Be Proactive || What You Need to Know about Nursing Home Care---Make Informed Choices

Years ago before time slipped away

Daddy, Padi, Mother
Daddy, Padi, Mother | Source

When this article was originally written something very important was left unsaid. It is something that we all know but that we may forget.

it is this.

Your Momma or Daddy may become elderly and unable to take care of themselves at some point.

Every day they are on the planet is a gift.

Taking care of them will ask a great deal of you and your immediate family. It will mean that you have to go out of your way to do things for them.

It will mean that you may spend long hours in the doctor's office or at their bedside in the hospital.

Choose Carefully

The bottom line is that while they are on the planet they need you. When they close their eyes for the final time, they will no longer need you. When they are gone, they are gone. So each moment you spend with them will be moments you can cherish when they have died.

You will not second guess whether you did right by them or not. You will know that you did all you could for them. Whether they live in your home till their last days or whether they live out their last days in a nursing home will be determined by many factors.

If a nursing home is a choice, you will want to choose very carefully and consider all sides of the decision.



I want to awaken the passion and creativity of youth, combine it with the wisdom, experience and insight of elders, and transform our world.

— Ocean Robbins

Getting Started

For some of you, the decision about your Mother or Father's care will be made even before you have made your plans for your life. The main focus of this article is on care of your loved ones. However as you consider all of these issues, you will also be thinking about how to plan for these needs in your own life.

There are some families who are able to afford assisted living facilities; for others, nursing homes are the choice.

For either one of those, basically the same factors should be considered. In this article several things will be discussed. The first segment of the discussion will be my experiences with nursing home care for my Mother and the second segment will provide some information you will want to begin thinking about as you and your family begin to plan for the future.

Have a Plan for Your Elder Years Too


If we are lucky, we live to be old enough that decisions about where we live must be made. Lucky may not be exactly the correct word. It may be good genes or living well but for whatever reason old age, becoming a senior citizen, an old codger, or perhaps some less endearing term happens to us.

Since we know this will probably eventually be our reality, we have a responsibility to make decisions about what will happen to us before we are unable to make those decisions. Tell someone one, preferably more than one person, what your plans are. Better than that, write it down so that there is no question. When you make your will draw up a second document that states your exact wishes. That way the decision will be made and your family will not need to make such decisions.

You do not want this to happen to someone you love...it is heart breaking to watch.

When I was young I was called a rugged individualist. When I was in my fifties I was considered eccentric. Here I am doing and saying the same things I did then and I'm labeled senile.
George Burns

Have you made decisions about assisted living or nursing home care for you or your parents/

  • Yes. I have taken care of that.
  • No. I will do that sometime later
  • i am in the process of visitng nursing homes/assisted living facilities.
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The child is now the parent


There comes a time in the life of a family when changes occur that will turn the entire dynamic of that family on its head. Those who have loved you, counseled you, cared for you, shared with you, clothed you, fed you, and were there for you through all that you faced are no longer able to be all things to all people.

Often a time comes when the child is the parent. It is heart wrenching.

It is a lonely, sad, terrifying, and, very humbling place to be.

The transition comes gradually in some families. Turning over some of the responsibility for managing bills or driving them to the grocery store or to the doctors are some of the gradual ways that change occurs.

In some cases, not all, the deterioration of physical and mental abilities does not become debilitating to the point that nursing home care becomes necessary. In other cases, it does. Now, if the family is blessed to have enough money that nursing home care is not the only choice for a family that is an ideal. You are blessed and your parent or parents are blessed.

Some things to consider when choosing nursing home care

 
 
Track Record
Does this nursing home have reported abuse cases?
Location
Can I travel to and be visible at this nursing home facility often?
Personnel
Do I feel welcome when I visit? If I place a family member there, how does she or he react to the staff who offers care?
Medical care
is medical care readily available in case of an emergency? Is medication dispensed properly? How is that monitored?
Cleanliness
Is the facility clean? Is there a storng odor upon entering that make it clear that cleaning is not a priority?

A difficult decision

WIth great trepidation, we conferred, my sisters, her sisters, and I and the decision was made for her to be placed in a nursing home. It was one of the single most difficult moments in my life. I had heard so many horror stories about nursing homes. The thought of my precious Mother being in ONE was horrendous to me. I did not sleep well. Nightmares filled my days and nights but we had no choice.

I visited her once a week for 3 weeks and each time I went to that place I left unhappier than the time before. It was a sad, sad place. One of the worst parts about it was that when I entered the doors, it was too warm, almost hot. And the odor was one of a lack of total lack of cleanliness. i do not mean to be too graphic but it was kind of like when you go into a public restroom and you leave without using it because it is so stifling and filled with unpleasant odors. It was inescapable.

If that was not bad enough, there were be wheelchair after wheel chair filled with someone's loved ones in the hallways. There was no joy in any of the eyes that longed for a touch or a kind word as I passed.

This just was not working. Our family had another round table discussion about Mother's placement and we found a place in DeLand, Florida, that came highly recommended. I was still sketical and unhappy about the whole situation as the facility we had placed her in had also been highly recommended.

Family discussions

Our lives are filled with many choices and decisions. My Mother was almost fifty when I was born and my Father was almost sixty. I was not ready for the transition from child to parent when it came.

When my Father became bedridden in his ninety second year, his precious Martha, my mother, cared for him each day until his final day. She was fragile herself and there were a few of us to help her but basically she cared for him, day and night. Bathing, changing his feeding tube, and loving him, until his death.

After he died, another part of her light went out. The first part had gone out many years before that when our nine year old sister died of a brain tumor.

Mother had had many health concerns over the years and from that point on her physical well-being declined more rapidly than previously. Finally she was unable to live alone. She moved in with my daughter and me. For about a year, I was able to juggle working, being a Mom, and caring for her. After a time that became impossible. Mother began to have medical concerns that required supervision and care throughout the day and night. There was no way that I could work and meet her growing needs. Financially I was unable to hire someone to come in and care for her. A predicament most children of elderly, infirm parents also share.

Source

Visit often

The nursing home in DeLand proved to be a wise choice. My involvement in her stay at this new facility was much different than it had been in the previous one. I realized it was my responsiibilty to insure that she got the best care. I could not assume that someone else would love her the way I did, they way my sisters did. I knew that I had to be the factor that made it certain she got the BEST possible care.

Mother was in a facility located an hour from the home I shared with my daughter That was not to be a stumbling block for me. Each day I rose at four, dressed, and drove to the Nursing Home. I visited with her as long as I possibly could before leaving from there to go to work.

Talk to Loved Ones When You Visit

I was never one to be at a loss for words so I jabbered on and on about this thing and that thing. Often I would tell her of some new plant in the yard, describing it in great detail and thanking her for her gift of being in touch with nature and how to grow spectacular things. That had been her life's work: loving her family and making the world beautiful.

At the end of the day, I repeated the morning routine in reverse. I drove from work to the nursing home to visit. I usually stayed a couple of hours at this visit. This time of the day I would rattel on and on about Stef, my daughter, and some new milestone in her life. And her eyes would light up with recognition. By this point she could no longer speak. When the visit ended, I drove home and spent the rest of the evening with my daughter.


My Mother taught us to love all things in nature...

Source

Abuse in nursing homes

No one wants to talk about it but it happens. Elderly loved ones are abused in nursing homes. We have all seen video about such abuse. We have read articles about this type of abuse.

And the sad fact is, most of us have thought "O, how sad" and flipped to a different article or pressed our remote or mouse to go to a new topic. We do not want to read of this.

Beating because they use the bathroom in the bed, abuse by other residents, abuse by the staff at the nursing home facility, being raped by staff members are all examples of what happens. And it happens far too often.

Be certain too that the facility is paying vendors who provide services such as waste removal, pharmacies, and other such services.

This is reason enough for you to be on top of things when you choose care.

Unexpected visits

While I did go twice a day, every day, no one knew the exact time I would appear. That is important to remember.

Her care while she was there which was until her death about nine months later was superb. Her bedclothes were pristine. Her body never had a bed sore and she was bedridden so chances of one occurring were great. Her body was clean. The light in her eyes was still there..some of the light in her soul had left with the passing of her Papa but I could still see some joy when I came to visit.

When I entered that facility, I never inhaled the usual unclean, not fresh odor of a nursing facility that was not well kept. The general feel of it was that it was a place that I felt comfortable to be the place my Mother received her care when I was away.

I do believe that my frequent visits were at least in some small part responsible for the remarkable care that my Mother received. No one ever knew when I would be coming around the corner on the way to visit her as was mentioned above.

It was my responsibility to see to it that she was well cared for. My attitude toward her and toward the workers direclty influenced how she was treated and cared for. There is no doubt about it.


Consider these important issues

■■If a resident has a problem with confusion and wanders, how does the staff handle this type of behavior in the facility to protect the resident?

■■Does the nursing home’s inspection report show quality of care problems (deficiencies)?

■■What did the quality information on “Nursing Home Compare” at www.medicare.gov/NHCompare show about how well this nursing home cares for its residents?

Location

■■Is the nursing home close to my family and friends so they can visit often?

Availability

■■Is a bed available now or can I add my name to a waiting list?

Note: Nursing homes don’t have to accept all applicants, but they must comply

with local, state, and Federal civil rights laws that prohibit discrimination."

Questions to consider

On the medicare.gov site there is a comprehensive section about choosing nursing homes as well as assisted living facilies. It is worth the read. The following is only a small series of questions that is given for you to consider. What I like is that the questions were formulated as if the person who will be in the facility is asking them. If your family member is unable to consider these questions, you can do so.

"Steps to Choosing a Nursing Home Quality of care

■■What’s a plan of care and what does it look like?

■■Who makes the plan of care and how do they know what I want, need, or what should be in the plan?

■■Will I be included in planning my care?

■■Will my interests and preferences be included in the care plan?

■■Will I be able to change the plan if I feel there is a need?

■■Will I be able to choose which of my family members or friends will be involved in the planning process?

■■Will I get a copy of my care plan?

■■Is there enough staff to give me the care I need?

■■Who are the doctors that will care for me? Can I still see my personal doctors? Who will help me arrange transportation if I choose to continue to see my personal doctors and they don’t visit the nursing home?

■■Who will give me the care I need?

An archaelogist is the best husband a woman can have. The older she gets the more interested he is in her.

Agatha Christie

Never forget the humor....it keeps the soul moving right along.


Down to the nitty gritty

The point is in order to insure excellent care in a nursing home it is necessary for family members to put themselves out for their loved one. If your family member does not live near you, then, you need to select a facility that IS near you...within an hour or so drive of where you live. That is the way that you will be able to insure the kind of care you would wish for your most precious family members to have. It is your responsibility. In case you are thinking, that is not my problem. Wrong. It is your problem. Your responsibility. Even if no one else steps up to help. It is your time to give back.

Maybe you will be unable to do as I did. But with them near you, frequent visits can be possible. The more frequently you visit, the more likely your parent(s) will be treated as you desire. If you make it clear by your actions that you will be there often, you can expect that your family member will be 'fluttered over' often and well.

If on the other hand, you take them to a facility and drop them off and do not visit, again your actions speak louder than words. Your message is. " I don't have time for this. YOU take care of them." I was even told by a worker at a facility that if the family leaves a family member and does not visit that they will be neglected and possibly abused. Pretty damning words.

There really is no excuse not to be there often for those family members who cared for you each day as you grew up. All things being equal. If you had a horrible childhood experience, then chances are you would not be involved in this decision making process anyway. Your decision about your involvement in visiting will of course be a decision you, and you alone, can make. The only thing I can tell you from personal experience is: you will never, ever regret the time you spend with your Mother or Father or other loved one at the end of their life.

Again...

  • The best nursing home care for your family member will be in a facility that is within close proximity to where you live.
  • The best nursing home care will happen if you are actively involved and are proactive in the care of your loved one.
  • Will it cause some prioritizing on your part?
  • Will it cause a new responsibility for you and maybe shift some of your already existing responsibilities to someone else in your family?
  • Will you be so glad when this precious person dies that you did spend the last months of their life as a main focus of your life?

The answer to those questions is obvious. One thing is certain...you will never have regret. You will never have to second guess your decision. You will never have to 'shoulda', woulda', coulda' this decision. You will know that you returned to your parent(s) in some small way the gift of your time and attention that they gave for you throughout your life.

"It's okay, Grandma, We will take care of the flowers for you."

On one of the last visits to Mother, at the nursing home, it was a Saturday and my daughter was able to go with me. As we were about to wind up our visit, she said with no prompting from me and we had not discussed this before our visit either:

"Grandma, it is okay. You can go now. We will take care of the flowers for you." You could see the smile in Mother's eyes.

Even now as I write this, tears flow. She is gone but we are still connected to her. My daughter loves to plant and grow things as is very skilled at it. Her Grandma taught her when she was a very young girl to love the land. And she of course saw me follow in her footsteps and she continues the legacy. We remain connected to her as you know if you have read any of my writings.

Choosing and following through on your parent's care at the end will bring your life full circle.

© 2012 Patricia Scott

More by this Author


Comments 11 comments

pstraubie48 profile image

pstraubie48 22 months ago from sunny Florida Author

And I am not insensitive to those who cannot visit often. But being nearby is the most important way to insure good care.

Angels are on the way to you this morning ps


GoldenRod LM profile image

GoldenRod LM 22 months ago from Superior, Arizona USA

I agree that unexpected visits are a must. If a facility is on the up and up, nobody need feel offended. One can never be sure of who is working at such places, even if a care facility has a good reputation. I tell all in my family of the importance of frequent visits and adjusted times. You said, "Once they are gone, they are gone." Sometimes we only learn that after they are gone. What a pity. Good hub and advice.


pstraubie48 profile image

pstraubie48 23 months ago from sunny Florida Author

Yes it can backfire but usually in my experience that happened because someone was not kind to the staff. I know that is not always the case..but I do know that my Momma got the best care...she never was abused, neglected, or any such thing. She never had a bedsore and she was cared for kindly. And for that I am ever grateful

thank you for stopping to read and give your in depth comment.


RachaelOhalloran profile image

RachaelOhalloran 23 months ago from United States

This was a very informative article that anyone faced with nursing home placement should read. It is true that being a "presence" in the nursing home gets your loved one more hands-on care, but sometimes it backfires in that the staff are snide to the loved one, especially if the family is demanding or ill-natured about their loved one not being cared for in the manner they expect. Two faces are put on; one for the patient and one when the family is in the facility.

I was a critical care nurse for 10 years, and later went into home hospice care - a job I stayed in for 15 years. It is a similar situation that families face - choosing the right agency, then clicking with the right nurse. I was not always the right nurse. lol

But I am proud to say that I have helped more patients pass over to death in as easy and comfortable a manner as was possible, kept in touch with family members with alerts and complete reports and told them I expect impromptu visits from them at any time.

You see, most families were wary of me in the initial days of employment and some even went to the agency to request another nurse because they doubted my skills due to my disability. Some didn't understand how I would be able to be alert to their loved one's needs if I couldn't hear them in distress or calling out.

Choosing a home care agency (and nurse) is just as important as choosing a nursing home and your outline here can be attributed to both.

Loved ones absolutely MUST drop in unannounced. They MUST NOT expect the home care agency to be the family to their loved one - their presence is required, their loved one MUST know they are in the room and often.

I learned that it is not how long you stay, it is how often you visit that counts. A patient will tire out on long visits, and short visits seem to work best for everyone all around. Families tire out just as easily as the patient when they stay for hours and hours. Visits should always include mealtime, medication time, and getting ready for bed so families can be assured that their loved one is being properly cared for.

I'm so glad to read how your Mother was taken care of, that you did your homework in gathering information and recommendations before placement and that you are able to pass that on to all who read this.

Rache


pstraubie48 profile image

pstraubie48 3 years ago from sunny Florida Author

I so understand, Liz It is a gut wrenching decision when we have to place our dear loved ones in the care of someone else. All I can say is to try to visit as often as you can. The more present you are the better for her.

To you today I am sending special Angels to comfort you and to protect your Mum.

ps


Lizam1 profile image

Lizam1 3 years ago from Victoria BC

I have just moved my mum into a care home. Living so far away and not, at the present time, being able to move closer has made this necessary. A tough decision.


pstraubie48 profile image

pstraubie48 4 years ago from sunny Florida Author

Good evening, Lindacee

Sadly we do all have to face this. My eldest sister is in this age group now. She is not well but she still lives in her own home. I try to visit her at least once a month; she lives 2 and one half hours away. Hopefully she will never have to go to a nursing home. It is a devastating time for a family. But as we know, if we are nearby and can visit, that makes all of the difference. Thank you so much for stopping by. I will be over to visit soon.


lindacee profile image

lindacee 4 years ago from Southern Arizona

I went through this with my mother. It is a gut-wrenching decision. But being diligent and doing your homework will make things slightly easier. Your suggestions are right-on. I also agree it is best to have your loved one in a nearby facility so you can make those unexpected pop-in visits. Wonderful and important information on a subject that most of us will face at one time or another.


pstraubie48 profile image

pstraubie48 4 years ago from sunny Florida Author

Hi, rfmoran,

I do not think that families leave their family members in the care of someone else shirking all resposibility. I just think perhaps they do not realize how important it is that they are actively involved in the whole process. thank you for stopping by. I will be over to visit soon.


pstraubie48 profile image

pstraubie48 4 years ago from sunny Florida Author

Hi, rfmoran,

I do not think that families leave their family members in the care of someone else shirking all responsibility. I just think perhaps they do not realize how important it is that they are actively involved in the whole process. thank you for stopping by. I will be over to visit soon.


rfmoran profile image

rfmoran 4 years ago from Long Island, New York

This is a powerful resource hub for the millions of us who go through this experience. You are so correct: we have a responsibility and can't fork it over to the nursing home. Good point about visiting frequently and varying the times of the visits. Voted up, useful and interesting.

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