A Guide to Nursing Homes

From: http://www.helpguide.org/elder/nursing_homes_skilled_nursing_facilities.htm

As the population ages, more of us are faced with the prospect of moving
either ourselves or an older family member into a nursing home. It may be a
decision that arrives suddenly after a recent hospitalization or you may have
gradually noticed more and more needs becoming difficult to manage in other
types of housing.
The decision to move to a nursing home, skilled nursing facility, or
convalescent home can be a stressful one for both the older adult and their
family. Some of this is a result of the many misconceptions about these types of
facilities. To make an informed decision, it’s important to learn all you can
about how nursing homes work, when a nursing home is the best option, and how to
find the nursing home that is right for you or your loved one.
In This Article:
What is a Nursing Home?
When should I or a loved one consider a nursing
home?
Choosing a nursing home
Understanding nursing home costs
What you may be feeling as you go through the process
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What is a Nursing Home (Skilled Nursing
Facility)?
A nursing home is normally the highest level of care for older adults outside
of a hospital. Nursing homes provide what is called custodial care, including
getting in and out of bed, and providing assistance with feeding, bathing, and
dressing. However, nursing homes differ from other senior housing facilities in
that they also provide a high level of medical care. A licensed physician
supervises each patient’s care and a nurse or other medical professional is
almost always on the premises. Skilled nursing care is available on site,
usually 24 hours a day. Other medical professionals such as occupational or
physical therapists are also available. This allows the delivery of medical
procedures and therapies on site that would not be possible in other housing.
The label “nursing home” has negative connotations for many people. Yet
nursing homes provide an important component of senior housing options. It's
important to separate nursing home myth from fact.
Myths about nursing homes
If I can’t take care of myself at home, a nursing home is the only
option. Today, there are many options to help older adults to stay at
home, ranging from help with shopping and laundry to caregiving and visiting
home health services. If home care options are no longer possible, other
options, such as assisted living, may be a better fit if the primary need is
custodial care rather than skilled medical care. Even if hospice care is being
considered, home care is also often a possibility.
Nursing homes are for people whose families don’t care about them.
Many cultures have strong beliefs that it is family duty to care for
elders. However, in today’s world of smaller families living farther apart, work
conflicts, and people living longer with more chronic illness, it simply may not
be possible. Considering a nursing home does not mean you don’t care about your
family. If you cannot provide the necessary care, it is the responsible decision
to find a place where your family member’s needs will be met.
Nursing homes are poorly run, and I or my family member will get
awful care. While it is key to research homes thoroughly and visit
frequently, it is not true that all nursing homes provide poor care. There are
more and more safeguards in place, and a facility’s staffing information and any
previous violations are available to the public to help you make your
decision.
Once I’m in a nursing home, I’ll never leave. Some illnesses
or injuries have progressed to the point where both ongoing medical and
custodial care may be necessary through the end of life. However, many people
encounter a nursing home for the first time after a sudden hospitalization, such
as from a fall or stroke. After rehabilitative care, either returning home or to
another housing option may be a better fit.
Living arrangements in a nursing home
The ambience and layout varies from nursing home to nursing home. For
example, some rooms may be private and others shared. Rooms may have their own
bathroom, or they may need to be shared with others. Some meals may be provided
in the room, while others may be in a centralized dining area.
While nursing homes have traditionally been set up in a medically-oriented
design, with ease of patient care being the primary goal, some homes are now
moving to a newer design model. This features smaller communities of 10 to 30
people within a home, private kitchens, communal areas, and continuity of
staff.
When should I or a loved one consider a
nursing home?
Whether you and your family are facing a quick decision about a nursing home
due to a recent event, or have been coping with a worsening progressive disease
such as Alzheimer’s or Parkinson’s, considering a nursing home is not an easy
decision. Emotions such as guilt, sadness, frustration, and anger are normal.
Working through the possibilities of housing, finances, and medical needs can
help you and your family make an informed decision.
Here are some questions to ask when considering a nursing home:
Has the senior been assessed recently? If a nursing home is
being considered as the next step from a hospitalization, this probably has
already been done. However, if a senior is considering a move from home or
another facility, a more formal assessment by a medical team can help clarify
the senior’s needs and see if other housing options may be a possibility.
Can the senior’s needs be met safely in other housing situations?
The risk of falls may be too great, or the senior’s medical needs may
no longer be able to be met at home or in another facility. If the senior needs
24-hour supervision, or is in danger of wandering off or forgetting about a hot
stove, for example, a skilled nursing facility may be the best option. If the
senior’s needs are solely custodial, though, an assisted living facility may be
a better fit.
Can the primary caregiver meet the senior’s needs?
Caregivers are often juggling the needs of work, other family, and their own
health. It’s not possible for one person to be awake and responsive 24 hours a
day. Sometimes other family members can help fill in the gap. Day programs, home
care services, and respite care, where a senior temporarily stays in a nursing
home, may also provide the support a caregiver needs. However, there may come a
point where medical needs become too great and home care services are unable to
bridge the gap or become too expensive.
Would the need for a nursing home be temporary or
permanent? Sometimes, a temporary situation may be covered through home
care, or family members might be able to rotate care on a short-term basis.
However, if the level of care is expected to be permanent, this may be too
expensive or coverage might not be enough.
Nursing home
vs. other types of senior housing
Nursing homes provide some of the highest levels of care, both medical and
custodial. If you’re not sure that you or your loved one needs that level of
care for the long term, learn more about other types of senior housing,
including home care, to see what will best fit your needs.
Choosing a nursing home
Finding a nursing home
Finding the right nursing home is not easy, and you may be under pressure to
move fast due to a recent hospitalization or deterioration in a health
condition. The more information you have, the greater your chances of finding
the right fit for you or a loved one. Here are some tips on narrowing down your
options:
Start with referrals. Does your family physician or
specialist have any recommendations? Or do you know any friends who have used
different homes? Knowing someone with first-hand experience of a nursing home
can help you narrow your choices. However, remember your needs may differ: one
size does not fit all.
Educate yourself. Online resources for nursing homes
include ranking sites that utilize existing state data to rate nursing homes. In
the U.S., every state has what is called a long term care ombudsman, which can
be a valuable resource about the current condition of a nursing home. Advocacy
groups can also provide hints on searching for the right facility. See the
Resources section below for more information.
Consider your medical needs. Different nursing homes may
have more expertise in different areas. Are they experienced in handling your
condition, such as for Alzheimer’s or a stroke? Or are you looking for more
short-term rehabilitation?
Factor in distance. In general, the more convenient the
home, the easier it is for family and friends to visit.
Planning a visit to a nursing home
Once you’ve narrowed down your list of homes, it’s time to plan a visit.
Visiting is key to understanding if a home is right for you. As with other
senior housing options, it’s the people that make the place, both the residents
and staff. In a nursing home, you’ll also need to make sure that the medical
care is delivered appropriately and promptly.
What to look for in staff at a nursing home:
How is the staff turnover? What is the staffing level on weekdays, weekends,
and evenings?
Do they have time to speak with you or does it feel rushed?
How would they manage your health condition? How are medications and
procedures arranged? And how do they handle emergencies or accidents such as
falls?
Do they appear genuinely interested in you, and do you see them interacting
warmly with current residents?
What to look for in current residents and their
families:
Do the residents appear happy, engaged? Or excessively groggy and
overmedicated? Do they seem clean and well groomed? Do they seem like people
you’d enjoy getting to know? How do they respond to you? Try to observe social
gatherings such as meals or other activities. If needed, are residents getting
timely help to eat, and with getting to and from the gathering areas?
If you see a family visiting, you can ask them about their impressions of
the home and how their loved one has been treated. Ask if there is a family
council and if you could attend.
What to look for in the nursing home facility:
Cleanliness. Does the facility appear clean? Do you smell
urine or strong deodorizers that may be covering up the smell of urine?
Food. What kinds of meals are normally served? Does it look
nutritious and appetizing? How are special diets handled? What kind of help is
available with meals, and do they have to be eaten at the same time or in a
common area?
Arrangement. Traditionally, nursing homes have been run
like a medical facility, including a centralized nursing station and set
medication and mealtimes. Some nursing homes are now moving to a different
model, with smaller communities and communal areas. If this type is available in
your area, it may provide a more homely feel.
Activities. What quality of life activities are available
for residents? Are outside activities also arranged, health
permitting?
Experience with your condition. If a loved one has
Alzheimer’s, for example, is there a special care unit or specialized staff and
activities? How does staff handle behavioral problems like agitation or
wandering?
Understanding Nursing
Home/Skilled Nursing Facility Costs
In the U.S. nursing home costs are a big part of nursing home care and can
vary widely depending on the state you live in. Average costs are around $70,000
per year so you need to know how you’re going to pay for nursing home care. It’s
important to understand the limitations of insurance in covering costs:
Medicare only covers limited stays in nursing homes. Skilled nursing or
rehabilitation services are covered for a period of about 100 days after a
hospitalization. Medicare does not cover custodial care (such as assistance with
feeding, bathing, and dressing) if that is the only care needed.
If your income and assets are limited, you may qualify for Medicaid, which
does cover most of the costs of nursing home care. However, not all nursing
homes accept Medicaid. If you suspect that you may need extended nursing home
care in the future, you may want to contact an elder law attorney to learn more
about which assets are protected and to what extent. For example, if you have a
spouse living at home, your home is normally not considered in eligibility for
Medicaid for nursing home purposes, and some of your savings may be partially
protected as well.
If you have long term care insurance, check the provisions of your plan to
see what portion of nursing home coverage is protected.
The Resources section below provides more information on managing and
planning for nursing home costs.
Handling the emotions of moving to a nursing
home
Moving is a stressful transition, even at the best of times, and moving to a
nursing home brings with it a whole host of different emotions.
If you are the one moving, you are leaving behind a familiar place and
memories. If the nursing home move was due to a hospitalization, the transition
may have been abrupt and you may not have had time to even process what has
happened. Add to that increased medical needs and decreased mobility, and it’s
no wonder moving to a nursing home can be so stressful. You may even feel angry
and abandoned by family members, even if you realize that they can’t provide the
level of care you need. Anger and grief are perfectly normal emotions.
If a loved one is moving, you may feel guilty for being unable to provide
care, or sad that your loved one has to go through this transition. You may feel
relief that your loved one is getting the care they need, tempered with guilt if
caregiving has been particularly intense. Family members may have been arguing
about whether a nursing home is necessary, where it should be located, and who
should be the point of contact.
Easing the transition
Everyone needs time. Both the older adult and his or her
loved ones need time to adjust to this transition and come to terms with their
own their feelings. Trying to sweep anger and grief under the rug or refusing to
acknowledge the difficulties of the transition will only intensify these
feelings.
The older adult takes the lead. As much as possible, the
older adult should be the one making the decisions about which nursing home is
best. Whenever possible he or she should come along on visits when making a
nursing home decision, and make the choices about what to take along and how to
personalize the room. If the older adult is unable, loved ones should try to
think about what his or her wishes might have been. A familiar blanket or
favorite music, for example, may provide comfort even if the older adult is
unable to verbalize it.
Tips for loved ones
Keep in regular contact. Even if you live far away, frequent
calls, letters, and emails make a big difference. Regular visits by family and
friends help ease the transition. Keep your loved one in the loop about family
events as much as possible.
Stay involved. Regular contact not only reassures your loved
one, but allows you to serve as an advocate for your loved one’s needs. Even if
you’ve chosen the finest facility, you want to make sure your loved one’s care
continues to be of the highest standard, so visit at irregular hours to make
spot checks, and get to know the staff. The more engaged they feel you are, the
more attentive they are likely to be towards your loved one. If the nursing home
has a family council, a group of relatives and friends who meet on a regular
basis to discuss concerns and issues, consider joining.
Related articles and resources for choosing
nursing homes