Many individuals struggle with making health-care decisions on behalf of their aging loved ones. Long-term-care resources such as home care, adult day centers, adult homes and assisted living facilities may provide alternatives for those who do not require 24-hour skilled care, allowing them to remain in the community and maintain optimal levels of independent functioning. However, once the determination has been made that placement in a nursing home is appropriate, there are a few simple steps to assist in the process of selecting the home that is right for you.
Begin by researching the available nursing homes in your geographic area. The Centers for Medicare and Medicaid Services has established a website, www.medicare.gov, that provides a section titled "Nursing Home Compare." In this section, nursing homes can be located by state, county, city or zip code.
Once selected, comparisons can be made in relation to quality, staffing ratios, survey reports and fire safety deficiencies.
Other resources for identifying and obtaining information on perspective nursing homes include hospital discharge planners, social workers, physicians and your local Office for the Aging. Each nursing home has an ombudsman (volunteer resident advocate) who can be contacted through the local Office for the Aging as well.
Visiting each nursing home will also assist you in your selection. Formal visits or tours can be scheduled through the Department of Social Services, or you could just stop by and take a look around (though staff may not be available to assist you without an appointment). Visit with residents, families and staff as you look around, and observe the activities.
Prepare your questions in advance to ensure all your issues and concerns are addressed, and ask for clarification for anything you see or hear and don't understand.
Other things to be considered when selecting a nursing home include, but are not limited to:
Bed availability _ Is there a bed available now, or will you be placed on a waiting list?
Staffing _ Are there a sufficient number of certified nurses' aides and nurses available?
Activities _ Monthly calendars can be reviewed to see the variety and frequency of programs offered at each nursing home. Further discussion with activities staff should be initiated for specific questions or comments.
Policies _ What policies and rules are in place that residents and sponsors must follow? This may include smoking, visiting hours, etc.
Services and fees _ What's included in the monthly charge? Are all the services required available at this home? How does one nursing home compare to the other?
Preventative care programs _ Are programs available such as immunizations for flu and pneumonia? Is there routine monitoring of blood pressure, weight, etc.?
Resident and sponsor involvement _ Does the home promote involvement through group forums, including resident and family councils? How often do these groups meet? What occurs at these meetings?
Resident information _ Interdisciplinary reviews are scheduled quarterly to review and update any care plan changes. Does the facility promote sponsor and/or resident involvement at these meetings quarterly? Biannually?
Hospice _ Some (but not all) nursing homes participate with Hospice for terminal care needs.
Nutritional services _ Can the facility comply with special diets and dietary restrictions?
Treatment availability/options _ All nursing homes provide custodial care, but some offer additional treatment options including peritoneal dialysis, central line care, intravenous medications, wound vacs, etc.
Once you've selected a nursing home, allow some time for everyone to adjust. The moving process is often very stressful for the resident as well as the family and significant others. It is very important to maintain open communication with nurse managers, social workers etc, so that any issues can be resolved quickly, and satisfaction with placement can be achieved.
According to CMS, about 9 million men and women older than 65 will need long-term care this year, and by 2020, 12 million older Americans will need long-term care. Most care will be provided at home by family and friends, and they will be the sole caregivers for 70 percent of the elderly. A study by the U.S. Department of Health and Human Services indicates that people who reach age 65 will have a 40 percent chance of entering a nursing home as they continue to age, and 10 percent of them will stay there five years or more.
Free booklets are available on Medicare and long-term care issues can be ordered by calling (800) MEDICARE. Titles include: "Choosing Long-Term Care," "Medicare Savings Programs," "Medicare and You," "Medicare Coverage of Skilled Nursing Facilities," "Medicare and Home Health" and "Medicare Hospice Benefits." Visit the CMS website, www.cms.gov, and click on "Long Term Care" to begin the LTC planning process. A few minutes of your time today may significantly reduce the stress of making a difficult and often unprepared decision in the future.
Karen Mowers, a registered nurse with a Bachelor of Science degree, is director of nursing services in the Fox Nursing Home.
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