Choosing A Long-Term Care Facility
How to Know When the Decision is Imminent
In many instances, a hospital stay or visit to a family doctor will necessitate the decision that a move to a long-term care facility must be made. Other times, family members or close friends will notice that a senior's health or safety seems to be at risk due to physical and/or mental limitations.
Sometimes, it is the senior himself who broaches the topic of the need for nursing home care. Don't take the opening of this topic lightly. Relinquishing the last vestiges of independence is not a decision that anyone comes to easily. This is as true for someone in the latter stages of life as it is for those just beginning adulthood.
Indications that nursing home care is needed may be issues related to undesired weight loss/gain, other nutritional concerns, safety concerns, memory impairments, multiple chronic illnesses, frequent falls, trouble walking, difficulty managing medication administration and others. The need for constant supervision to prevent exacerbation of illness and considerations of safety and quality of life are important considerations in making the decision that long-term care is needed.
Choosing a Nursing Home
Make Use of Available Resources
Choose among licensed nursing facilities. Most long-term care homes are licensed by the state where they are located, but there may be a few that are not. Choosing a licensed nursing home means that the facility has to adhere to the basic care and management requirements of the state to have its license renewed annually.
The National Council on Aging provides a comprehensive list of the departments of health and aging for all states. The U.S. Administration on Aging provides free Eldercare Locator services that can be accessed online or by phone Monday through Friday at 1-800-677-1116.
Each nursing home must also provide records of annual licensure surveys to the public. You may ask to look at these records at any time.
Any nursing home that receives payment from the Medicaid system must also pass an annual certification survey. The requirements to pass a Medicaid certification are more specific than that of a the licensure survey. These records must also be available at each facility for public availability.
Another reliable source of information on various nursing homes can be found through each state's long-term care ombudsman or senior advocacy services. Ombudsman are available to any nursing home resident or concerned citizen about concerns regarding nursing home care.
The ombudsman is a neutral observer who visits any long-term care facility that has had a complaint or concern lodged against it. Reports of these visits and how the complaints/concerns were answered and corrected if found to be justified are a matter of public record.
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The single best way to determine if a particular nursing home is for you or the senior in your life is to visit each of the places under consideration. Visit during different times of the day, if possible, and do so unannounced.
Frankly, smell, or the lack of it, is the most-notable feature to visitors. If the facility smells of human waste throughout the building, that's likely a sign that conditions of cleanliness may be an issue.
During the day, are there residents engaged in social activities? Are meals served in various areas of the facility to accommodate residents' needs and desires? Do staff members look harried and unavailable? Are residents clean and appropriately dressed? Are personal possessions such as dressers or upholstered chairs allowed in resident rooms?
These and many more issues should be considered before making a final determination on which facility to choose--if time allows. Sometimes, discharge from a hospital to a nursing home happens quickly, with little time for decision-making. If so, the senior always has the option later to request transfer to a different facility.
Social and Emotional Aspects of Long-Term Care
The senior's level of functioning will help to determine what issues are important in making the best possible nursing home choice. In addition to considerations of physical and mental function, what type of nursing home care is needed will depend on the services required.
There are two basic types of nursing home beds: skilled and intermediate care. Skilled care is needed when the physician orders services such as physical or occupational therapy. Certain medical treatments such as IVs require skilled nursing care.
Intermediate care facilities are nursing home beds that provide all the traditional services of a long-term care facility
Many nursing homes have some beds that are just for residents requiring the higher level of skill required in skilled nursing and the rest of the beds are for intermediate care. The advantage of choosing a nursing home with availability of both skilled and intermediate care beds is that the resident wouldn't have to move to a whole new facility should their level of care change.
Gone are the days when elderly people can be made to go to a nursing home unless they wish to do so. It doesn't matter if the senior chooses not to eat, take her medication, or go to the doctor. Until and unless a person has been adjudicated to be incompetent, that person is as capable as any other adult of making decisions, wisely or unwisely.
If you have a concern about the mental competency of someone you care about, consult an attorney to learn about the process of a person being deemed incompetent. This is not an easy thing to prove--and justifiably so. Taking away a person's ability to make their own decisions should be taken seriously and is likely irreversible.
Useful Online Resources
- NORC - Locate an Ombudsman and State Agencies. :: Locate an Ombudsman
Locate an Ombudsman or Senior Advocacy Group any where in the United States.
- State Aging Departments - Center for Healthy Aging - NCOA
This section of the Center for Healthy Aging's website provides a list of all State Aging Departments and links to each department's website.
- Eldercare Locator
Government-provided service to aid location of services for seniors throughout the United States.