A Brief Look at Life in a Nursing Home

August 24, 2009
 
By KATIE ZEZIMA - New York Times
MAMARONECK, N.Y. ”” For 10 days in June, Kristen Murphy chose to live somewhere she and many others fear: a nursing home.

Ms. Murphy, who is in perfect health, had to learn the best way to navigate a wheelchair around her small room, endure the humiliation that comes with being helped in the bathroom, try to sleep through night checks and become attuned to the emotions of her fellow residents.

And Ms. Murphy, 38, had to explain to friends, family and fellow patients why she was there.

Ms. Murphy, a medical student at the University of New England in Biddeford, Me., who is interested in geriatric medicine, came to New York for a novel program that allowed her to experience life as a nursing home patient.

Students are given a “diagnosis” of an ailment and expected to live as someone with the condition does. They keep a daily journal chronicling their experiences and, in most cases, debunking their preconceived notions.

The program started in 2005 after a student approached Dr. Marilyn Gugliucci, the director of geriatrics education at the medical school. “ ‘Dr. G,’ ” she recalled the student saying, “ ‘I would like to learn how to speak with institutionalized elders.’ What came out of my mouth was, ‘Will you live in a nursing home for two weeks?’ ”

To Dr. Gugliucci’s surprise, she found nursing homes in the region that were willing to participate and students who were willing to volunteer. No money is exchanged between the school and nursing homes, and the homes agree to treat students like regular patients.

“My motivation is really to have somebody from the inside tell us what it’s like to be a resident,” said Rita Morgan, administrator of the Sarah Neuman Center for Healthcare and Rehabilitation here, one of the four campuses of Jewish Home Lifecare.

“But she is really there to study herself, her own feelings about living in a nursing home,” Ms. Morgan added, referring to Ms. Murphy.

Geriatric specialists hope the program and others like it help generate interest in the profession, one of the most underrepresented fields in medicine. Medical schools and residencies require little to no geriatric training, and many students are reluctant to get into the field because it is among the lowest paid in medicine.

In 2005, there was one geriatrician for every 5,000 people over 65, according to the American Geriatrics Society; by 2030 that ratio is expected to increase to one for every 8,000 patients. Geriatricians must participate in a two-year fellowship program after medical school to become certified. In 2007, only 253 of 400 fellowship slots were filled, and only 91 of the physicians graduated from medical school in the United States.

“It’s kind of a crisis,” said Dr. Cheryl Phillips, president of the society. “I don’t think many seniors recognize this.”

Like many medical students, Ms. Murphy was scared of nursing homes. The feeling began when, as a young adult, she visited her grandmother, who had Alzheimer’s disease.

“I think nursing homes are scary,” she said, “but I don’t think you can be a good doctor if you’re scared of the place where a lot of your patients live.”

The first few days, which included filling out paperwork, undergoing a full-body mole and sore check, eating pureed foods and being raised out of bed with a lift, did nothing to validate her decision. When she wedged her wheelchair into a corner and could not get out, she cried in frustration.

“All I wanted to do was shut my door and stay in here,” said Ms. Murphy, whose “diagnosis” was a mild stroke that affected her right side, difficulty swallowing and chronic lung disease. “But I understood I had to go out.”

Not everyone does. Some patients want to talk for hours, while others act out, like a woman who pinched Ms. Murphy as hard as she could. Many sit in the hallway by the nurse’s station each day because it is a hub of activity. Emotions run high.

Ms. Murphy said she soon learned that many patients cried because they knew that they would most likely never live anywhere else, or because they missed family and their old life.

“At times I felt really lonely and got depressed,” she said. “Sometimes it was an emotional roller coaster, up and down, up and down.”

No one said a word the first time Ms. Murphy showed up at the daily bingo game. She started to talk to anyone who would listen. And she was surprised what happened.

First she bonded with Camille Stanley, the “queen bee” of the social scene. Then she found Dr. Thomas N. Silverberg, 89, a former internist and arthritis specialist with advanced rheumatoid arthritis. “My specialty is slowly killing me,” Dr. Silverberg said.

The two talked for hours about life and medicine. Unlike the friendships she makes as an adult, slowly nurtured over dinners and drinks, bonds in a nursing home, where there is nothing to do but talk, are forged quickly and deeply.

“When I came in, I was worried about working with older folks because I was afraid I wouldn’t be good at it,” Ms. Murphy said. “Now, if anything, I’m worried I’ll love them too much and it will really hurt to work with folks at the end of their lives.”

Most residents knew why she was there. During her going-away party they presented her with a big card, and shouts of “We love Kristen” were heard throughout.

The program has solidified Ms. Murphy’s desire to work with older people. And the hardest lesson she learned ”” that for some people, it is better to be in a wheelchair or to have limited mobility ”” will make her become a better doctor, she said.

“As a doctor, my job is to help patients live the life they want to,” she said. “And if they’re in pain, you have to say ‘That’s O.K. if you want to spend your time in a wheelchair.’

“For me that’s such a different place to be. Because I hate this chair. It still startles me that that’s the choice.”

Ms. Murphy said the care she received at the home was outstanding. But there were things that could use improvement: she did not realize she could ask for things like soda, and she felt that shower bars were too high for someone in a wheelchair. She also told the staff at a debriefing session that families should be included in more activities.

Dr. Phillips of the American Geriatrics Society, which is not involved with this program, said the challenge was to see “how this replicates everywhere else and how enthusiastic medical students are to take this on.”

Another of the 10 students who have gone through the program, William Vogt, spent 10 days last summer in a nursing home at the Veterans Affairs hospital in Augusta, Me. Mr. Vogt, who spent a day wheeling around with petroleum jelly smeared on his glasses and cotton stuck in his ears, said he was particularly struck by the fact that many patients considered the nursing home to be home and the staff “a second family.”

Mr. Vogt said the little things counted, like lowering nameplates so patients could locate their rooms and not putting a remote on top of a television, out of reach.

“There’s a little part of it that works its way into everything I do, from patient interaction and awareness of how I come across to what I say,” said Mr. Vogt, a medical student doing clinical work at a hospital in Watertown, N.Y. “There’s this shift of the humanity of it.”