While some nurses feel pulled into treating children, others love to care for those in their later years by working in the geriatric field.
If you’ve ever wondered what these nurses do, why they like it, or if it’s the facet of the field that fits you, we’ve got you covered.
We interviewed Nancy Mitchell, RN. She has more than 37 years of experience in geriatric nursing care, both as a senior care nurse and director of nursing care, and she took the time to answer our questions.
What follows is our interview, edited for length and clarity.
Nancy Mitchell, RN, has more than 37 years of experience in geriatric nursing care, both as a senior care nurse and director of nursing care.
How did you get interested in being a geriatric nurse? What drew you to it? How long have you been doing it?
I’ve worked in senior care for more than three decades. Geriatric care is unique in that it is less hectic than working in the emergency department or on surgical wards but can be equally demanding.
What drew me most to this discipline is the patient care aspect. It’s not strictly medical. Eldercare allows me to give back to communities in more than one way. The senior population plays a significant role in enriching any social group. Ensuring their health is my way of contributing to the holistic wellness of our communities.
What does a geriatric nurse do? What types of patients do you serve? What do you provide for them?
One of the primary roles of a geriatric nurse is to help elderly patients–those 65 and older–continue to live independently. We manage and treat underlying conditions to avoid having them progress into debilitating stages. We also educate patients and their families on ways to help support their health at an older age.
However, as a geriatric nurse, managing debilitating diseases also comes with the job. We deal with cases of Alzheimer’s disease, Multiple Sclerosis, and other neurodegenerative conditions regularly. Some of us are based in hospice care, specializing in making the transition process as pleasant as possible for terminally ill patients.
It is our responsibility to care for and protect the older population.
Did you need to get additional education for this position?
There’s no obligation to pursue additional education beyond your BSN to become a geriatric nurse. It depends on your plans for career advancement. Some nurses become geriatric nurse practitioners, specializing in diagnosing ailments and prescribing treatment for elderly patients.
What do you like most about working as a geriatric nurse?
Unlike ER work, geriatric nursing is a socially enriching profession, where you treat patients tonight and send them off within hours. Most elderly care facilities serve as extended living centers for patients temporarily or permanently. This allows you to forge meaningful, professional relationships with patients.
Seniors have lived some of the most exciting lives, and they love sharing fascinating stories and life lessons that anyone can benefit from hearing.
What are your biggest challenges as a geriatric nurse?
Geriatric wards see some of the highest mortalities. Most patients struggle with three or more underlying conditions. The profession requires a high level of emotional intelligence and fortitude.
What are your greatest rewards as one?
My greatest reward is touching patients’ lives, even in the later stages of their lives. Some of these patients live alone and are lonely, so they depend on the social interactions of nurses as encouragement throughout their treatment. I’m honored to provide a helping shoulder to them.
Is there else that is important for our readers to know?
People tend to assume that the body follows a steady trend in how it works throughout your lifetime. But, in reality, the geriatric body significantly differs from someone in their mid-30s or teens. So geriatric care is a discipline on its own.
Poring over historical pictures at the Good Samaritan Society long-term care facility in Algona, Iowa, is a person who’s been pivotal. “It opened in March of 1966 and I began employment in the summer of that year,” says Nurse of the Week Mary Hannover, LPN.
Do the math and Hannover’s service at the Society, still ongoing, adds up to an unheard of 55 years. “Half of my life. Half of my life has been living and working in a nursing home and supporting of,” Hannover says.
Administrator Joe Bartolo says 55 years in one place is “crazy” to think about. “Good Sam is in her heart,” Bartolo says. “She knows the ins and outs of everything from day one in Algona.” Retired administrator John E. Kern adds, “When people in Algona think of Good Samaritan, they immediately think of Mary.”
“We would not be here” without her
When the current long-term care facility opened in ‘66, Hannover split time as a CNA between the new building and the old home down the street.
“We had three levels of residents. The guts of the operation was still in the basement. So, the washers and that. If you walked up the stairs from the basement and did not carry a basket of laundry, you were not well thought of,” Hannover says.
It’s hard not to see similarities to how the Society got its start nearly 100 years ago in a little house in Arthur, North Dakota.
“They didn’t have any elevators or lifts at that time. They’d have to carry food from the basement all the way up to the first, second, third floor. Same with residents – if you had to get a resident to the first or second floor, you had to carry them up the steps,” Bartolo says.
Lifting others up through care is the 73-year-old’s passion. After she grew up on a farm west of Algona, her career got off to a slow start.
“I applied at three different community colleges to go into nursing. I was rejected by all of them,” Hannover says with a laugh. “So I came to town, I got a job and I kept my job.”
First as a CNA, then a licensed practical nurse and finally a fundraiser in resource development.
“If we didn’t have someone like her in our facility for the last 55 years helping get funding and things like that, and being a member of the community and church, getting people to come live here, work here, we would not be here in Algona without Mary Hannover,” Bartolo says.
Proud of Society’s development in Algona
Hannover’s personal mission is to spread the Good Samaritan message and raise funds to support its mission. “I remember going around in the community selling our point of view. ‘Why would you need that? We’ve never had that before,’” Hannover says about the responses she would hear. “I’m kind of proud about the fact that we’ve raised some wonderful buildings here. I always said it’s well worth every dollar that you’ve had to ask for.”
From independent living apartments to a rehabilitation center, she didn’t shy away from promoting the cause.
“Mary would often remind me to ‘never be afraid to apologize.’ She was always about service to others. She was very loyal and committed to the residents, their families and to the staff. She loved talking about the history of Good Samaritan and specifically Algona,” Kern says.
Looking back on all the additions to the campus, she says it’s incredible to imagine the number of lives touched by the Society.
“You talk about someone who is here for the center, here for the residents and not concerned about her time, that’s someone who lives out the mission,” Bartolo says.
“She’d do her Monday-Friday, resource development, and then she would come in on Saturdays and Sundays and feed breakfast. Every Saturday and Sunday, every holiday, she never missed any time unless she was really sick.”
‘Everybody is equal and the same’
Hannover admits her body is showing some wear and tear these days as she nears retirement. Her mind, however, is sharp and her focus the same.
“In Christ’s love, everyone is someone. You can’t help but think that the smallest resident, the largest resident, the most active resident, the inactive resident, everybody is equal and the same. If you don’t have that squared in your thought process, life becomes more complicated,” Hannover says.
“It’s a great organization. It’s served me well. I’ve enjoyed my time. Have I enjoyed every day? No. Nobody does. I’ve had some bad days and I’ve had some very, very good days. Your emphasis is always on life and where you can make life better.”
To see a video interview with Mary Hannover, click here.
Whether it’s nature or nurture, nursing is often a calling that runs in families and creates a special, additional family bond between parents and their offspring.
“I remember performing some Christmas programs and ballet recitals for the residents in the center,” says Rindels, now the Society’s vice president of nursing and clinical services.
Her mom, Nancy Van Dam, RN, spent nearly 40 years as a nurse at Luther Manor, and Rindels says “I grew up personally with Good Sam. We would eat lunch on the weekends that she worked. I volunteered in the center several times.”
Van Dam retired in 2017. If she would’ve waited a few years, her daughter would have been her boss.
“I think Good Sam is in good hands. I think she’s very innovative and wants to learn and really enjoys trying to get everybody up to the best standard of care,” Van Dam says.
“Fell in love” with nursing
Nancy Van Dam, RN tears up as she recalls singing with a patient as they passed on.
Van Dam and Rindels both started out as certified nursing assistants.
“Fell in love with it. I would find myself listening to the nurses giving reports and thought, I could do that. It was so interesting. So, then I went to nurses training. In fact, I graduated from Sioux Valley Hospital School of Nursing,” Van Dam says.
A calling to work in long-term care brought her to the skilled nursing facility in 1978. She never left.
“I love the wisdom of the elderly. The chance that you get to make relationships that last,” Van Dam says about serving in a nursing home as opposed to working in a hospital.
Raised in a Christian home, she appreciates the faith-based mission of the Society.
“It’s not about profits and it’s not about names or fame or anything like that. It’s about caring for people and trying to do God’s will for them,” Van Dam says.
Getting to know residents and their families was her favorite part. Even when times were tough, Van Dam believed she was fulfilling a calling. One of her most vivid memories is caring for a resident who was nearing the end.
“We got her settled in bed and the other staff left. I just sat there with her and held her hand. I started singing ‘Jesus Loves Me’ to her. It always makes me tear up,” Van Dam says as she wipes her eyes. “She started singing with me and she was so short of breath. But that was something she remembered and it comforted her. She died later that day but I thought, I made a difference,” Van Dam says.
“Continuing this from one generation to the next”
Always proud of her mother’s efforts, Rindels didn’t know if nursing would be in her future.
“I think in high school, I don’t know that I thought much about being a nurse,” Rindels says.
Along with a passion for learning and science, her interest in the human body and how it works drew her closer to the profession. Being around the Society her whole life also helped inspire her to pursue a career in care.
“The meaning of family and the inclusion of family at the Society,” Rindels says played a big role in her career choice.
Seeing firsthand the impact a nurse can make, she went from a CNA to a licensed practical nurse at a long-term care location. Since then, she’s advanced through progressive nursing degrees.
“It’s almost like a legacy maybe, or tradition almost, that we’re continuing this from one generation to the next and able to build on very strong history and nursing practice that I was raised in,” Rindels says.
Technology improving future care
While she’s been at the Society for four years, Rindels has been a part of Sanford Health for 13. She thinks the integrated health system will provide many new opportunities in the future.
“We’ll be able to strengthen our nursing practice through new wound technology, the telehealth piece, being able to have a provider’s eyes on a resident immediately, especially in the rural setting that we’re in,” Rindels says.
Van Dam says connecting doctors with residents from the comfort of their own home was just starting when she retired.
“Saves a whole trip out. Your person isn’t feeling good. Why do you want to put them in something and travel them somewhere?” Van Dam says.
She adds another advantage will be seamless communication between long-term care nurses and the residents’ healthcare providers.
“You’re going to have the same people talking to each other at the same time. It will be a wonderful thing,” Van Dam says.
Rindels says advancements in virtual doctor visits, “will only strengthen our service and care in the future.”
“Build on that foundation”
As the Society approaches 100 years, technology and talented clinical care teams are enhancing the level of care that can be done right at the building.
Through the Great Plains Medicare Advantage plan, Rindels says some locations in the midwest are beginning to see nurse practitioners.
“We are adding in the mid-level nurse practitioners into the buildings five days a week or at least weekly. Visiting residents, providing care, giving that additional level of complexity and support to the nurses at the locations,” Rindels says.
Constantly learning and improving care for residents. Van Dam and now Rindels believe the Society’s past is rich and the future is bright.
Rindel’s personal goals are “to build on that foundation for the next 30 years.”
A new study published in the Journal of the American Medical Association Internal Medicine (JAMA IM) found several factors – including staff assumptions about minoritized groups – may play a role in the variability in the quality of care provided to U.S. nursing home residents with advanced dementia
The study, “Nursing Home Organizational Culture and Staff Perspectives Influencing Variability in Advanced Dementia Care: The ADVANCE Study,” identified organizational factors and staff perceptions at nursing homes that may drive known variability in the type of care provided nursing home residents with advanced dementia, especially in the use of more aggressive interventions like tube-feeding or hospitalizations. These aggressive interventions are considered by many to be markers of poor quality of care, as they often do not promote clinical benefits or comfort among persons with advanced dementia.
Prior research has shown Black residents (versus white residents and those in facilities in the southeastern part of the United States) get more aggressive care, including greater use of feeding tubes and hospital transfers.
“The study identified several factors that nursing homes could target to improve delivery of goal-directed care to all residents. One is to improve provider knowledge and communication skills that less aggressive interventions may be more in line with the residents’ wishes and best evidence,” said Dr. Lopez. “For example, many nurses may believe that feeding tubes prolong the life of advanced dementia patients, but this is not borne out by existing studies. Nursing homes need to make sure their staff is aware that hand feeding is better for residents. Based on prior research, aggressive interventions can be less effective compared to less-intensive interventions, like feeding residents manually, while requiring more time of the nursing staff provides better care to their patients.”
The most concerning finding was that staff in nursing homes had preconceptions that families of Black residents did not want to engage in advance care planning and preferred more aggressive care.
“Staff preconceptions that Blacks are less willing to engage in advance care planning and want more aggressive care speaks to the need to address systemic racial biases in nursing homes,” said Dr. Mitchell, noting that nursing homes in the United States tend to be racially segregated and low-resource homes tend to have more Black residents. “Achieving health equity for all nursing home residents with advanced dementia must be the driving force behind all efforts aimed at reducing disparities in their care.”
Researchers conducted 169 staff interviews at 14 nursing homes in four states. They identified factors that were typical of nursing homes that provided less intensity of care including: the quality of the physical environment (e.g., good repair, non-malodorous), the availability of standardized advance care planning, greater staff engagement in shared decision-making, and staff understanding that feeding tubes do not prolong life. Aggressive intervention was considered suboptimal.
More equitable advanced dementia care, the study concluded, may be achieved by addressing several factors, including staff biases towards Black residents. Other solutions include increasing support and funding for low-resourced facilities, standardizing advance-care planning, and educating staff, patients, and their families about evidenced-based care and goal-directed decision-making in advanced dementia.
Other researchers collaborating in this study work at Beth Israel Deaconess Medical Center, Harvard Medical School, Meyers Primary Care Institute, University of Massachusetts Medical School, Oregon Health & Science University School of Nursing, the University of Tennessee at Martin, Emory Center for Health in Aging and the Nell Hodgson Woodruff School of Nursing at Emory University, the Center for the Study of Aging and Human Development at Duke University School of Medicine, and the Geriatrics Research Education and Clinical Center at Veteran Affairs Medicine Center.
President Joe Biden’s edict that nursing homes must ensure their workers are vaccinated against covid-19 presents a challenge for an industry struggling to entice its lowest-paid workers to get shots without driving them to seek employment elsewhere.
Although 83% of residents in the average nursing facility are vaccinated, only 61% of a home’s workers are likely to be, according to data submitted by homes and published by the Centers for Medicare & Medicaid Services as of the week ending Aug. 8. More than 602,000 staff members have contracted covid and more than 2,000 have died from it.
That led Biden to declare Wednesday that the government would require employee vaccinations as a condition for nursing homes to receive Medicare and Medicaid reimbursements, which account for most of the industry’s income.
“More than 130,000 residents in nursing homes have, sadly, over the period of this virus, passed away,” Biden told reporters. “At the same time, vaccination rates among nursing home staff significantly trail the rest of the country.”
Nursing homes in Florida and Louisiana have the lowest average staff vaccination rates among states, with 46% of workers in a facility fully vaccinated. Rates are highest in Hawaii, with an average of 87% of workers vaccinated by facility, and California, with 81% vaccinated on average, the data shows.
The American Health Care Association, a nursing home lobby, said it appreciated the order but that the mandate should apply to other health care providers as well so that workers who refuse vaccination won’t have a reason to change jobs within the industry.
“Focusing only on nursing homes will cause vaccine hesitant workers to flee to other health care providers and leave many centers without adequate staff to care for residents,” Mark Parkinson, president and CEO of the association, said in a statement. “It will make an already difficult workforce shortage even worse.”
David Grabowski, a professor of health care policy at Harvard Medical School, said that, because many nursing home aides are paid only the minimum wage or slightly higher, they would be more likely to seek out work at retail establishments. “The risk isn’t that they go to the hospital down the street — the risk is they go to Starbucks or Target,” he said in an interview. “It’s great if you want to mandate the vaccine, but you also want to make sure these workers are making a living wage.”
Jon Green, CEO of Pinewood Manor Nursing and Rehabilitation in rural Hawkinsville, Georgia, said the “vaccines are necessary for control of the virus,” but “if we would have mandated it ourselves, it would have caused [many workers] to leave.’’ His facility, which is a nonprofit home, has about 85 employees.
Just over half of nursing home workers in Georgia, on average, are vaccinated.
Some facilities have already placed vaccination requirements on employees, including PruittHealth, a large Southern nursing home chain. The company set an Oct. 1 deadline for employees to have received at least an initial dose of vaccine. About 45% of its nursing home workforce has received a shot. PruittHealth said only medical and religious exemptions to its vaccine mandate will be considered on a case-by-case basis.
Lori Smetanka, executive director of Consumer Voice, a nonprofit that advocates for people receiving long-term care services, said that if nursing homes succeed in getting more employees to accept vaccinations, it might make it easier for them to retain and recruit others who have been fearful of catching covid at the homes.
“We did see that a number of workers fairly early on in the pandemic had quit because they were worried about their own safety,” Smetanka said. “This is one opportunity to attract people who have not been willing to work in the facilities.”
CMS said it would issue an emergency rule in the coming weeks that adds staff vaccination to the requirements for nursing homes to receive Medicare and Medicaid reimbursements. That rule would presumably spell out the criteria for compliance.
In practice, nursing homes rarely are thrown out of the Medicare and Medicaid programs for violating the government’s conditions of participation. The government generally gives facilities multiple opportunities to correct violations before proposing termination, even when facilities have repeatedly flouted the rules.
People with dementia receiving home health care visits are less likely to be readmitted to the hospital when there is consistency in nursing staff, according to a new study by researchers at NYU Rory Meyers College of Nursing. The findings are published in the journal Medical Care, a journal of the American Public Health Association.
Home health care—in which health providers, primarily nurses, visit patients’ homes to deliver care—has become a leading source of home- and community-based services caring for people living with dementia. These individuals often have multiple chronic conditions, take several medications, and need assistance with activities of daily living. In 2018, more than 5 million Medicare beneficiaries received home health care, including 1.2 million with Alzheimer’s disease and related dementias.
“Nurses play a pivotal role in providing home health care,” said Chenjuan Ma, PhD, MSN, assistant professor at NYU Meyers and the study’s lead author. “As the population ages and older adults choose to ‘age in place’ as long as possible, the demand for home health care for people with dementia is expected to grow rapidly.”
For most patients, their home health care often begins after being discharged from the hospital. Given that hospital readmissions are a significant quality, safety, and financial issue in healthcare, Ma and her colleagues wanted to understand if having continuity of care, or the same nurse coming to each home visit, could help prevent patients from being readmitted.
Using multiple years of data from a large, not-for-profit home health agency, the researchers studied 23,886 older adults with dementia who received home health care following a hospitalization. They measured continuity of care based on the number of nurses and visits during home health care, with a higher score indicating better continuity of care.
Approximately one in four (24 percent) of the older adults with dementia in the study were rehospitalized from home health care. Infections, respiratory problems, and heart disease were the three most common reasons for being readmitted to the hospital.
The researchers found wide variations in continuity of nursing care in home health visits for people with dementia. Eight percent had no continuity of care, with a different nurse visiting each time, while 26 percent received all visits from one nurse. They also found that the higher the visit intensity, or more hours of care provided each week, the lower the continuity of care.
“This may suggest that it is hard to achieve continuity of care when a patient requires more care, though we cannot exclude the possibility that high continuity of care results in more efficient care delivery and thus fewer hours of care,” explained Ma.
Notably, increased continuity of home health care led to a lower risk for rehospitalization, even after the researchers controlled for other clinical risk factors and the intensity of home health care (the average hours of care per week). Compared to those with a high continuity of nursing care, people with dementia receiving low or moderate continuity of nursing care were 30 to 33 percent more likely to be rehospitalized.
“Continuity of nursing care is valuable for home health care because of its decentralized and intermittent care model,” said Ma. “While continuity of nursing care may benefit every home health care patient, it may be particularly critical for people with dementia. Having the same person delivering care can increase familiarity, instill trust, and reduce confusion for patients and their families.”
To improve continuity of nursing care, the researchers recommend addressing the shortage of home health care nurses, improving care coordination, and embracing telehealth in home health care.
“Multiple structural factors present challenges for continuity of care for home health nurses and other staff. These can include long commute times, few full- or part-time staff, agencies relying mostly on per diem staff, and organizational cultures that do not foster retention of home health care staff,” said Allison Squires, PhD, RN, FAAN, associate professor at NYU Meyers and the study’s senior author. “Proposed legislation in Congress that seeks to increase nursing and home health care frontline staff salaries will pay for itself because agencies can improve continuity of care, and therefore reduce penalties associated with hospital readmissions.”
A hybrid care model of in-person visits and telehealth visits could also help achieve more continuity of care, the researchers note. They encourage policymakers to consider expanding coverage for telehealth visits in home health care.
In addition to Ma and Squires, study authors include Margaret McDonald and Penny Feldman of the Visiting Nurse Service of New York, Sarah Miner of St. John Fisher College Wegmans School of Nursing, and Simon Jones of NYU Grossman School of Medicine. The research was supported by the Agency for Healthcare Research and Quality (R01HS023593) and the NYU Center for the Study of Asian American Health under a National Institute on Minority Health and Health Disparities grant (3U54MD000538-18S1).
