Travels Beyond the Sheyenne National Grassland

December 20, 2016

A recent excursion to the North Dakota State Veterans Home revealed a lot to UND School of Medicine & Health Sciences’ Department of Geriatrics Chair and Professor Dr. Donald Jurivich. He was invited to the Lisbon, N.Dak., facility to harness his long-term care expertise and potentially help staff solve some tricky problems. The following is Dr. Jurivich’s recollection of his visit.

As a state-funded medical faculty member, I was absolutely delighted to accept the invitation from a state and federally supported facility for our aging veterans. I have over 30 years of service to the Veterans Administration, and while technically retired from the VA, I look forward to volunteer efforts with the Fargo VA and the North Dakota State Veterans Home to strengthen geriatric care across the state.

My mission at the North Dakota State Veterans Home was to address some difficult safety issues such as overuse of chemical restraints and falls. My early observations were that the staff at the ND Veterans Home are vibrant, dedicated, and hugely mindful of patient-centered care. In fact, the care is so patient-centered that one elderly veteran was seen boiling his daily shellfish for lunch with staff assistance. I visited with the veteran and joked that being new to the state I did not know that the Sheyenne River next to the veterans’ domiciliary sported shellfish. The comment was enough for the veteran to ask me to join him for lunch, which I kindly declined because I “forgot my lobster bib.”

The ND State Veterans Home is relatively new, less than five years old. The hallways are enormous and connect multiple living pods or “home units” for the veterans. It bears a striking resemblance to the Eden concept, which is an architectural design meant to deinstitutionalize the long-term setting and make living quarters more “homey.” It was a good thing the hallways are as wide as they are because the electric scooters and chairs were whizzing by at breakneck speeds. When I asked why there were so many electric scooters in the facility, the Director of Nursing Wanda Cavett commented that it is a relatively new phenomenon. “In the old building, we had three stories and the fire code did not allow for electric carts in the upper floors,” she said. “Now that the building is only one floor with great distances between the residents’ rooms and the activities center, just about everyone wants electric transportation. In fact, we have so many electric scooters that sometimes the bingo room does not have enough parking slots.”

I then asked whether the residents were getting enough exercise as a result of the trend toward electric scooters. “Funny you should ask,” said Cavett. “Yes, over the past year we have seen a decline in residents’ endurance, and we have had an uptick in falls since moving to the new building. We also are issuing a lot of tickets for driving mishaps, so I can’t honestly say that I am a fan of the newly issued indoor vehicles.”

I suggested that perhaps the facility could limit the hours of indoor vehicle operation or “activate” driving privileges once the resident demonstrated 10,000 steps from the previous day. In geriatrics, the electric chair or scooter is the nemesis of the elderly. It causes deconditioning, increases fall risk, and overall causes more harm than good.

Another observation at the facility was the happy barks at each corner. Therapy dogs and pets were found at just about every unit. Many of the veterans walked the dogs around the facility with the canines serving as social ambassadors for veterans who meet other veterans who may not have enough memory to know all the people, but they sure recognize their dogs. According to one research study, walking with dogs creates more exercise benefit than walking with human companions.

After touring the domiciliary areas, I was directed to the Skilled Nursing Unit, where approximately 50 veterans receive care because of restricted abilities to perform daily activities of living. As a staff safety measure, each room is equipped with an electric lift to move veterans from bed to chair or washroom if necessary. To avoid unsupervised bathing, most of the SNU rooms had only toilets and washbasins. “Many of our veterans value their independence to a fault,” said Cavett. “They seem to sacrifice good judgment for independence and just refuse help, which often results in falls.”

“It’s part of the pioneer spirit I suppose,” I thought out loud, “where there is a lot of self-reliance and resiliency. The problem is when stubbornness leads to injury, and that is never a good result as you get older.”

The highpoint of my Veterans Home visit was when I was introduced to World War II veteran and the oldest resident, John Schreiner Jr. He is 98 years old and just recently moved from the assisted living area to the skilled nursing unit because of increased needs for ADL (activities of daily living) support. He also is using his oxygen more frequently.

When I was introduced, Mr. Schreiner immediately asked how the roads were given the first snowfall of the year. “Not too bad,” I said.

I asked him how he was doing.

“Pretty good,” said the near centenarian. “How do you like my wood cutouts?”

“Amazing, how do you make these?” was my response.

“I make the pattern, drill holes in the negative space, and then take a long thin saw and cut 'em out.”

“Wow, negative space, you’re a really good artist,” I said.

“Well, I have not been able to do them here since I moved,” Mr. Schreiner said.

I suggested that perhaps he could make the patterns and get a “young apprentice” to help him out.

“Something to think about,” he reflected.

When asked about what he does to live a long, good life, Mr. Schreiner’s visiting daughter chimed in that “He has a good attitude.”

During our exchange, I noted Mr. Schreiner’s attributes that are commonly shared by 100-year-olds: sense of purpose, live for today, don’t sweat the small stuff, and keep moving. Also typical of the Greatest Generation, Mr. Schreiner revealed that he was deployed by the Army to New Guinea, and rather than discuss his service, he reflected on the topography and weather of the Asian Pacific—quite a contrast to Lisbon, North Dakota, he pointed out.

Perhaps the most endearing part of my encounter was Mr. Schreiner’s response to my inquiry about coming back to visit him next month to which he said, “You betcha! But watch them roads.”

Somehow, my original mission to help with safety at the Veterans Home got flipped back at me. That’s what I love so much about WW II vets—it’s never about them; they’re always looking out for the other guy.

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Denis F. MacLeod
Assistant Director, Office of Alumni and Community Relations
University of North Dakota
School of Medicine & Health Sciences
501 N Columbia Rd, Stop 9037 | Room 1106 | Grand Forks, ND 58202-9037
701.777.2733 direct | 218.779.3107 cell
denis.macleod@UND.edu
www.med.UND.edu