47.8 million people, or 13% of the U.S. population are now over the age of 65. About 1.5 million of those people currently reside in nursing homes. A nursing home is a residential facility that provides skilled nursing care. Nursing homes provide a level of medical, cognitive, behavioral and functional care that independent and assisted living communities do not typically provide.
Unfortunately, for relatives of elder family members, the search for nursing home care is often necessitated by a crisis: a mother is unexpectedly hospitalized after falling and suffering an injury and cannot return to living at home, or a father has suffered a sudden stroke. These pressured situations can be emotional and distressing for both the elder adult and their families, particularly as there is usually a time constraint on the family to find nursing accommodation quickly. This can result in hasty placement without the benefit of careful consideration of a life changing decision.
If possible, a better plan is to look for nursing home communities ahead of time, before a potential crisis occurs. This research can be undertaken when you first start to see physical and mental health issues in your family member and enables you to plan a continuum of care for the future. Alternatively, your family member may currently reside in an independent living, or assisted living community. These residential settings may be appropriate now, but as your family member's level of care increases, you should be aware of potential nursing home care that might be needed in the future.
But, how do you know what to look for in a nursing home to make sure that it meets all the needs of your loved one? Jan Clark R.N., is a former elder care nurse and certified nursing home inspector. She spent over 10 years evaluating hundreds of nursing care communities and talking to countless staff members, residents and family members. As a strong patient advocate, Jan's experience has given her great insight into understanding what nursing home residents have the right to expect whatever their needs or disabilities. Based on her extensive geriatric nursing care experience, Jan lists 7 issues to think about when looking for a suitable nursing home community for your parent or other family member:
Should you locate your family member closer to you or in the area where he or she lived previously? Moving a parent or grandparent from an area with which they are familiar and may have long-term habits and friends is a difficult decision. However, for anyone in a nursing community, visits are a highlight in an otherwise long day. While a family member may expect that friends will visit, in reality, visits may be more frequent from family than from aged friends who often have to contend with their own physically limitations. It also helps to have the parent or family member's patient advocate or guardian nearby in case of emergencies.
Once you have decided on the geographical area, another consideration is whether your family member would prefer a rural or urban setting. The advantage of an urban setting is the opportunity for short outings to a local mall, restaurant or park. A nursing home may have more of a bustling atmosphere if it located near schools and churches that might volunteer to visit. Alternatively, a rural setting might suit someone who enjoy peace and quiet, country views, birdsong and a garden to sit in. Don't discount such small pleasures to someone to whom this is now his or her home.
Once the search has narrowed down a selection of nursing homes in the right location then ask to see the most recent inspection reports or find them online. The Centers for Medicare and Medicaid Services (CMS) rate every Medicare and Medicaid certified nursing community in Michigan by a five-star rating system. These ratings reports cover an extensive range of requirements that the home must meet and will give indications as to any outstanding areas of concern.
You can look at the most recent two health inspection reports and learn about staffing ratios and the average hours of care provided to each resident. There are also 16 different physical and clinical measures for nursing home residents noted. Inspections will usually raise several minor issues as no nursing community is perfect, but any serious issues will be highlighted with timescales for compliance. Subsequent inspection reports will outline the steps taken to rectify any situation and the satisfaction of the inspection team. These reports are a mine of information that you might not otherwise find out on a routine visit to the nursing home.
There are 446 Medicare certified nursing homes in Michigan so the ratings system is a valuable tool to compare different nursing homes on a side-by-side basis.
Unfortunately, nursing home care is expensive. According to survey conducted by Genworth Financial, the cost of nursing care in Michigan ranges from approximately $8,000.00 -$9,0000 per month. This increase compared to assisted living is due to the round-the-clock skilled nursing care and other specialized services. While monthly fees are inclusive, they usually do not cover "extras" such as hair care, phone charges and outings.
While the adage that you get what you pay for is true, note that the commercial nursing care industry is competitive and you can shop around to get a better rate. For example, if you are not sure that your parent needs long-term care or simply a few months, you can ask for a respite care rate, which is typically lower than the monthly cost. You can consider a smaller room or shared accommodation to reduce cost. You would be surprised how many nursing home residents quite like a roommate to talk to. In addition, if your family member has advanced dementia or other cognitive deficits, it is unlikely that a shared living situation will bother them as much as you think. Other ways of defraying cost include veteran's benefits and long-term care insurance.
Every person choosing a nursing home has different needs either physical or mental and the nursing community must have the appropriately qualified staff and facilities to cater for those needs. The admissions manager or director should be able to provide information as to the suitability of the home to meet the specific needs of your loved one. This is particularly important in the event of cognitive issues such as Alzheimer’s disease, as the needs of these residents requires specialized staff and some homes may not be appropriate. A memory care nursing community, for example, will have keypad activated locked doors, alarm systems and other precautions to safeguard wondering and other behaviors that are associated with dementia.
Meals and the quality of the food is one of the most important elements in a nursing home. There should be choices at meal times and meals should be attractively presented with nicely laid tables. Snacks should be available between meals and drinks available at all times. Ask the following questions:
The best way to assess the catering is to ask to join residents for a meal on your visit, or to talk to residents if they are willing. Mealtimes are a chance for social interaction. Check to see whether residents are grouped in a way to encourage conversation or sitting alone in the dining room. Is there one dining room setting or an additional cafe type setting where residents can socialize?
What does the home provide for recreation and activities? These will vary according to the ability of individual residents but there should be dedicated staff to ensure that residents are provided with a program of events and activities depending on individual interests and abilities. At the very least, there should be a gym or exercise room, where even residents who are wheelchair bound can have physical therapy.
Is there a schedule of events given to residents? How varied are the activities? Ask if there is an opportunity for on-site religious services if your loved one is active in a particular faith. Look to see if there are outside trips planned. These might be limited given the physical restrictions of the residents, but there might be age appropriate outings if weather permits. See if daytime activities go beyond bingo to more inventive activities. Your family member might be in a wheelchair or have memory loss, but there is no reason why she might not enjoy sitting "jazzacise" or painting.
When you visit, ask if the nursing community schedules volunteers to visit. Residents always appreciate visiting musicians, school choirs and therapy dogs.
Touring a variety of homes and observing is one of the best ways to get a “feeling” for the home and the following examples are indicators of what the home provides.
The above provides the information needed to make a start on the task of researching a nursing home. With careful preparation for a “just in case” situation it can be an easier process than otherwise would have been to find the right home where your family member will be looked after with respect, dignity and have his or her specific needs met.