For many families, having their loved ones move to a nursing home for caregiving is a last resort. There may come a time when you ask yourself, “What is best for my loved one?” Your Mom may be living with you now, but you are unable to provide care much longer. Your Dad may be living on his own, but needs help with the housework and cooking. Your husband or wife may need 24-hour care. Many families consist of two working parents with many errands and chores shared between them. Their children are out of the home, at school or extra-curricular activities. This usually leaves their elderly grandparents alone at home. Even if one parent works or stays at home, looking after an aged parent or parent-in-law can be a difficult task with all the other chores heaped together. Since each situation is different, there are several options for caregivers to consider when deciding on what to do.
Before you decide on what would be the best for your loved one, there are many things that need to be taken into consideration:
- How much is your loved one able to do?
- How much is your loved one unable to do?
- Has your loved one told you what they would like?
- How much time can you spend with your loved one a day?
- Is there anyone else that can help you care for your loved one such as a sibling?
- Does your loved one have a dementing disease such as Alzheimer’s?
Once you have explored the questions above, you can then begin to plan on how the needs of your loved one can be met. There are many options of care available, some of the care options are explained below.
Some elderly people prefer not to live in the same house with grown children and their families because of the noise or a clash in lifestyle. The retirement community is the best option for such elderly people. Retirement communities dedicate an entire residential area to senior living.
The proper nursing home facilities provide 24-hour care, daily activities, daily exercises, and assistance with eating, bathing, and walking. These facilities have nurses on duty if a situation should occur. Nursing home facilities can be helpful for loved ones who are bedridden or for persons who need round the clock care.
If your loved one is aggressive, be sure to find out the qualifications of the staff. There have been many instances where the loved one acts out and the worker does not know how to deal with the behavior. This can lead to nursing home abuse if the situation is not dealt with properly. If you are considering a nursing home placement, please visit the nursing home section on my website.
Assisted Living Facilities
Unlike nursing homes, assisted living facilities are for those persons who need limited care rather than total supervision. These facilities offer daily activities and some assistance with the activities of daily living (bathing, dressing, eating). Many facilities offer units that look like an apartment and have a kitchen, bedroom, and bathroom. Each facility is laid out differently, so it is important to visit several facilities to see which would better suit your loved one. When you visit the facilities, ask what they do and don’t provide. If your loved one has a medical condition, make sure they can provide it.
In Home Care with a Stranger
If your loved one refuses to live in a facility or if you feel your loved one would be better in their own home, there is the option of a live-in care provider for your loved one if the primary caregiver is unable to provide 24-hour care. The care provider will usually cook, clean, and help with dressing, bathing, eating.
In Home Care with a Family Member
This is a great option for the caregiver who would like to live with their loved one. The caregiver will either live in the loved one’s home or in their own home with the loved one. Make sure that you have the time to provide this type of care. If you are unable to leave your loved one alone, you can receive various services that will assist you.
Benefits of Elder Care Assisted Living Facilities
Assisted living facilities have quite a few advantages. As a person ages, he or she may find that caring for oneself may become difficult due to chronic or acute health conditions. Sometimes the care needed does not warrant living in a nursing home, but home care may not be a viable option either.
Friends and family members may assist many seniors with various activities of daily living while they live at home, but those who are helping may become overwhelmed with multiple responsibilities or they may be unable to assist due to other reasons. Some seniors prefer not to ask friends or family members to help them with daily care or do not have anyone living near them that is able to assist.
Older adults who live at home may find the responsibilities of maintaining a home, cooking meals, managing multiple medications, keeping a yard, and finding adequate transportation to be exhausting. They may also feel isolated and lonely, particularly after the death of a spouse. Older adults who live at home alone may be frequent targets of scams to solicit money. Some seniors who live at home alone may be in an unsafe situation, such as the case of an elder who takes narcotics and another person who is addicted seeks those drugs.
Below are a few services that are offered by many assisted living facilities, although each facility may offer more or less services than those listed:
- help with activities of daily living, such as bathing, dressing, eating, mobility, and using the bathroom
- meals at predictable times in a common area
- transportation to appointments, shopping, entertainment, etc. (some assisted living facilities have on-site medical care options)
- management of medications
- housekeeping and laundry services
- access to health, exercise, and wellness programs and equipment
- socialization by living near others and through scheduled programs
- secure environment
Here are some other benefits from elder care assisted facilities living that should be part of any family’s considerations about senior caregiving.
- Community living
- Professional healthcare providers
- Ensured Safety
- More Active Life
Disadvantages of Assisted Living Facilities
Despite the advantages, assisted living facilities may not be the best choice for every senior. Many seniors prefer to live in their own homes. They may have lived in the house since childhood and find their current living situation comfortable, friendly, and do not wish to move in late stages of life. They may find unknown environments difficult to navigate, dread parting with most of their possessions, fear further isolation from family and friends, and look at any facility as a step away from independence.
Different facilities offer different levels of care, and it is important to look at what services are offered to ensure that needs are properly met. For example, someone who has moderate dementia or Alzheimer’s disease will typically require more specialized care that may be provided at some facilities but not at others. Those who required certain medications or specialized medical care may also require a higher level of care than that offered at an assisted living facility.
Seniors who have lived alone for many years may not relish the idea of living in a facility that houses many other people. Some facilities offer semi-private rooms, and elders may find it difficult to live with a roommate. Some assisted living facilities may have certain rules that might be bothersome to a senior, such as smoking and pet policies. Schedules for meals and other activities may differ from the ones typically kept by a senior living at home.
One of the biggest drawbacks of an assisted living facility is the cost. Most assisted living facilities charge a monthly rent with fees added for additional services. At the writing of this article, Medicare does not cover the costs of assisted living facilities, and many seniors find the cost of such a facility is prohibitive. The senior may have saved money all his or her life planning to leave a legacy to children but may discover that funds can quickly dwindle when paying for care such as this.
Although assisted living facilities offer a secure environment, some employees, guests, and other residents may attempt to take items that do not belong to them. Many seniors who reside in assisted living facilities have few personal items, but they often carry a heavy sentimental value. Although infection control is a priority in any facility, seniors may be vulnerable to illness, such as influenza or MRSA, due to facility-acquired infections.
Although assisted living facilities may offer different services in different locations, many seniors find this type of living arrangement to be convenient, safe, and a welcome way to keep from being isolated that encourages their independence as much as possible.
Assisted living may not be the best fit for everyone as these facilities tend to be costly, are not covered by Medicare, and may not provide the level of care needed. Elders who have lived alone for years may be used to a routine developed over many years and prefer to stay in their own home rather than to live in a setting near others with different rules and regulations.
Choosing the Best Nursing Home
Finding the right nursing home for a loved one can be difficult under the best of circumstances. Most people don’t think about elder care until the need is urgent, leaving little time to make an informed and careful decision. There are some resources to assist family members in making this transition for their parents or elderly relatives.
Tips for Assessing the Quality of a Nursing Home
There are normally several choices for nursing homes in any given community. Deciding which one has the highest level of care is not readily apparent. The first and easiest step for evaluating a local nursing home is through the Medicare website, at their Nursing Home Compare page. On this page individuals can search by zip code or community, specifying the distance from home to come up with a list of nursing homes. The nursing facilities are ranked by health inspection, quality measures, and nursing home staff, using a five-star rating. The chart allows for closer comparison of three homes and the viewer can see which have Medicare and Medicaid coverage, the number of beds and type of ownership.
Another dimension for assessment is individualized care. Make sure that a care plan, one that is individual and specific to your family member, is addressed and discussed. Also, make sure that assessments are conducted. They are often done by the staff such as one’s family physician, family, social services and a dietary assessment. These assessments should be reviewed now and then to ensure that the resident is receiving the necessary help that he or she needs.
From here a selection can be made for facilities to visit. A visit is crucial for determining the type of atmosphere, the friendliness of the staff and other patients as well as compatibility for the family member.
Visiting the Nursing Facility
There are certain things to be looking for when visiting nursing homes. Making an appointment to talk with administrators is important, but an unannounced visit allows for a glimpse of normal operations. Make a list of questions to ask beforehand, and carry the list along. Being prepared lets the administration know that this is a serious visit and ensures that crucial questions are addressed. Notice the willingness of staff to talk with visitors and answer questions.
While visiting, look at the following:
- Dining facilities: Ask to see the dining room during a meal. Are patients being assisted with eating? Is there a menu which allows for individual choices? How are individuals seating, in groups, or large tables?
- Living areas: How many available attendants are visible on the floor? Is there a call button ringing and if so does it seem to be answered promptly?
- Hallways: Look at the residents, are they sitting in the halls alone, or in groups talking? Do they seem well groomed and clean?
- Nursing staff: How many registered nurses work for the facility? Is there a nursing administrator? Qualifications are extremely important, especially if your loved one has dementia. If the staff is not familiar with a dementing illness, it will be difficult for them to communicate with your loved one. I suggest finding a nursing home that is geared towards dementia persons. Many homes have a separate wing for dementia residents. However, please be careful. You want to make sure that your loved one will receive quality care. Do not be afraid to ask the qualifications of the staff.
- Family Support: Ask the administrator if there are family councils, groups set up to work with other families. Get the name and information of the contact person.
- Family Intervention: Family is crucial for your loved ones well being. Some homes do not contact family members if a problem occurs, such as if your loved one is wandering or if your loved one had to go to the emergency room. As a caregiver, you have the right to be informed if something should happen to your loved one.
- Activity: Residents need social interaction. Be sure that your loved one receives the appropriate activity throughout the day. Your loved one has the right to activity and should receive it. Some homes may use the excuse that your loved one is unable to do certain activities. This is NOT an excuse. Your loved one should not lie in bed all day. A worker can walk with your loved one or if they are in a wheelchair, the worker can push your loved one for a ride. Being cooped up in a room is not healthy. Just because a person has dementia, does not mean that they cannot join in on social gatherings and activities. If the loved one does not wish to participate in activities and has challenging behaviors, the staff should be able to come up with alternatives such as sitting in a chair by the window.
- Safety: How safe is the facility? If your loved one wanders, how do they handle the situation? I have heard of residents being restrained in the evening to stop wandering. Quality homes will have safety measures inside the facility. Many facilities have security systems where the only way to get out of the building is to press in a password number. Does your loved one keep falling? If you answer yes, then you may wish to find out why. There may not be adequate handrails in the washroom or along the walls of the facility.
- The Odor of Rooms: Notice the odor as you walk in the home. Remember that these facilities handle incontinence, so a slight urine smell is not always bad. However, you do not want it to be overpowering. You will be able to tell the difference as soon as you walk in the door.
Here are some sample questions to ask the nursing home administrator:
- Is this nursing home Medicare or Medicaid certified?
- Does this nursing home have the quality of care needed?
- Is a full-time registered nurse on duty in the nursing home all the time?
- Is there a choice of food at every meal? Are the residents able to receive their favorite food items?
- What are the daily activities available for all of the residents and are these activities posted so that everyone knows about them? Are announcements made that help those who can’t read?
- Is there a volunteer program that is active and used often?
- If there is an emergency, what are the plans that will be implemented?
- Speak to the social services worker. Find out what she/he is there for. Many social services workers ensure that your loved one is being treated well
Choosing the Best Nursing Home
After visiting at least two nursing homes or assisted living residences, it’s time to make some decisions. One way to assess the loved one’s comfort with a particular facility is to arrange for a weekend stay. Many facilities have respite care; a short visit allows the family member to test it out and meet other residents. Family has a chance to interact with staff as well and can see how agreeable the nursing staff is to family requests and concerns.
Review billing procedures and ask for the list of additional costs. Nursing home costs can be higher than expected and are based on a number of different criteria.
Carefully look at room rates, proposed increases in rates and whether there are assessments based on the level of care required. Ask specifically how many of the daily living chores are performed by the nursing home staff. Be clear on what the expectation is for family participation.
Making the choice to place a loved one in a nursing home or assisted living facility can be stressful for all members of the family. Using guidelines and checklists to assess available facilities can assure loved ones are safe and well cared for.