PROVIDENCE, R.I.— When their mother became a nursing home escapee, her helicopter daughters wondered what the sweet 93-year-old widow was thinking. With her daughters hovering anxiously, she was quick to answer. “I wanted to pick up a few things to cook for your father tonight.”
The woman’s daughters gave a collective deep sigh. Their mother remained young at heart, but the memory thief of dementia turned her mind into an intermingling of long-term remembrances, short-term forgetfulness and delusional thinking. She was stuck in her married past unable to comprehend why she had to live in a room with no kitchen to cook pasta for her husband, who had actually died.
Her daughters realized that they could neither stop their mother’s mental deterioration nor prevent behavior one would expect from an impetuous teenager. But, what they could do was to find a nursing home where their mother would be safer and maybe happier, too.
Despite their hovering and search for the perfect nursing facility, their mother’s worsening dementia limited their choices. Questions to ask about quality ratings, activities and atmosphere as well as cultural sensitivity, patient rights, and physician availability may seem obvious.
Key Questions to Ask
However, even with all the guides designed to help families, getting answers is a challenge.
In addition to general manuals, such as the comprehensive 72-page Your Guide To Choosing A Nursing Home — Medicare.gov, getting a sense and feel of a home by visiting more than once may make the difference between sleepless nights and peace of mind.
Questions to admission directors are important, but observation is often a better predictor of how well a person will adjust to the new environment. Answers from staff may dramatically clash with the reality of a nursing home’s ratings, atmosphere, activities, patient rights and physician availability.
Things to Look for Onsite
Often a nursing home placement is made hastily because of a hospital’s “time’s up” policy. Patricia L. McGinnis, executive director of California Advocates for Nursing Home Reform, [http://www.canhr.org/] said, “Contradictory to their role -- appropriate placement – discharge planners are often pressured to get patients out of the hospital because of billing issues.”
Atmosphere is important: With nursing homes, beautiful furniture and new curtains do not necessarily translate into good care. You may see a facility that has a four- or five-star rating, but the atmosphere or patient population may not be well suited for a potential resident.
Always look at dining rooms during lunchtime to see how many residents are there instead of eating alone in their rooms.
Ask to look at activity charts to determine how those requiring various levels of care may participate and benefit. While offering residents Wii Bowling sounds good on paper, residents with dementia will not be able to remember the steps involved for knocking down the pins. On the other hand, BINGO plays an important role in routine and socialization.
Music in nursing homes should be more than just recreation; it should be therapy, even for residents who are cognitively challenged. Some experts in aging say that making music can be a protective factor against the most difficult aspects of dementia.
For example, the documentary Alive Inside, explores how patients are transformed by listening to iPods. In a nursing home there can never be too much music.
Patient rights and physicians: From small issues to more substantive ones, patients’ rights versus the best interest of a patient is tricky. Be certain to ask about patient-choice issues. Important examples are:
Dining room seating -- Do new residents get assigned tables and is there flexibility to be able to move to another table? You want flexibility.
Room changes -- Residents may be shifted to different rooms merely for the convenience of the home. But sometimes roommates are not compatible. Ask how this is handled, and is the staff quick to make changes if problems arise?
Showers and changes of pull-ups or diapers -- To prevent urinary tract infections, or UTIs (a common health issue that can also worsen a senior’s mood), it is important that residents are changed and bathed frequently. Ask how often this takes place and how they handle a person who refuses. Hiding behind patient rights is not acceptable when a health issue is involved. Incontinent patients should be checked every few hours.
Make certain family caregivers are permitted to be involved with helping a person with dementia make appropriate choices.
Ask how a facility handles conflict. A well-trained staff can often coax even the most belligerent resident into complying with a health issue. Hydration and frequent diaper changes are key to preventing potentially debilitating UTIs.
In the elders, a UTI can create agitation and delirium that leads to preventable hospitalization. This is only one reason why having a full-time physician or nurse practitioners on staff makes good sense. Does the home have one?
Ombudsmen and Other Resources
Despite your best efforts, if nursing home issues concern you, contact the local long-term care ombudsman. These people, usually found through the state or local government department or commission on aging, are independent officials designated by the U.S. Older Americans Act, to monitor area nursing homes and assist residents. They usually can fill you on about a facility’s record.
However, keep in mind what Donna McCormick, managing attorney for the Elder, Health and Disability Unit at Greater Boston Legal Services—ombudsman programs are uneven around the country. She explained, “In theory all nursing homes should have ombudsmen, but the challenge takes place when they become so intertwined with management that they don’t always advocate effectively for residents.”
The other alternative is to find a different home. Physicians and researchers tell us that seniors can be more adaptable than we realize.
What is every family’s goal? Dr. James M. Ellison, a professor of psychiatry at Harvard Medical School, said, “Families need to know that their loved ones are being cared for by a kind staff in an atmosphere that stimulates them emotionally, socially and cognitively. It’s important to remember that even with a diagnosis of dementia people can find joy in the appropriate surroundings.”
As a result, families often find themselves in search of a different nursing home.
Here are some helpful resources keyed to quality of care, nursing staff, health inspections and safety issues.
* Medicare.gov - Nursing Home Overview;
* Nursing Home Compare - Medicare.gov directs one to state sites and phone numbers;
* America’s Best Nursing Homes - News - US News and World Report, is a star-rated overview;
* Nursing Home Inspect, makes nursing home inspection reports.
* California Advocates for Nursing Home Reform’s “Nursing Home Guide,” a national model for state searches.
Rita Watson, MPH is a 2013 MetLife Foundation Journalist in Aging Fellow, a program collaboration of New America Media and the Gerontological Society of America. This article is adapted from versions that appeared in the Providence Journal and Psychology Today. Copyright 2013 Rita Watson/ All Rights Reserved
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