Making Decisions About Nursing Home Care
When a Decision MUST Be Made
You notice that a parent or relative is becoming unusually forgetful. Your mother gets lost on the way home from her regular visit to the hair salon. More than once, you've found a meal on her stove she doesn't remember cooking. Or, your widowed father falls as the result of a stroke. You know it will be impossible for you or your siblings to provide the care and support necessary for him to continue living independently.
These are painful scenarios because they often result in making a difficult decision that most people dread...giving up home, independence, familiar surroundings, and moving to a senior living facility. You can make steps to this process easier on both you and your loved one. Documenting you converns and discussing them with family members, trusted friends and healthcare professionals will enable you to take appropriate action.
Evaluate The Situation
Your family's first challenges are to make a realistic evaluation of your loved one's diagnosis and needs, and to understand the options available. This means answering several questions:
. How unsafe is the current living situation, or how critical are the health needs of my parent or loved one?
. What financial resources or insurance benefits are available?
. What level of care is needed, and for how long?
. Does my loved one recognize the need to make changes for his/her health and safety and my peace of mind?
. How involved is my loved one able to be in the decisions that need to be made?
. What if my loved one refuses to make the necessary changes?
. How can I find people and resources to enable us to make the most informed choices?
With answers to these questions in hand, you can move forward on making a decision about what kind of care is best for your loved one.
Get a Head Start
Steps to smooth the application and admission process:
Obtain a Healthcare Proxy
asserting that the stated decisions have been discussed by your loved one with the designated proxy and the alternate. These are available from your physician, or from home healthcare or senior advocacy agencies.
Obtain a Valid Power of Attorney through your lawyer.
Get an Advanced Directives Form
that provides guidance about future medical decisions, such as life support or organ donation. Consult your doctor or elder-care agencies.
Gather Financial Records
from the past three years, including income tax, insurance information (including long-term care benefits), investments, Social Security, assets and liabilities.
Obtain a Medical Report
from your loved one's doctor that has been updated within the last 30 days.
Obtain a Patient Review Instrument
that has been completed within the last 90 days. PRIs indicate the level of care a resident may need. These are done by healthcare professionals.
Picking a Facility What to Look For
Visit any facility you are considering and ask as many questions as needed. The staff in a good facility will welcome them. Make your first visit to the prospective care facility without your parent or loved one. This will give you a chance to be candid and probing in your questions. It will also ensure that when you take your loved one there, your initial reaction or concerns will not be an influence. Rely on your senses. How does the facility look, smell, and sound? Will you feel good about knowing your loved one lives there? Do residents look comfortable, clean and content?
Prepare for the Decision
. Use the Internet and local elder-care resources to gather information on facilities and services.
. Gradually point out to your loved one why assistance is needed, and the consequences of not addressing these needs,
. Explain care options.
. Seek professional help from a care manager if you find the situation difficult to discuss with your loved one. Get a referral from your doctor or consult local elder-care agencies to find an experienced care manager.
. Take time to make your decision. If your loved one needs immediate assistance, consider paying privately for awhile to extend your decision-making time before permanent placement in a facility.
Questions to Ask
. What is the level of coverage by doctors? Is there a geriatrics specialist on staff? Will your loved one have to change doctors?
. Has this facility received any honors or awards in the last three years? What is its professional affiliation?
. Ask to see the facilities most recent state survey. How serious were any deficiencies, and what was done to correct them?
. How is the meal choice and presentation? What are the provisions for assistance with eating? How is nutrition monitored?
. What are the staffing ratios on each floor and shift, both weekdays and weekends?
. What amenities are available, such as podiatry, nail care, massage or hair care?
. Are residents who were admitted on a private-pay plan allowed to stay if resources run out and payment shifts to Medicaid coverage?
. What services does the daily rate cover? Are prescription drugs and doctor's visits included?
. When can you visit? Are times restricted? Can you bring the family pet?
. What activities are available and how can families be involved?
. How are spiritual needs addressed?
. How is laundry handled? Can your parent be ensured that a favorite sweater will be returned? Are there any options?
. What security systems are in place?
. What is the procedure for leaving the facility for a family visit or special occasion?
. Who will handle ongoing concerns, and when is this person available?
. Ask if you may visit unannounced before you make your decision.
Explore the Range of Care
At-Home Services
Enables some elders to remain at home through the use of home health aides, companion services or a meals-on-wheels program.
Senior Apartments
Offer on-site services such as meals, medical support, hair salons, and recreational and social activities. Transportation and cleaning services are available.
Assisted-Living Facilities
Provide residents a private apartment, one to three meals a day in a community dining room, and social and medical support.
Extended-Care Centers
Afford a higher level of medical support, with private or semiprivate rooms and a range of activities.
Day Centers
Offer care for up to seven days a week. They provide a safe environment for a widowed parent or relief for a caregiver who cannot handle caring for someone 24 hours a day, seven days a week. Some may transport participants to and from the program.
Traditional Nursing Homes
Provide complete and permanent residential care for those needing skilled nursing services.
Transitional Care
Provides rehabilitation and skilled nursing care for six to eight weeks, after which the patient returns home or to another facility. This service is available in some nursing homes and hospitals.
