Tips and advice on how to find the best living arrangement for your loved one
Nursing homes are places most people don’t think about too much. But suddenly your mom or dad can no longer care for themselves. You can’t afford to take care of them, you’re too busy. The complexities of care are now too much to handle. Your mom may need care around the clock or have medical issues such as dementia and risk for fall. Now you need professional help and finding good help, proved to be more challenging then you’re expected. I hope my experience in this business may be of help to you.
As you begin looking for a place, you realize the name nursing home doesn’t mean much. On top of being confronted with an maze of options you are also overwhelmed by the dramatic changes taking place with your mother. I hope this article shines a light on how to find a good nursing home, and also helps you psychologically for the task ahead.
Finding a honorable living situation for your mom or dad is a once in a lifetime opportunity, but also a challenge. Your parents took care of you when you’re a child, and now you find yourself having to care for them. But before you jump in search for a quick solution to your problem, I invite you to engage in some soul searching. This may lead to a positive experience and in the end, provide your loved ones with a meaningful end of life.
Your extra thoughtfulness can provide a much better living situation for your loved one. You might consider not placing them in a nursing home at all and choosing home instead. There are advantages and disadvantages in nursing homes, and I’ll explain that in a moment. Slow down, take your time reading this article and begin by understanding the levels of care involved for a elderly person.
Levels or care
There are two main of levels of care for the elderly, you should be familiar with them. Once you understand their differences it will be easier to choose an appropriate place. These two levels of care are sometimes blurred but they are fundamentally distinct. They are:
#1 ASSISTED CARE
Assisted care is a lower level of care. Usually consists of having a structure able to provide supervision and light touch support. There might be a nurse on the premises but they might not provide skilled services. Assisted care is usually found in residential apartments or living complexes designed for the elderly. These places may also provide some social activities, building management, cleaning, groceries delivery, transportation, and a number of other support services depending on each individual place and package deal.
#2 SKILLED CARE
Skilled care is also called SUB ACUTE CARE. Skilled care is for people who can no longer take care of themselves. Skilled care are for those who are not sick enough to go to a hospital, but some kind of service provided only by licensed health care professionals.
Skilled care is usually needed in cases of dementia, immobility, incontinence, and the inability to feed alone, or perform the activities of daily living (ADL). Skilled care relies on trained licensed staff such as Registered Nurses (RN), certified nurses assistants (CNA) physiotherapist (PT) and doctors on call who provide around the clock services, medication orders and administration, rehabilitation, therapies, hygiene, feeding, clinical evaluations, medical appointments, small intervention such as placing IV’s, Foley catheters and IV antibiotic and a variety of other small interventions. Skilled care also makes the decision if the patient need more urgent care and arrange the immediate transportation to an emergency room.
Assisted care living examples
Assisted living is designed for older adults who value their independence, but need some assistance with daily activities such as bathing, dressing, transportation, and reminders to take medication. Seniors may live in their own suites or with a companion, and are relieved of household chores such as laundry, cooking, and cleaning. A combination list of these services may be offered by places that provide assisted living.
There are many types of businesses offering assisted care, but don’t get confused. They all offer similar services but all have one thing in common – don’t offer skilled care. But be mindful however that some may have some kind of skilled services. Here’s some of the names you might run into:
- Assisted Living
- Retire Community
- Independent Living
- Assisted Living
- Senior housing
- Long term care
- Board and care
Finding a assisted living situation that also offers some skilled services is indeed a good idea. This is specially advantageous for those who could be transitioning to skilled care in a near future. The elderly often needs skilled care temporarily from time to time. The relocation from assisted living to a facility offering skilled care can be a traumatic. Skilled facilities feel different and impersonal. They are noisy, and hospital like. More on that at the end of this article under the heading: limitation of nursing homes.
Skilled care living examples
- Skilled Nursing Facilities – (SNF): Are very common. These facilities usually offer a variety of services ranging from rehabilitation, short and long term stay, sub acute care, post surgery care, and hospice and comfort care only. SNF’s are also another name for nursing homes, and many elderly take residency in these places. Almost invariably because they need some type of skilled service. They function much like hospitals, providing care around the clock. Admissions can be short or for long periods of time. Some patients are full time living residents. Some might need minimal care but others residents need full services.Like hospitals they employ licensed health care professionals such as registered nurses (RN), licensed vocational nurses (LVN), certified nurses assistant (CNA), licensed nutritionists (RD), and physical therapists (PT) and others. Doctors are on call and may visit the facility weekly. Skilled services consist of, IV lines placements, Foley catheters insertion, NG tubes, IV antibiotics and a series of other minor procedures requiring licensed health care professionals. Keep in mind that some facilities have different levels of skills. For example, some facilities might be more skilled placing IV lines, others may not.
- Nursing home – is just generic name. The name nursing home can mean a lot of different things. Nursing home services can range from skilled care to housing for the elderly. Know what each place has to offer. Talk to the case manager or social worker. Prepare your questions ahead of time. Some nursing homes have limited skilled services and might focus more on stable or very old population.
- Residential hospital – Are usually associated with substance abuse and behavioral issues. They are basically SNF’s that specializes in a specific type of care and are part or owned by a hospital complex. It could be cancer treatment, psychiatric care, advanced dementia and other chronic conditions needing one on one attention over a long period of time or temporarily.
- Rehab Centers – they are like skilled facilities but usually specializes in drug rehabilitation. Some skilled facilities may come with the name rehab center but don’t have drug rehab as their focus. They might provide other types of rehabilitation as well. But you’ll find that in that a large number of these places treat substance abuse and alcohol abuse.
Home care might just be the best option for all concerned, if you can work out the details. Invariably, home is where everyone wants to be and it is no different as we age, perhaps even more so as we age. There are however, some advantages in nursing home living; we’ll talk about that in more detail in a moment.
Almost everything you’ll need in order to take care for your loved one, can be purchased online and installed at home. Home care is like having a nursing home inside your own home. There are advantages and disadvantages to that.
Disadvantages of home care
It can be expensive. While nursing homes have one staff taking care of many, you’ll need your own personal staff 24/7. You might have a inadequate home filled with obstacles such as stairs and difficulty of access.
You will need to dedicate hours of your day to provide care. Taking care of your loved one might be more difficult then you may realize. Most people don’t take into account, the emotional stress that comes with caring for family members.
Being at home can also be lonely for the elderly. It is difficult to provide company for the elderly around the clock. Even though there will be always someone around, it will not be the kind of companionship they need and were used to.
Advantages of home care
There is no better place to be than home. There are obvious advantages of being at home: better supervision; family proximity, better food and care to name a few. You are among family and still able to have life continuity. One of the hardest changes for the elderly is the loss of everything familiar to them – loss of control and the power to make their own decisions.
Moving to a nursing home will strip them of all things familiar to them, sometimes worsening mild dementia or depression. Home care also eliminates the need for you to get out of your house and make visits to a nursing home.
There are countless agencies providing or connecting you with home care services. From assessment to providing nurses and health aids on demand or arranging a regular schedule. They will provide an admission nurse or a case manager who will evaluate your needs case by case. Next they will arrange a schedule of nurses and nurse’s assistants and create a plan of care (POC). This could come at a price. More on how to obtain medicare payments bellow.
Family and informal caregivers
What aggravates our difficulty in taking care of our elderly is our modern lifestyle. Families break apart, people move to a different places, it becomes harder and harder to keep your family and friends nearby was we age. This is a big problem.
Government agencies have stepped in trying to minimize the impact of this new condition. The Family Caregiver Support Act was created. It is one of the first new federal initiatives designed to expand services and assistance for family caregivers. Family member who help with care can get federal or state money support.
Here are some helpful resources on how to get funds:
- Paying for Senior care
- National Family Caregiver Support Program
- Family Caregiver Support Program (FCSP)
- The Arch
The usual placement process
A common scenario
It might be comforting to know that many others are going through a similar situation as you. In most cases, an admission to a nursing home will start with a fall causing trauma.
You take her to the emergency room. She is then admitted to a hospital, and when time for discharged comes, she cannot go back home because she can no longer take care of herself as she did before. She might need a temporary placement in a facility.
The hospital case manager will then find you a available facility. He will check a large database of all available places. From this point on, the communication between you and a facility will begin.
You’ll visit a few facilities and agree with the placement and the admission process takes place between the hospital and facility. You can always change to another facility if you’re not happy. Your best friend in this case is the social worker or the case manager. From there he will be able to assist you in finding a new place in case you’re not happy.
Keep in mind that places can be very different in how they feel, and that can be for you and for your loved one. It is difficult to evaluate a place in just a few hours or in just one visit. It takes a few days for you to know.
Costs and financial help
Tip # 1 – Consult a social worker: They are the most underused resources when trying to find an ideal placement. Every facility has a social worker on staff. These professionals know all about placement, insurance, medicare and a host of other useful information. Some even run agencies to supplement their income. A social worker can the difference. Medicare system and state laws are far to complicated for you to tackle alone. Use the help of a professional.
Tip # 2 – Pay attention to facility staff: Don’t be impressed by beautiful or new furniture in the lobby. Even though it may be a sign the facility is well kept, new furniture will not make a difference on how your loved one will be treated.
A happy staff that enjoy their workplace is your best chance you have for quality care at a reasonable price. The facility should feel warm and welcoming. The staff should not be uptight and stressed, it they are chances are the place has some problems. A happy staff is what create harmony. This in turn translates into personable and quality care to the all residents despise the usual limitations.
The bottom line in a nursing home is – a nursing home is only as good as the people that work in them. Pay attention to how the staff interact with one another. Pay attention to how they treat you as you visit a facility. Give sufficient time, but if you feel the love, chances this place will not work out.
Tip # 3 – Non profit Vs. for profit: Stay away from for profit nursing homes as much as possible. Unfortunately 68% of nursing homes in the United States are for profit, a trend that is only growing. Here are the main problems:
- Nursing home providers that operate for-profit prioritize shareholders first and foremost. Their goal is to provide as much money to their owners and shareholders as possible, while non-profits have no responsibility to shareholders and can thus prioritize patients and quality of care.
- Overbill Medicare. Overbilling is illegal but nonetheless a common practice in healthcare. Essentially, it means a nursing home or hospital bills the government – Medicare or Medicaid – for treatments patients do not need or never receive. In other words, the nursing home gets paid for doing nothing, in a form of fraud.
- Falls, bedsores, and overmedication are also more common in for-profit nursing homes simply because there are fewer nurses. Under staffing leads to resident neglect and abuse, including malnutrition and dehydration, fraud, and wrongful death.
- For-profits suffer from an omnipresent tension between what is best for patients and what is best for profit margins. Facility managers are expected to watch labor and overtime hours vigorously while pushing for Medicare reimbursements and longer patient stays.
Tip # 4 – Participate in the care: your participation is fundamental. Most people think once they live their loved one in a nursing home, all problems are taken care of. But the reality is that nursing homes are only able to provide basic needs. Residents are fed, cleaned and kept safe. You can provide many other needs by just being present and even helping with parts of the care. Staff react very positively when they see family involvement.
Tip # 5 – Different places have different specialty areas. Be aware that the word nursing home is just an generic name for many health care places. Many places share similar characteristics. Some places specialize in some areas more then others.
In any case, nursing homes will not necessarily tell you what their specialty is. These places are businesses and they are trying to make money. Is up to your to find out and investigate. These differences are also pertinent to the kind of license the facility may have, since assisted living is regulated in all 50 states. These areas could be:
- Exclusively elderly population
- Post hospital care
- Exclusively residential
- More attention to activities
- More medically skilled
- Dementia skilled
Tip # 6 Size matters – In most cases you’ll be better off finding a small nursing home. Chances are you’ll find a good place among the small facilities with no more then 40 beds. Most facilities are very large with 90 – 180 beds. These large places tend to be less personable, more noisy, have unhappy staff and things can get lost in the shuffle much more easily.
Tip # 7 It takes time – Admission to facility or a nursing home can be traumatic to your loved one. The first few days are the worst. However, within a few days there is a dramatic change. And what seemed impossible becomes more tolerable. So give yourself a few days to adapt. Don’t judge anything for the first 5 days.
Tip # 8 How many nurses? – When visiting a facilities. Ask how many Registered Nurses are on staff. Ask what the patients load is for an RN. A healthy number should be around 15 – 20 patients per RN. Ask how many Licensed Vocational Nurses (LVN) are on the staff. You want to see a higher numbers of RN’s and fewer LVN’s. Even though there are very knowledgeable and experienced LVN’s out there. RN’s are more prepared to deals with emergencies and higher levels of care.
Nursing home’s common problems and limitations
Lack of nurses
Providing meaningful, healthy, and fulfilling care for the elderly is difficult and challenging requiring exhausting labor that can only be accomplished by a large staff. Even though some places may say they are adequately staffed, they fall short of meeting the truly ideal numbers. This can be evidence by commonly seen overworked and burned out staff.
A system in need of repair
There is a fundamental problem with how we treat the elderly in the United States. Like children, our elderly is vulnerable, can’t make decisions on their own, and need guidance and care. But we think is OK to just house, feed, and keep them medicated. We are failing to provide our elderly with a dignified and fulfilling life. And likewise we are doing it to ourselves because one day, we’ll be in the same situation.
Lack of meaningful occupation
Nursing home residents are usually bored because there is nothing for them to do. Activities are usually TV, bingo and board games. We could be providing them with more interesting activities like creative projects that would stimulate their minds, like cooking and art giving them a sense of self worth. Even the most advanced dementia patients show signs of improvements when creative activities are implemented.
Food in nursing homes certainly needs improvement. Hospital food is world famous for being terrible, and nursing homes follow the same is no different. The culprit again is the lack of investments in the area. Nursing homes buy industrialized cafeteria type foods because is cheaper. The concept of food as healing is not a very well understood concept in nursing homes and in health care as a whole.
Nursing home living offers little privacy. It is very expensive to have your own room, usually rooms are shared with 2 or 3 others or more. But you are also exposed to other types of privacy invasions such as being mixed with patients with different problems. Behavior problems, patients in the final stages of cancer, patients in severe pain, and patients dying. This is not exactly a pleasant situation to be in.
Nursing homes alternative projects
There are a few alternative nursing home projects in the United Sates. I only found three, but if you know of any other please send it my way through the comment box bellow.
Getting old is not for sissies because the changes to our body and mind are dramatic. We cannot change old age sickness and death. Some nursing homes are doing a better job providing a fulfilling end of life, other not so much. Finding a good nursing home is not easy, but your efforts will be rewarding for you and your loved one in more ways then you might realize.
The best option might be to avoid nursing homes altogether. You might look at home care as an alternative. Being home is always better but could be lonely and expensive alternative. The greatest advantages of being in a nursing home is that you are always in the company of others. Despised all the imperfections mentioned above, many nursing homes have a warm and incredible personable staff. In the end of the day, good and well intentioned people is what matters. Socially intelligent people will make for all the shortcomings and lack of finances, when money will not buy you much.
- Medicare Interactive
- How can I get Medicaid if I need long term care in my home or my community and have Medicare?
- Paying for senior care
- Physical Environments of Assisted Living: Research Needs and Challenges
- Assisted Living Laws by State: Know Your Rights
- Challenged To Care: Informal Caregivers In A Changing Health System
- OLDER AMERICANS ACT AMENDMENTS OF 2000
- Creativity with Dementia Patients
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