WHAT DO I NEED TO THINK ABOUT WHEN DECIDING ABOUT LONG-TERM CARE?
A GUIDE TO THOUGHTFUL DECISIONMAKING
More than 1.4 million Americans currently reside in a nursing home. The decision regarding how to obtain the best care for a loved one and where that loved one should live can be complex. It is important for friends and family to arm themselves with the information and skills necessary to weed through the options and make an informed decision. Finding a suitable facility requires a lot of research and a bit of investigative prowess. You will find that the right place will feel like a home, rather than an institution. Finding the right place for your loved one will provide both of you with the comfort that your loved one will continue to lead a happy, healthy and safe life.
DETERMINING THE LEVEL OF CARE NEEDED
What activities are limited – feeding themselves, dressing themselves, medication management, mobility, capacity, money management? Does the loved one have an illness that requires constant medical intervention – dialysis, IV medication, 24-hour memory care? Is the loved one capable of handling only certain parts of activities – they can take their medicine, but forgets to; can they get around pretty well, except on “bad days”?
Skilled Nursing Facilities
Skilled nursing facilities, commonly referred to as nursing homes, are typically what comes to mind when long-term care is mentioned. This type of facility is the highest form of residential care. Generally, eligibility for skilled nursing care (particularly those accepting Medicaid) requires the inability to accomplish activities of daily living without direct or readily available assistance. The primary factors that qualify a person for this type of facility are the inability to fully eat, bathe, or clothe themselves. Commonly, these types of facilities are for those that are significantly impaired – immobility, having to be fed, having serious medical ailments that require specialized medical attention.
Skilled nursing facilities provide around-the-clock medical care, in addition to regular assistance with activities of daily living. These facilities require the presence of medical doctors and licensed nurses, where less intensive facilities are not required to provide such expertise.
Assisted Living Facilities
Those that are able to do self-care tasks sufficiently will find it difficult to qualify for nursing care. Fortunately, loved ones able to complete these tasks, more or less, on their own may qualify for a minimized level of care called assisted living. In these facilities, caregivers take on a less direct role in the care management of the loved ones residing there. Residents typically handle the activities of daily living while staff provide 24-hour availability for assistance. These communities typically do not offer 24-hour medical services.
RESOURCES FOR LOCATING SUITABLE ESTABLISHMENTS
Finding the right skilled nursing or assisted living facility is challenging. With so many options to choose from, it is helpful to have a way to sift through the possibilities. The following resources provide guidance through comparable results of nearby facilities of different calibers. These resources may help you compare facilities and narrow down the list to a manageable number of facilities that may be best for your loved one.
Medicare – offers a way to compare institutions in your area. You will be able to find detailed statistics, health inspection reports, staffing ratios, penalties imposed, and other helpful information.
A Place for Mom – provides guidance from local advisors in many cities. The organization provides information for assisted living facilities, nursing homes, memory care, and more.
SeniorHomes.com – provides resources for locating independent living, assisted living, and more.
SeniorLiving.org – provides resources for locating various options for elder care.
In the search for suitable care facilities, no stone should be left unturned.
Questions to Ask of the Facility
Not only should you look to the facility to answer questions, you should also seek out the opinions of others that had a loved one reside at various establishments. Asking friends, co-workers, and neighbors about their experiences will give you a perspective outside the claims of the facility. If you learn that Facility A had a history of the staff being inattentive, you better know what questions to ask at the facility and what signs to look for in their care history. Check online reviews and with the Better Business Bureau.
Once you have decided that a facility may be the right fit for your loved one, make an appointment to go for a tour. This will give you the opportunity to ask questions, see the grounds, check out the activity schedules, see how clean the facility is kept, and see the potential room that your loved one may live in. Most importantly, a visit will give you the chance to see, and possibly talk with the current residents to learn their quality of life at the facility. It is not unreasonable to show up for another visit without calling ahead, but keep in mind that they may not have as much time as when you set up a formal visit. Surprise visits may give you insight on how things appear when the facility is not forewarned that will be showing off the facility.
When speaking with the facility directly, no question is off limits. Any reasonable question asked should be returned with a polite and educated answer. Some questions include:
Who are the doctors and other staff that will care for your loved one? Does this rotate or will your loved one consistently have the same caretakers?
Does your loved one’s current primary care doctor come to this facility? If not, does the facility provide transportation to appointments?
Is there access to physical therapy at this facility? How about chiropractors or acupuncturists?
How is preventative care handled?
What are the facility’s policies on vaccinations (like flu shots) or use of anti-psychotics for dementia patients?
What types of meals do they offer? (Asking to see a menu can be helpful)
Are there community activities? Does the facility provide transportation to outside activities?
Are there religious services offered?
The Centers for Medicare and Medicaid Services provides a useful checklist for facility interviews.
Things to Look for at the Facility
Your observations are important. Your impression of the facility is paramount to any raving statistics or reviews that you may find about a facility:
Look at the cleanliness of the facility, including the activity rooms, the dining areas, even the tidiness of the nurse’s stations.
Does it look like it is well maintained – no chipping paint, bubbling wallpaper, unstable dining tables, poor lighting or burnt out lightbulbs?
Does the nursing staff appear to enjoy their job, or do they look like they are only there for a pay check?
On your tour, does the guide barge into resident rooms to show you the amenities, or do they knock and wait to go in?
Are there places to walk outside, place to sit and enjoy the outdoors?
What about the residents – do most of them look happy, or at least content, or do many of them appear sad or depressed?
Try to talk with a few residents. Ask them how they like living there – if they are treated well – if there is much to do at the facility – you may even ask how they like the food.
POSSIBLE ALTERNATIVES TO RESIDENTIAL FACILITIES
Medicaid does provide services outside of residential facilities. There are various volunteer organizations that can provide free or low-cost services to your loved one in their home. You can also receive more information on options from your loved one’s doctor, a hospital social worker, or a hospital discharge planner. These organizations and individuals may be able to provide guidance on:
Home Health Nurses and Physical Therapists
Meal Preparation Services
Medication Reminder Assistance
Helping with finances or legal matters
Some organizations with information concerning alternatives to residential facilities include:
Area Agency on Aging – individual locations and programs are available in every state
Aging and Disability Resource Center
Center for Independent Living Options
National Association for Home Care & Hospice
National PACE Association.org
LIVING WITH RELATIVES
There are many questions and scenarios to consider when deciding if it is best for your loved one to move in to your home. In considering this option, you must evaluate whether you can provide the level of care that your loved one needs. Do you have access to transportation to get them to and from appointments? Do you have a job that would conflict with their care? Is your home equipped with safety devices, or are you willing to put forth the expense to provide them? Are you able to provide your loved one with their specific medical needs? Do you have the space in your home? Can you afford the added expense? Would your loved one be embarrassed if they needed you to help them in and out of the tub or shower – or to help them dress? How does your loved one feel about the idea in general? These are some of the myriad of questions to consider.
The above guide should put you on the right track for thoughtful decision making on the topic of long-term care. Holy & Schultz attorneys are available to help navigate these complex waters, including review of often complex long-term care residency contracts. Please contact Michael Holy or Carl Schultz to discuss your important legal matters.
DISCLAIMER: The above is for informational purposes only. No statement, opinion or commentary is intended to provide legal advice to any specific person, organization or entity. Only a written attorney-client agreement will create an attorney-client relationship. Please contact Michael C. Holy or Carl M. Schultz to discuss all potential legal matters.