Medical students spending time in a nursing home as a patient

An interview by Curaspan Health Group with Marilyn Gugliucci, PhD.

Every summer, a handful of medical students spends two weeks in a nursing home as a patient. That’s part of what’s been called “the life-altering education” established by Marilyn Gugliucci, Ph.D., the director of geriatrics education and research at the University of New England College of Osteopathic Medicine.

Gugliucci spoke with Curaspan Connections about the inspiration for her unique approach to elder-care education, The Learning by Living Project, and what the outcomes have meant to her students and participating post-acute facilities.

Curaspan: What inspired you to start the program?

Marilyn Gugliucci: After a lecture, one of my students expressed a desire to learn to speak with “institutionalized elders.” My first thought was to tell her to speak with elders as she would speak with any adult – but instead I asked her if she would live in a nursing home for two weeks as an elder resident to find her own answer to the question. I had no idea where this thought came from nor if it could be done, but she agreed to the idea. This was a 23-year-old, born and raised until she was 7 in Lebanon. She never knew her grandparents – she had never been inside a nursing home. The experience was life-changing for her, and I knew we just had to build on this.

How do students get involved?

It’s all volunteer. You need to be 21 or older. The students who sign up are really eager. As the program has grown, I’m seeing more and more interest. Not everyone who expresses an interest follows through, but I can tell pretty much up front who will commit to do this. Each student lives the life of elder resident for 10 to 14 days.

Why two weeks?

It usually takes four days for the student to assimilate, to get into a sense of routine. And it’s critical that the student stay over at least one weekend, to see the change in care. The idea is to observe the environment over an extended period and learn about the culture. If a student was “admitted” on Monday and “discharged” on Friday, they would only be thinking about getting out and not what the nursing home environment offers residents. Students and staff need time to get desensitized in order to fully experience the environment. One of my students said that after four days he had forgotten what it was like to be home.

What is the program’s goal?

This experience will help students become more compassionate as physicians. They are learning the importance of physical touch, being at eye level with the patient, communicating with sincerity. Ultimately, they will be better physicians because they are learning to treat the person, not the disease or frailty.

How do you get skilled nursing facilities involved?

There are two ways: One is through personal connections, through people I know, and the second way is that word is getting out there. The Soldiers’ Home in Chelsea (Mass.) contacted me and said they were very interested in culture change and wanted to be involved. There have been 20 students from various schools admitted into nine different nursing homes in four states for this project.

How scalable is the program?

We’ve now done this in Maine, New York, Ohio and Massachusetts. The remarkable piece of this is that no money changes hands. Nursing homes donate a bed, because they believe in the idea. They’re giving us a free bed that could bring in $300 to $500 a day. That’s generous. But to really grow this, I’m out there pursuing a grant. We will need funding. Ideally, I’d like to expand the program into a national fellowship for students interested in geriatrics.

Have you considered expanding the program beyond nursing facilities?

I piloted a “Learning by Living at Home.” A UNE medical student lived in a home with a couple in their mid-80s. She lived there for one week to understand their lives and the care that takes place. The wife had advanced Parkinson’s disease and the husband had terminal colon cancer so he had made arrangements in case he went first. My student saw the bonding, observed the treatment and care of the wife by the husband, and pitched in to help sometimes, but it was mostly observation. It was quite an education for the student.

How about a rehab facility?

Students have been admitted into both a skilled nursing rehab unit and long-term residential care; it depends on bed availability. A student even stayed in a dementia unit – but I try to have students live in the residential care wings of the home so they can communicate with the elder residents. Nursing homes are based on the medical model – it’s a good environment for observation and learning.

What is the health-care staff learning from your program?

There are simple things nurses could stop doing if they realized the patient impact. It could be something as innocuous as knocking before opening a door. Or not talking about what they’re going to do on a weekend. One of my students wrote that nurses were talking about all the fun things they were planning to do and it made him feel awful. This was his home, and he didn’t have those opportunities.

And have you seen changes?

One student reported how the residents hang out in front of the elevator door, so she did as well. As visitors would come in, they would avert their eyes. It made the student feel like a non-person. She gave that feedback and the facility has started a family orientation program to assist with resident interaction when visiting the nursing home. The staff and administration take the student presence seriously and welcome feedback to advance the home environment.

What have students learned?

Creature comforts are of major importance. Pillows, tissues, toilet paper – this is all important to patients. The students could see and feel this firsthand, because they lived it. Another student wore a security bracelet and said when he’s a geriatrician, he’ll think twice about assigning one to a patient. He was not able to go outside. He said making a decision that affects someone and their ability to go outside needs careful thought.

Is the program working as you planned?

My goal in life is to change the world’s attitude toward aging. If I can get one person to think more positively about the aging process, I’ve accomplished my goal. To see the change – to see students maintaining the lessons they’ve learned from this experience – is very rewarding. One of my students called this life-altering medical education research. And I agree.

Marilyn Gugliucci is the director of geriatrics education and research at the University of New England College of Osteopathic Medicine and the president of the Maine Gerontological Society.

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  • Anonymous

    I loved this article. Growing old is definitely not for the faint of heart.

  • http://twitter.com/prnlist PRN Jobs

    Marilyn: I love that you are doing this. This perspective is great for students to gain before entering the workforce.  Maybe it will spark innovation and help make patient-centered care more foundational to how healthcare is provided.

  • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

    Well, I was involuntarily placed in a rehab hospital/Alzheimer’s home for 3 weeks following a diabetic coma, because my family felt I was not able to take care of myself at home (and in retrospect, I think they were right). In this place, I was the only one who was relatively mentally intact, and it was the loneliest 3 weeks I have ever spent. None of the activities held any interest to me, and the only ones I could really talk to were the therapists, but they were understandably busy. The nurses gave me insulin on THEIR schedule, not mine, and I had to demand it from the nurses’ station in order to get to meals on time, only to be met with stubbornness and anger. The nurses seemed to be thinking more about themselves than caring for me. Some of the aides were pleasant, but again, so overworked that they couldn’t care for my emotional and intellectual needs. My friends did the best they could, but there were long hours when I just laid in my bed and retreated into my own world, because there was no stimulation other than the loud blaring of my roommate’s TV or the clatter and yelling in the brightly lit hall. One roommate was dying, and the staff left music on for her 24 hours a day, and needless to say, I couldn’t sleep and DIDN’T like the music they were playing. The food was barely edible, even though the dietitian made every effort to accommodate my special needs.

    So I have made the decision that I would rather die than ever go into a nursing home again. I don’t wish to be totally infantilized, and I don’t wish every pleasure in life to be taken away from me. Ideally, nursing homes shouldn’t be like this, but they are.

  • Doug Capra

     Great idea. Every caregiver in nursing homes needs to have enough sociology to understand
    the concept of a “Total Institution,” so they can make sure that their “residents” don’t feel 
    more like “inmates” than they do “patients.”

  • http://profiles.google.com/molly.ciliberti Molly Ciliberti

    What a wonderful idea. Next 48 hours in an ICU bed. That would open some eyes fast. Being human and hanging on to our humanity is a real problem for our patients and elder population. Once I was young and competent and now I am no longer really fully human.

  • http://pulse.yahoo.com/_CKSY7QAHIZGZSKZKJEOCCYV2AA Gloria

    Thank you Curaspan Health Group, for sharing. 
    Thank you for taking initiative Dr. Gugliucci. 
    Thank you for encouraging your students’ curiosities and for creating opportunities.  
    Your future docs are learning priceless lessons.  

    I recently read a few very moving physician stories by patient physicians.  Not physicians with patience, but physicians who shared thier invaluable experience of being the patient.  Even with their vast knowledge of healthcare and innerworkings of hospital settings, their physician experience was of little comfort when they were helpless and dependent on others.  Recovered and back to work, these patient doctors are extremely thankful for thier new found insight, one after decades of patient care.  They spoke of a newfound mission, a more patient centered mission.
    The articles were on this site I believe, but darn if I can find them.  Sorry about that. 

  • http://pulse.yahoo.com/_FSSAWAQVC66GAVSR24QD2IPF4E Lorraine

    I have just started working at a nursing home in my small town.  Reading this article has given  me insight into  what I need to change to be a better caretaker and friend of these wonderful elderlly people.  Thank you.

  • http://twitter.com/ClaireBoyles Claire Boyles

    Brilliant!  Genius, yet simple concept.  Experience exactly what it is like to receive care from the medical profession, is THE best way to understand how to provide the care that YOU would want to receive.
    I look forward to the day when this is a mandatory part of ALL medical students training, nurses & doctors, we’ll soon see a dramatic increase in the quality of care then, and I’m guessing a dramatic decrease in the death rate too…. 

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