Effective Nursing Home Advocacy: Grace, Communication, and Escalation

Advocating for a loved one in a nursing home is a challenging yet critical responsibility. It requires a delicate balance of understanding, patience, and assertiveness. In this blog post, we’ll explore effective advocacy strategies that encompass grace, communication, and escalation, ensuring the best care for your loved one.

A caring nurse in blue scrubs kneels beside a senior patient in a wheelchair, engaging in a warm, attentive conversation, illustrating the compassionate advocacy and communication in nursing home care.

The Power of Grace

It’s crucial to remember that nursing home staff often face understaffing and overwhelming workloads. In most cases, these dedicated caregivers are doing their best to provide care in a demanding environment and if they are struggling to care for their residents it is often the result of poor staffing from management seeking to put profits over people. As advocates, it’s essential to extend grace and compassion to these professionals. Recognize their efforts and try to catch them doing something right. As my grandmother used to say, “sometimes you catch more flies with honey than vinegar”.

The “Be Nice Until It’s Time Not to Be Nice” Approach

Advocacy doesn’t mean being confrontational at every minor issue. Instead, consider the motto, “Be nice until it’s time not to be nice.” This means exercising patience and understanding for small, occasional mistakes. If someone forgets a blanket or if your loved one’s routine is slightly delayed, it may not warrant immediate action. If you have been extending grace and perhaps rewarding the staff occasionally with a gift card or bringing in some treats you have already demonstrated that caring for your loved one is in their interest. This helps negate the idea that you are just a “troublemaker” or that you are “nitpicking” the staff over minor issues. This translates into you having credibility when you do make a complaint. The family that complains about everything won’t be given credibility when their complaint is something large. By being kind and gracious about most minor issues in the facility you are likely to be heard and respected when you must raise a more serious concern.

Overhead view of a healthcare professional in blue attire taking notes while attentively listening to an elderly woman gesturing during a conversation, symbolizing effective communication in nursing home advocacy.

Effective Advocacy: Escalation with Grace

Escalation of concerns should be a gradual and proportionate process, primarily based on the severity of the issue. It’s essential to maintain a sense of grace when dealing with minor problems while being prepared to escalate when necessary. Here’s a practical approach:

1. Minor Issues:

1st Time: If a minor issue occurs, such as a missing item of clothing, consider saying nothing or simply asking for its whereabouts without an attitude if the staff can’t locate it.

2nd Time: Politely mention the issue to a Certified Nursing Assistant (CNA) or staff member and point out that this is not the first time the issue has arisen.

3rd Time: If the problem persists, bring it to the attention of the charge nurse and indicate that it is now a pattern.

4th Time: If the issue still isn’t resolved, send a formal letter or email detailing the history to the Director of Nursing (DON) and Administrator.

2. Major Issues:

Major concerns, especially those affecting your loved one’s health and safety, require quick and assertive action. Care failures that can impact the health and well-being of your loved one are not to be slowly “escalated” like lost clothes or a drafty room.
For instance, if your loved one complains of pain or discomfort, potentially indicating a pressure injury, report it to the charge nurse immediately and insist that an assessment be done. If your loved is out of character, sweaty, hot to the touch, in significant pain or any other medical concern that could legitimately be an emergency, insist on the physician being called.
Follow up daily, ensuring proper care and assessment until the issue is resolved satisfactorily.

3. Know When to Escalate Further:

If a major issue persists or worsens, escalate your concerns to the DON, attending physician, or regulatory agencies.
Issues like pressure ulcers, medication errors, elopement, or other severe violations demand immediate attention.
If you are not getting satisfaction for a health concern involving your loved one, consider contacting an attorney well-versed in Nursing Home issues, like us.

A professional consultation in progress with a lawyer in a suit explaining legal points to a client, with a focus on gavel and justice scales, emphasizing the legal aspects of nursing home advocacy and the importance of clear communication.

Maintaining a Collaborative Approach

While advocating for your loved one, it’s essential to recognize that nursing homes and their staff should not be seen as adversaries but as allies. Your goal is to ensure your loved one receives the best care possible. By providing positive feedback when things go well and addressing concerns effectively, you can build a collaborative relationship with the care team.


Effective nursing home advocacy involves understanding the nuances of when to act and when to extend grace. It’s about recognizing minor issues and escalating major concerns proportionally. By following these guidelines, you can advocate successfully for your loved one’s well-being. Remember that your ultimate aim is to ensure their health, safety, and quality of life in the nursing home environment.

If you or a loved one has been injured in a nursing home, please contact Williams DeLoatche, P.C. now for a free case evaluation at 757-547-5555.