Daily care standards for the elderly

The core principles of the "Daily Care Standards for the Elderly" are by no means a unified operation checklist. Instead, they take the individual needs of the elderly as the core, take into account the three dimensions of physiological safety, psychological comfort, and social function retention, dynamically adjust the care plan, and avoid the two extremes of over-care and under-care.

I have worked as a nursing supervisor in a community nursing home for 7 years. I have seen too many family members and even novice caregivers use the "standard comparison table" found online. In the end, they either protect the elderly so much that they can't even hold chopsticks, or they fall and fracture the femoral neck in order to "train the elderly's self-care ability". , last month, two family members came to our site to discuss their explanations, and they just became two extreme examples: Aunt Zhang suffered a cerebral infarction, and her left limbs were not strong enough. Her daughter hired a caregiver to do everything for her, including feeding, dressing, and carrying the bedpan. After three months, Aunt Zhang's arms that could be lifted to her chest were finding it difficult to even lift them to her shoulders.； Another uncle, Mr. Li, has the same type of hemiplegia. His son believes in "completely independent exercise" and lets him do everything by himself. Last week, when he got up without help, his foot slipped and he fell straight into the hospital.

Let’s first talk about the physiological care that people are most likely to go to extremes. The most common misunderstanding is that “all elderly people must eat soft food and drink lukewarm water.” This is really not the case. Elderly people with type 2 diabetes should drink less boiled white porridge, which raises blood sugar faster than milk tea. It is safer to eat it with dry rice. ； Only elderly people with Kubota drinking water test ratings of level 3 or above and dysphagia need to make food into a thick paste to avoid choking, coughing and aspiration. Oh, by the way, there have been two schools of debate in this industry: the safety-oriented group believes that it is safest for elderly people whose swallowing ratings do not meet the standard to directly insert nasal feeding, with almost zero risk of choking. ； Functional preservationists believe that as long as the risk is controllable, eating pureed food by mouth as much as possible can delay the deterioration of swallowing function. Our current operation is to clearly explain both options to the family members, and choose based on the elderly's own wishes. Last week, an 80-year-old grandmother had her nasal feeding removed for half a year. Now she can eat less than half a bowl of pumpkin porridge every day, and she says to everyone she meets, "I can finally taste the fragrance of rice."

What is more controversial than eating is how much daily activities should help. I have seen many novice caregivers memorize the rules by heart, "To prevent falls, you need to be accompanied 24 hours a day." However, when the elderly want to bask in the sun in the yard, the caregiver directly pushes the wheelchair over and does not even let them stand. In fact, the judgment criteria in this area are very simple. First, do the Berg Balance Scale assessment: if the score is lower than 4 points, you really need more assistance. You need support when walking and a hand when dressing. ； If the score is above 4 points, encourage him to do it by himself even if it is slower. For example, even if it takes 10 minutes to put on socks, it is better than you helping him put them on in 30 seconds - there was an 82-year-old grandfather at the station before, and the nursing staff always helped him get dressed every day. He remained sullen and silent, and then we tried to let him button his shirt by himself. It took 15 minutes for the first time. After buttoning, he raised his arms and showed off to the old man next to him for half an hour, "Look, I can still use my hands." His energy was better than taking tonics. Of course, you also need to make flexible adjustments. For example, if an old man has a cold and feels dizzy today, don't force him to walk by himself. If he falls, he will lose more than he loses.

What many people don’t know is that half of the care is actually invisible. Many people think that "just take care of food, drink and not fall" and do not pay attention to the emotional needs of the elderly at all. Last month, there was a grandma Liu in our station. She had no health problems, but she always secretly hid in her room and cried. After we talked, we found out that she was a retired elementary school teacher. Her children always said, "Don't do anything and enjoy your happiness." She felt that she had become a useless burden. We later found a job for her, telling old stories for 10 minutes every afternoon to the children in the Yizhan summer nursery. She now goes out of her way to comb her hair and change into a clean shirt every morning, and she is in great spirits. There are currently two different nursing ideas in this industry: one advocates treating the elderly as "cared for", minimizing their responsibilities and avoiding stress. ； The other group is the "social role retention group" who believe that as long as the elderly are willing, try to let them take on small responsibilities within their capabilities, even if it is helping to pick vegetables or giving newspapers to other elderly people, it can enhance their sense of self-worth. In fact, both are correct, it all depends on the personality of the old man: some old people just like to sit in the sun and listen to the opera every day, and they will find it annoying if you insist on giving them work. ； Some elderly people have been hardworking all their lives and feel uncomfortable when they are idle, so it is appropriate to find something for them to do.

After working in this business for a long time, I always say that norms are dead but people are alive. You have gone through all the evaluation scales, and in the end you have to squat down and ask the elderly person, "Would you like to dress yourself today or should I help you?" "Would you like softer rice or multi-grain rice for lunch?" After all, the purpose of our nursing is never to "make no mistakes", but to make the elderly live comfortably and with dignity, right? If you really have to follow the form one by one, it is no different from taking care of a puppet with no ideas.