Nursing homes: A beginner's guide
If your parent is no longer able to function independently, you and he will need to consider the options, including a nursing home. What makes a nursing home different from other eldercare choices is the fact that he'd be under the 24-hour care of licensed or registered nursing staff (in a skilled nursing facility) or of certified nursing assistants (in an intermediate care facility).
In addition to nursing care and room and board, a nursing home also provides assistance with what's known as "activities of daily living" -- dressing, bathing, grooming, toileting, walking, and so on. Physical therapy and activities are usually included. But make sure you're clear on exactly what services are provided before signing the contract.
Decide what kind of nursing home your parent needs
If your parent has a medical condition that requires continuous monitoring -- anything from a feeding tube or respirator to an ongoing need for physical or occupational therapy -- he'll likely need to be in a skilled nursing facility. If his main need is for ongoing help with activities of daily living, then an intermediate rather than a skilled facility may suffice. Sometimes elders transition from the hospital to skilled nursing and later to intermediate care. Some facilities have both skilled and intermediate wings. Each facility will have intake planners who can help you evaluate your parent's needs and find the right level of care.
Narrow down your nursing home choices
If your parent is going to a nursing home after a hospitalization, the hospital will have a social worker known as a discharge planner who can help you find one. But there's no substitute for doing your own legwork.
One quick way to compare nursing homes in your area is through HealthGrades.com's nursing home ratings tool. You'll have to pay a fee to use it, but if you need to make a decision in a hurry, it may be worth it to have the information consolidated in one place. By analyzing information from state inspections and consumer complaints, HealthGrades ranks nursing homes on a five-star system and offers a detailed report on everything from cleanliness and diet to "dignity and respect of each resident" to how often patients typically get bedsores.
Check a nursing home's reports
Each nursing home is required to keep copies of state licensing reports on-site and to show them to you at your request. Once you think a home is a good possibility, take a close look at it. You can also call your state or local long-term care ombudsperson and ask if there have been any substantiated complaints against the home you are considering for your parent. (An unsubstantiated complaint in itself, with no other red flags, may not be reason enough to steer you away, as complaints are fairly common.)
Log some time at the nursing home beforehand
Above all else, try to spend time -- with your parent if possible -- at a place you are considering, and trust your instincts. Remember that, even if your parent needs round-the-clock nursing supervision and a nursing home seems to be the only way to go, this is a difficult step for many parents to take. The sight of other elderly and ill residents, often in wheelchairs, may evoke depressing feelings of being "put in a home." Staff at a good facility will be aware of these feelings and treat your parent with care and courtesy. Do they address your father by name from day one and ask him about his preferences rather than seeming to treat him as "just a number?" Do the long-term residents look well-groomed and animated? Are there little touches like well-tended plants that make the place seem less institutional? Small things like these can ease a challenging transition.
What else can I expect the nursing home to provide for my parent?
Besides nursing supervision, meals, and assistance with personal care, a nursing home should offer laundry and housekeeping; linens and towels; personal hygiene items; activities; physical, occupational, and speech therapy; dental care; and mental health services. A dietician is usually on staff. All of this should be spelled out in a contract you and your parent receive upon admission, along with a detailed list of basic and additional charges.
The nursing home is required to assess your parent within two weeks of admission and to review his condition every three months after that. This information should be used to develop a care plan, which should be shared with you in care plan conferences. If you don't get invited to one of these, ask! This is your chance to pose any questions you've been saving up and to share important details about your parent's needs and preferences.
Who will provide medical care for my parent while he's in a nursing home?
In most nursing homes, a doctor is on call and makes rounds periodically but isn't on-site at all times. By law, the minimum required frequency of doctor's visits to patients in nursing homes is once a month during the first three months and once every two months after that. If you want your parent to remain under the care of his private physician, you can ask her to visit him in the nursing home -- but if she sees patients only in her office and you're in the area, you might also consider bringing your parent out for appointments.
What should I do if something seems wrong?
If you suspect or know of a problem with your parent's care, the first thing you'll want to do is talk to the nurse assigned to your parent. If that doesn't solve the problem, go up the chain of command to the charge nurse, then the director of nursing or the nursing home administrator. If you still have serious concerns, you may need to contact your local or state long-term care ombudsperson file a complaint. And of course, if your concerns have reached this level, it may also be time to think about looking into another nursing home.
What will a nursing home cost, and is there any help available?
If your parent is over 65 and requires only a short-term stay in a skilled nursing facility after a hospitalization, then Medicare should pick up the costs for the first 20 days and any costs over $128 per day for days 21 through 100. If your parent needs to stay in a nursing home for the long term, he may be eligible for coverage under Medicaid, but only if his assets fall below a certain level.
If your parent has long-term care insurance, skilled nursing may be covered. Otherwise, you'll need to find a way to cover the expenses, which average upwards of $200 a day.
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