and techniques to make meals as appealing as possible, even when the food needs to be pureed. This includes the use of garnishes, molds, and seasonings. Also, professional dieticians and speech pathologists routinely assess residents to ensure they receive the least restrictive diet possible.

Infection Control

Because of the expense of disposable gloves, staff rarely used them at the nursing home. We had to reserve them for times when we might come in contact with stool or vomit. We also didn’t have hand sanitizer, so everyone washed their hands frequently with antibacterial soap and water.

There was a time when nurses routinely recapped needles after giving injections. When word came out about the dangers of recapping, nurses came up with a unique alternative. They cut a styrofoam ball in half and glued it onto a small tray.

Nurses carried these trays as they gave their morning insulin injections and stuck each used syringe into the styrofoam ball. When their injections were finished, they brought the tray back to the medication room and dropped each syringe into the Sharps container. It’s scary to think about what might have turned up if anybody ever cultured one of those styrofoam balls!

Unfortunately, improper and excessive antibiotic usage over the years resulted in much nastier organisms than the ones we dealt with a few decades ago. That being said, today we know a lot more about preventative measures and treatments to help keep infections under control.

Environment

In those days, many nursing homes resembled hospitals. Nearly all residents shared a room with at least one other person. Four or more residents often shared a toilet, and everyone used the same shower down the hall.

Of course, pets rarely visited the nursing home. We considered them too dirty to be around the residents.

Over the years, nursing homes have become increasingly more home-like. Many now offer attractive private rooms, and residents have their own bathroom and shower.

New concepts continue to spring up, such as Greenhouses and Dementia Villages, that provide real homes for people in need of long-term care. And, of course, we now see pets visiting and living in nursing homes, and everyone knows how much they add to our residents’ quality of life.

 

Now that you’ve finished reading this post, I hope you’ll take a long look at today’s nursing homes. Think about what we do today that will seem silly or terrible when we look back at nursing homes sometime in the future.

What do we still need to change? I would love to see your thoughts in the comment section.