Choosing a Nursing Home

Your Resources
Since women live longer than men do on average, they are at risk for many diseases that are less prevalent among the rest of the population. Women currently make up about two thirds of nursing home residents. 72% of caregivers for the elderly are women.

When you conclude that a loved one needs full time care, deciding how to get that care for them is difficult. Develop a network of people to consult, including your relatives doctor, clergy, social worker, and other family members when making this decision. If your relative is mentally competent, it is very important to include her in this decision as well.

Planning ahead is important, but many families find themselves in the difficult position of needing to find a nursing home for a relative on short notice. In either case, there are several factors that must be taken into account when making this decision. The aim should be to come to an arrangement that every member of your network is comfortable with.

Your Options
Home and Community Care
In some cases, a relative may wish to stay at home and may not need full time care. For these cases, there are home services available in most communities. Home services may include meals on wheels programs, friendly visiting and shopper services, and adult day care. There are also a number of programs that help care for people in their own homes. Some nursing homes offer respite care. This is when they admit a person to the nursing home for a short period of time to give the home caregivers a break.

Subsidized Senior Housing
Some Federal and State programs subsidize housing for elderly people with low to moderate incomes. Many of these facilities offer assistance to residents who need help with certain daily tasks such as shopping and laundry. Generally, these residents live independently in an apartment within the senior housing complex.

Assisted Living (Non-Medical Senior Housing)
For those who only need a small amount of help, such as cooking, laundry, and medication reminders, assisted living facilities may be worth considering. Assisted living is a general term for a living arrangement in which some services are available to residents (such as meals, laundry, and medication reminders), but the residents still live independently within the complex. Usually, these residents pay a regular monthly rent plus additional fees for the special services that they require.

Board and Care Homes
These are group living arrangements that are designed to meet the needs of people who are unable to live independently, but who do not require nursing home services. These homes offer help with some of the activities of daily living, including eating, walking, bathing, and toileting.

Continuing Care Retirement Communities (CCRCs)
CCRCs are housing communities that provide different levels of care based on the needs of their residents. The living arrangements will vary from independent living apartments to skilled nursing in an affiliated nursing home. Residents can move from one setting to another based on their needs at a particular time, but continue to remain a part of the CCRC's community. Many CCRCs require a large payment prior to admission, then charge monthly fees above that.

Nursing Homes
A nursing home is a residence that provides room, meals, recreational activities, assistance with daily living, and protective supervision to residents. Nursing home residents usually have physical or mental impairments that keep them from living independently. Nursing homes are certified to provide different levels of care, from custodial to skilled nursing. These services can only be administered by a trained professional.

Gathering Information
Check your yellow pages to find out the locations of nursing homes in your area. Finding out about these nursing homes is the next step. Word of mouth can be a good source of information. Ask your friends and neighbors if they know people who have stayed in local nursing homes.

One source of information is your local long-term care ombudsman. Ombudsmen visit nursing homes on a regular basis. Their job is to investigate complaints, advocate for residents, and mediate disputes. Ombudsmen often have knowledge about the quality of life and care inside each nursing home in their area that may not be available from other sources. However, Ombudsmen are not allowed to recommend one nursing home over another.

Other resources that you should consult before choosing a nursing home include hospital discharge planners or social workers, physicians who serve the elderly, clergy and religious organizations, volunteer groups that work with the elderly and chronically ill, and nursing home professional associations. Other factors to consider include religious and cultural preferences, Medicare and Medicaid participation, HMO contracts, special care needs, and location.

The Nursing Home Visit
Make sure that you visit the nursing home before making your final decision. Some issues to keep in mind during your visit include:

  • Are staff members courteous to residents, and is the homes management responsive to concerns raised by residents?
  • Does the nursing home provide a variety of activities and allow residents to choose the activities they want to attend?
  • Does the nursing home provide menu choices or prepare special meals at the request of residents? (Sample the food if possible.)
  • Are family members encouraged to visit, and are they allowed to visit in privacy when requested?
  • Check the survey report and see if the home was cited for deficient practices in any quality of care areas.
  • Ask about the homes staffing, and ask residents if the staff is available when needed. Make sure that you are comfortable with the number of residents assigned to each nurse and nurse aide. Be aware that there might be fewer staff at night or on the weekends.
  • If you have any special care needs (i.e., dementia and ventilator dependency), it is generally a good idea to make sure that the home has experience in working with people who have had the same condition.
  • Even if you have a trusted doctor, ask about the nursing homes physician and how often he or she visits the home. Since the homes doctor may be called in case of emergencies, you should be confident that the homes doctor can take care of resident needs.
There are many other questions to consider, especially in terms of quality of life and safety issues. Medicare has a detailed checklist that may be very useful for those choosing a nursing home for a relative.

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