Family outreach = image upgrade.

Paying special attention to families' needs is good for them and for your reputation

Each time you admit a resident to your facility, you are (in a manner of speaking) admitting that resident's family as well. Those family members can be your most ardent supporters -- or your most cutting critics. From a legal standpoint, your direct responsibility is to those parties with legal guardianship of your residents, but the well-being of your residents' relatives is more than a legal consideration. Chronic illness and disability is a family affair. Resident care with a family-centered focus will go a long way toward establishing your facility as one that values the importance of maintaining family integrity, even in the face of a nursing home placement.

The nursing home should be a place where relatives feel comfortable -- and indeed, comforted -- coming to visit their loved one. The reality, however, is often quite different. Visiting a family member in a nursing home can be emotionally and physically draining, no matter how wonderful the facility. Family members deal with a range of complex issues, from guilt to frustration to helplessness and feelings of loss and grief. Even the long-time family caregiver who feels a great sense of relief upon a loved one's admission invariably feels guilty about experiencing that relief. Researchers at Duke University describe a period of transition after a family caregiver admits a loved one to a nursing facility. They found that it requires a number of readjustments to be made before the benefits of the nursing home placement can be realized.

Easing the Transition

Family members -- especially those who are new to the nursing home -- usually benefit from informal counseling to help ease them into the nursing home routine. This is almost always the responsibility of the social worker, but the entire professional staff should be sensitized to these needs.

In addition, nursing homes can reach out to family members by providing any or all of the following services intended to make the nursing home experience more palatable, and hopefully, positive. Implementing these suggestions will also send a clear message that you recognize and care about the needs of your residents' families and are committed to "going the extra mile" to see that they are met.

* Assess needs. The first step is to determine what those needs are. One of the best ways to do this is with questionnaires distributed to responsible family members at admission and periodically throughout the resident's stay. Family members should be asked about their areas of greatest need, as well as their expectations for assistance from the nursing home.

* Establish a "buddy system." Hooking up newcomers with "veteran" family members creates mutually beneficial one-on-one relationships. The opportunity to help someone else provides the more experienced family member with a sense of satisfaction and, often, a welcome diversion from their own family situation. The newcomer gains an invaluable source of information, resources and support from someone with a first-hand understanding of what they are going through.

The social worker or director of admissions can initiate this type of service by finding out who is willing to participate and by pairing family members as part of the admissions process. This type of program is usually most effective when family members in similar situations (spouse, adult child, etc.) are paired.

* Start a support group. Support groups can be extremely beneficial for family members who need to express their feelings and have those feelings validated by others in similar situations. This need is especially evident in the first few weeks after admission.

There are several schools of thought about how best to organize support groups, such as disease-specific groups, based on the differing needs of those with family members with Alzheimer's disease versus stroke, etc; or relationship-specific groups, which focus on the common experiences of spouses, siblings, or adult children. Logistically, however you organize your group will probably have to do mostly with the mix of residents and family members in your specific nursing home. Once the group members get beyond those topical issues, the caregiving experience and the feelings of guilt and sense of loss that often accompany a nursing home admission become a strong shared experience.

A weekly support group is an effective vehicle for easing the adjustment of family members of new residents. Groups held less frequently can serve as an ongoing means of support for all interested family members. In all cases, the group should be facilitated by a staff member who has the training to be objective and to recognize when to refer family members for additional assistance, should the need arise.

* Establish a caregiver resource center. A mini-library with books, articles and newsletters geared toward the family caregiver can be set up in an empty office or simply the comer of a lounge or entrance area. The AARP, National Family Caregivers Association and other groups are excellent sources of information on everything from services available to emotional support. These materials can also serve as the basis for support group discussions.

* Invite families to social events. Casual get-togethers such as barbecues or holiday gatherings provide an informal way for your residents' relatives to meet with other family members and relax in a social situation. These gatherings not only keep family members involved in the facility, but also provide a less structured alternative to formal support groups. Relatives can develop their own informal support system and find a friend they can relate to one-on-one.

* Suggest a family council. A family council, mn by and for family members, represents the interests of residents' families by handling grievances and suggestions, organizing activities and fundraising events, and providing family members with a comfortable avenue to communicate with administration. While the interest in forming a family council can be assessed by the social worker or other staff member, the council itself should be run by family members.

* Encourage involvement with other residents/activities. Regular or even occasional visits with an unresponsive family member or one who no longer recognizes loved ones are extremely draining emotionally. Spending time with other residents who don't have regular visitors or helping to plan and/or mn activities can help to fill that void. The activities director can help to match visitors with residents.

* Designate family-staff liasons. Asking RNs and LPNs to "oversee" the day-to-day status of a small number of residents provides families with a single source of information about their loved one and helps to cut through the communication red tape. Relatives take great comfort in the knowledge that they can go to one person who is familiar with their family's situation to answer their questions and deal with their concerns.

* Involve families in care planning. Inviting responsible family members to care planning meetings helps to curb frustration and helplessness by giving relatives the opportunity to take a more active role in their loved one's care. It also provides staff with the type of insight that only close relatives of residents can provide.

* Make visiting easier. Logistical concerns, such as transportation to and from the nursing home, can sometimes be the greatest sources of stress to family members, especially those with limited mobility. Any assistance provided -- from bus schedules to a shuttle to and from public transportation -- can seem like a Godsend to your residents' families.

Nursing homes can make great strides toward improving both service and image by focusing on family caregiver wants and needs. The suggestions outlined above are easily implemented at little or no cost. The returns in family good will can be immeasurable.

Suzanne Geffen Mintz is a family caregiver and President and Co-Founder of the National Family Caregivers Association (NFCA), based in Kensington, MD. NFCA provides a range of support and educational services aimed at improving the overall quality of life of America's family caregivers. For more information, contact NFCA at 9621 East Bexhill Drive, Kensington, MD 20895-3104; phone [phone].