When You are Faced with the
Nursing Home Decision, Part II

In the last issue of Family Ties, we talked about some of the factors that lead to nursing home placement, and the emotional impact of that decision. This article will address some of the practical issues in selecting a nursing home, and in adjusting to the placement once it is made.

If your loved one is not entering a home during a crisis situation, you will have time to research and visit several nursing homes. You can get names of homes from the LIFE (Lunderman Information For the Elderly) office, the telephone book, your doctor, or friends. Your choice of homes may be limited by waiting lists, location, or cost, but carefully exploring the options will allow you to make a wise and informed decision. Make sure you visit the home, and take the older person with you, if possible. Some things to look for and ask about:

 What levels of care are offered? Intermediate care offers nursing supervision and assistance with personal care. Skilled care provides skilled nursing, medical and rehabilitation services. Does the home have an Alzheimer's unit?
 Does the home look and smell clean? Is the atmosphere pleasant?
 What are the fees and charges? Does the home take Medicare and Medicaid? Are there additional charges for special services?
 Are safety measures apparent-fire doors, sprinklers, call lights, grab bars in hallways and bathrooms?
 Do the residents look clean, well-groomed? Do you see positive interactions between the staff and residents?
 Is the diet appealing?
 Are there special services offered, such as physical therapy, occupational therapy, accommodations for special dietary needs?

  Are call lights answered promptly?
  Is there a range of activities?
Any provision to match roommates for compatibility?
 Are there support groups for residents and families?

Spend some time in the facility to get a sense of the atmosphere. Inspection reports are available through the State Health Department.

Once you have chosen the nursing home, make sure that you understand the contract. The home may have policies that their residents must have advanced directives regarding health care decisions, or have someone designated with a durable or health care power of attorney. You may want to consult with an attorney if you have questions about the contract or power of attorney. Every nursing home resident has a "Bill of Rights" that protects their civil rights in the institution.

Transition to the Nursing Home

Moving to a nursing home will have a significant impact on the older person and their caregiver. The process of adapting to the new environment can take several months, with the first 4-6 weeks being the most intense time. Remember that people go through many changes in life, and will utilize their strengths at coping with change when they go to the home.

 Bring personal things to individualize the room.
 Emphasize the continuity of your relationship, that you are not abandoning them. Plan to visit frequently, especially at first. Once settled in, take them out for visits, drives, or meals.
  Expect there to be some sadness, anger, confusion. Also, new residents are more at risk of falling, as they are unsure of their new environment.

 Get to know the routines, the shift changes, the best times to call.
 Share information about the older person with the staff. Attend case conferences, get to know the plan of care, and contribute helpful information.
Support the staff and show appreciation for their work.
 If you have concerns or complaints, try to complain to the right person.

Suggestions for Visiting

Express your concerns privately, in a non-threatening manner. Your positive attitude will build a good relationship with the staff.

Often, when a person is first admitted to a nursing home, family and friends come to visit but may feel awkward. Over time the frequency of visits may begin to dwindle. Keep in mind that even if the older person may not remember you, they are aware of your care and concern. A friend's visit is often a great show of support for the family, helping to show that this special person has not been forgotten.

Visits to a memory impaired person can be a bit more challenging, but the above suggestions can be helpful. Your presence is the most important thing.

Nursing home placement can be one more step in the continuum of caregiving. The older person moves from the community to the institution, and the caregiver provides less of the hands on care, but your love and concern remain constant. The LIFE (Lundermann Information For the Elderly) office is available to help you with both the emotional and practical aspects of nursing home placement.

Need to talk to someone
about your loved one?
Call L I F E
(Lundermann Information For the Elderly)
(555) 555-5555 or 1-800-555-5555