What a Day in a Nursing Home Really Looks Like
What does a normal day really look like inside a nursing home? From meals to medications to staffing gaps, daily routines reveal a lot about quality of care. Small failures can add up to serious harm. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Irene Nobles to walk through a typical day for nursing home residents and what families should watch for.
Nobles:
We try to keep it consistent and make it a peaceful environment. But the goal is really to balance a combination of structure and consistency with also some flexibility to allow for the resident to have their individual preferences and needs respected.
Intro
Schenk:
Yeah, there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. I see that there’s, what is it in the background? Just a roll of paper towels. Okay. I usually clean my office up, but apparently I missed that one. Anyway, we have an excellent episode for you today.
We’re gonna be talking about what it’s like to live an average day. A nursing home. What time are we getting up? What time are we eating? Where are we eating? All that, but we’re not having that conversation alone. We have the fantastic Irene Nobles on to walk us through the day in the life of an average nursing home resident.
As I mentioned, we’re going through the day in the life of a nursing home resident, not doing that alone with a fantastic Irene Nobles. Irene Nobles, MSN, RN, HCRM is a seasoned nurse executive with over 35 years in healthcare specializing in clinical risk. Regulatory compliance and rehab nursing. Her diverse background spans, behavioral health, addiction medicine, pediatrics, hospice and trauma care, a licensed healthcare risk manager and former chief nursing officer.
Irene now consults and testifies as a legal expert in medical malpractice and personal injury cases across the country, and we’re so happy to have her on the show. Irene, welcome to the program.
Nobles:
Thank you, Rob. I’m happy to be here. It’s an honor.
What does a typical day look like for nursing home residents?
Schenk:
Great. Oh and honor’s a lot. But I appreciate that.
I think that we had an episode similar to this almost 10 years ago, but I wanted to but that was my former law partner that was given the explanation who was A-C-N-A-A a long time ago in nursing homes. But I wanted to have another kind of an updated episode about what life is like.
In a nursing home for the resident in terms of routines and such. So I’m glad that you’re on to walk us through it. So kinda the first question is just broadly what does a typical day look like if you’re a nursing home resident?
Nobles:
A typical day can vary, but usually starts, between six 30 to about eight o’clock in the morning.
Caregivers are usually assisting residents with getting up, getting out of bed, personal hygiene, dressing their activities of daily living and such. This is also the time where nurses are typically. To prepare and administer their morning medications. Breakfast usually follows thereafter, which is served in a main dining room area.
And that’s usually to encourage social interaction with the residents. Some residents that require assistance from staff because perhaps they have some dexterity issues, swallowing difficulties, or cognitive impairments, they may be assigned to what we call restorative dining, and usually they’re grouped together at a designated table within the main dining room.
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Where then a staff is assigned to provide the level of assistance that they need so that they can also participate and engage in a social dining experience. And residents can also choose to have their meals served in their rooms if they desire and that’s according to their preference, and they have that right.
So following breakfast, then typically residents engage in a mix of, social or recreational activities, and that again, is also depending on their preferences and abilities. Some may choose to have personal downtime during this time, but this is also a time where residents are getting into therapies, right?
They’re having physical therapy, occupational or speech therapy sessions. And sometimes they might have a visit from the medical provider, like their physician or an outside provider may come in and see them. Then lunch is served, typically midday and then that’s followed by a plethora of varied activities or visiting time and such.
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This is also a time where if it’s a holiday or a special occasion, perhaps there might be a social event planned during the afternoon like that. And therapy will continue into the end of day. Usually between four and four 30 therapy sessions begin to taper off and then dinner. It happens around five.
So the evening routine is a little bit more quiet in terms of social activities and such, but it can also be a very busy time because this is the time where residents typically like to get their showers done. They’re getting ready for bed, nursing’s, also giving medications again. And it also tends to be at the time when new admissions are arriving to the facility.
So that can make it a very busy time in the evening. And we try to keep it in a consistent flow and make it a peaceful environment, but the goal is really to have to balance a combination of structure and consistency with also some flexibility to allow for the resident to have their individual preferences and needs respected.
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How are daily routines structured in nursing homes?
Schenk:
So what about. I imagine in my brain as it’s working that you have, let’s just say the certain number of residents on a particular wing, let’s just say 15 of them, and getting up, I think you mentioned approximately six 30 to eight 30. How is it typical? How is it typically handled?
If there’s a particular resident that I wanna wake up at nine o’clock. Is it just there’s a thing on the wall that says, okay, Ms. Johnson is different off the routine and we handle her differently. How does that, how do specific requests usually get handled?
Nobles:
So that’s a good question.
Routines in nursing homes are structured around the resident care needs, but we also try to promote autonomy and allow for that individuality of them to have preferences. So there is a daily rhythm of meals, medication times. Therapy, personal care. All of that kind of tries to be, we try to have that happen consistently to create stability and so that residents know what to expect.
But that being said, we do want to encourage our residents to make independent choices about their schedule whenever possible. And so they do get to decide what time they wanna wake up. Which activities they wanna join. Even what times of day or days they wanna have their showers.
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And they even get to pick what they want to eat. So even though there’s a particular meal being served and that there might be something they don’t like, they get to make those individual choices. Staff are really trained to look for ways to promote the residents independence and preferences and structure the daily routine around that.
And not focus so much on getting tasks done, but integrating their tasks into a routine that meets the residents rights and dignity and preferences.
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What kind of activities do residents usually enjoy each day?
Schenk:
What kind of activities are we talking about? Like the social activities that you mentioned, like between the meals, is this, how stereo, the stereotypical bingo game. Walk us through what you do with the group of individuals in this time?
Nobles:
Activities can vary widely, and that just depends on facility to facility, but the focus is always going to be on engagement, right? Enjoyment and maintaining physical and cognitive abilities of the resident population.
And so facilities typically have an activities director who performs ongoing activity evaluations, and that’s really intended to determine the resident’s individuality. Preferences are for leisure and activities, so that they can then tailor the offerings, around the needs and the range of interests that occur within their resident population and that really is important to help promote engagement, right?
We don’t wanna just do the standard bingo if no one likes to play bingo. So ascertaining what the population really has an interest in is important. So some examples would. Be like exercise classes, for example, sometimes music therapy art projects, trivia games, spiritual services. They’ll have chaplains come in and sometimes host things right there on the unit.
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And then they do group activities. Like bingo. Bingo is common, but that it’s not limited to that. I see a lot of movie nights. Birthday celebrations are common. So facilities will often bring in entertainers also from the outside, and people will, play instruments and things like that.
Therapy animals are also very popular and themed events and such. There are some residents that prefer quiet time and more independent activities, and so we have to keep that in mind as well. And we’ll offer things like gardening. They’ll have a, maybe an indoor herb gardening or an area outdoors reading, knitting, video chatting, things like that.
I’ve seen as a, as. Opportunities for residents who like to be independent with their activity. So really the primary purpose is just to try to promote and enhance quality of life for the resident population.
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How are meals and nutrition handled in a nursing home setting?
Schenk:
With respect to the meal times. I think that I understand that you just say that if a resident elects to eat by themselves, they can do that.
But if not I’m assuming there’s a cafeteria typically with tables or does, and then once is kinda walk me through literally like what do we see, smell and hear during that period? Is it one person at a time as they’re taken outta their rooms? And go to the cafeteria and then, then once everybody’s there, but it gets a plate, walk us through typically how that’s handled.
Nobles:
Yes. So there are residents that can get themselves to the dining room independently, and they’ll do so when it’s time for the meals. And then others that maybe need some assistance with staff support either ambulating or wheelchairs. Then they are taken down to the dining room, one at a time till pretty much everyone’s there and then the meals are served.
Tray style, usually the cafeteria person is setting up trays. We usually try to hand out the special diets for those that maybe have some special health related diets or texture, alternate textured meals because they have swallowing difficulties. We tend to serve those first to that restorative dining table that I talked about earlier.
Families often ask what daily life looks like, which is explained in our guide to what a typical day is like for a nursing home resident.
And then from there trays are individually handed out and everyone kind of sits at a family style. Type of a dining experience. As far as the nutrition goes the dietician and every facility has a dietician and there have to be heavily involved in, they’re required to plan, balanced, appealing meals that meet the dietary needs of the residents.
That is CMS requirements. So there’s a menu generally that’s planned and prior to residents going down for, to the dining room for the day, they get menu served to them in their rooms where they get to then select what’s being served that day, select the items they want. Then when they go to the dining room the person gets, has their menu and knows what they want, and they’re served according to their preferences.
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What role do caregivers play in a resident’s daily routine?
Schenk:
So what kind of, what role does the caregiver play in the daily routine? I guess it would just depends from resident to resident, how independent or how much assistance they need.
Nobles:
Caregivers, to be honest with you, they’re really the heart of the resident’s day-to-day life.
They assist, of course, with all the essential tasks like we talked about, the a DL activities of daily living, bathing, dressing, grooming, those sorts of things. But, their role really goes. Far beyond that, they’re also companions a lot of times to the residents. They provide emotional support.
They’re often advocates for their residents because they spend so much time with the resident on a day-to-day basis just in through providing care. They tend to build trust and familiarity with their residents which is very beneficial in terms of recognizing subtle changes in health, for example, or mood.
And they often recognize it before anyone else does. And so they pray. They play a very integral role in the residents day to day. And really they aim to ensure. Safety and dignity, and they become like family. So we try to keep consistent caregivers with consistent residents for that reason.
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How is medical care integrated into daily nursing home life?
Schenk:
You, you mentioned a minute ago about how, sporadically there’s the attending physician will be there, or perhaps therapy is there every day from a certain amount of hours. Is this something that’s occurring in the resident’s room? Is there typically a therapy room or the, or a physician’s room for the attending physician to go to?
Kind of logistically, how does that work?
Nobles:
There is usually a therapy gym, a main therapy gym where residents will go down and participate in individual therapy sessions. They also can participate in group therapy sessions while they’re in the main gym, if the therapist feels that’s appropriate for them.
And then there are some residents that receive therapy in their rooms for whatever reason. Maybe they don’t feel like getting outta bed that day or they’re unable to get out of bed.
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Schenk:
So tell me about typically if someone is like on dialysis or someone has to go to an optometrist appointment, typically, how does that work?
Nobles:
So most of the time providers will come to the facility to see the residents. They can, it can be a plethora of physicians, nurse practitioners, other specialists and that includes dental or podiatry typically. And then there are times where residents do go and leave the facility to an outside provider.
And that could be a specialist, like an optometrist we mentioned, or dialysis, for example. And that’s just scheduled according to the resident’s need. And they’re taken there either by family, sometimes staff will assist or they have, a transport service. That’s common in facilities for residents.
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How do nursing homes support residents’ mental and social well-being each day?
Schenk:
I think that you mentioned the kind of the. The reassuring nature of having the same kind of group of caregivers every day, or on a particular shift and group activities. What are some of the other things within that daily routine that kind of supports the social wellbeing or the mental wellbeing of the residents?
Nobles:
We certainly had to up the ante on that when we got hit with the COVID pandemic. And everyone was on lockdown and we saw a lot of instances of social isolation, depression, and things like that, particularly with the cognitively impaired residents. And I think the nursing home industry really learns how to make the mental health and emotional wellbeing of the residents a priority.
And so it’s beyond just the physical health, we really learn how to incorporate. The other piece of that we do really try to encourage residents to connect with their peers in the facility and participate in the group activities, maintaining relationships. Family is very important.
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If a resident doesn’t have a local family that can visit, we try to assist them to get on maybe virtual calls, FaceTime, things like that. We have a social services director who usually focuses on that. She’ll make visits to the rooms and visit the residents to make sure that they aren’t having.
Symptoms of depression and loneliness and isolation. Many nursing homes offer behavioral counseling, and I mentioned earlier, religious services are helpful. Pet therapy is also something that’s popular. Residents really seem to respond to therapy, animals coming and visiting. And then there’s a lot of volunteer led programs that facilities will offer.
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Usually staff are trained to recognize signs of loneliness and depression, and this is then allows them to create opportunities where they can engage with the resident. Which we know is so important, for emotional health, but they do also spend a lot of one-on-one time with the residents, especially those who aren’t able to part, to participate in group activities or don’t want to.
And so we try to keep a pulse on that, and making sure we’re being cognizant of who, who’s been missing an action and who’s really active in the community of the facility. Those that have memory loss are of course going to be a priority and a lot of facilities have special programs to help maintain the cognitive engagement and emotional comfort that, is always gonna be the goal for those resident populations.
And we want them to feel valued and connected to community as well. Really the staff try to engage in special programs for that population.
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Schenk:
Very well said. And that’s the goal, right? Irene, we very much appreciate you coming on the show and sharing your knowledge with us.
Nobles:
Sure. My pleasure. I appreciate your informative podcasts and and I do enjoy watching, so thanks for having me.
Schenk:
Hey, out there folks, I hope that you found this episode educational. If you have an idea, I’m just gonna kick back. I don’t know why I just did that on camera. Something. What a drop. Is that a button on my jacket?
A button on my jacket just popped off. That’s correct. You, it’s exactly what you’re thinking. I am putting on a little bit of weight, so I need to get to the gym. Anyway, if you have an idea for someone you would like for me to talk to, please let me know. If you have an idea for a topic that you’d like for me to talk about, let me know that as well.
Be sure to enter the Nursing Home abuse podcast mug by telling us what your favorite romantic comedy is as you answer the question of the week. And with that folks. We’ll see you next time.
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Irene Nobles’ Contact Information: