Being in the middle of the generational sandwich that puts children on one side, whether school age or grown, and parents on the other comes with all kinds of challenges.
But one of the toughest, and often most heart-wrenching, is the responsibility of making decisions about an elderly parent’s care. This is especially true when Dad or Mom becomes too frail to live on his or her own or in assisted living, and suddenly the family is wading through the confusing process of finding a nursing home.
Many times, no one is prepared. A parent is admitted to the hospital because of a serious illness or fall, and soon the hospital staff is pulling the family aside and telling them their loved one has to be in long-term care. Then it’s a scramble to find a quality facility in a matter of a few days, noted Dr. Cheryl Phillips, senior vice president for public policy and health services for LeadingAge, an advocacy group representing providers of services for older adults.
There are tools aimed at helping families in the decision-making process. Medicare, for example, has an online resource called Nursing Home Compare and state inspection reports, including those in Nevada, are easily accessible to the public. These are good places to start, but families should keep in mind they don’t show the whole picture.
In fact, the best strategy involves the family’s own eyes and ears. Visits to the communities, if at all possible, are crucial to finding quality care and the right fit for Mom or Dad, experts noted.
The visits should go beyond the typical marketing-department tours. They should include conversations with staff such as the facility’s director, social worker and head of nursing regarding medical and custodial care. It’s also a great idea to make unscheduled visits to the specific area in the facility where Mom or Dad would reside.
Some of the basics to look for are overall cleanliness, including any bad smells that could indicate poor care with regard to residents’ hygiene, Phillips said. Also, whether the staff is regularly interacting with the residents, or if there are call bells or lights constantly going on yet being ignored.
There should be signs of energy and engagement in the community, with residents busy in the activity areas, being taken on walks, or involved in physical or occupational therapy, she added.
“Is there a sense that we’re actually moving along here, or are people all just quiet in their rooms in bed waiting for the next meal to come by?” she said.
Jennifer Williams-Woods, Nevada’s long-term care ombudsman, encourages families to talk to the residents who actually live in the facility about the care and attention they are receiving. She also noted that her office provides training to nursing homes in what’s known as person-centered care, and encourages families to look for that style of care during their search.
Rather than the regimented model that still permeates most facilities, it allows residents to be part of the decision-making when it comes to the details of their care, such as what time they get up in the morning or whether they have baths instead of showers, she said.
“So we want to focus more on who is this individual that’s walking in the door, and what are their needs, who were they before they came into the facility,” she said.
Another care-taking method to look for is called consistent assignment, Phillips said. This means a resident will receive assistance from the same aides as much as possible, resulting in stronger bonds and a higher sense of well-being for Mom or Dad. Sometimes even just a smile from a beloved caretaker can make a resident’s day, particularly if they are mostly bedridden because of their medical conditions.
“The nursing assistants are critical,” said Evvie Munley, director of health policy and regulations for LeadingAge. “They’re the ones who get to know the residents the best and they’re the ones who are going to spot a difference or a change in someone’s behavior or if something’s not quite right.”
Finally, it’s important to remember that the loved one is giving up a lot to move out of his or her home, so their own desires for a community should be considered as much as possible, Williams-Woods noted. Family members such as siblings also need to “play nicely” by putting aside their personal differences and focusing on the needs of Mom or Dad, she said.
The state of Nevada’s health-facility inspection reports can be found online at statistics.health.nv.gov/healthfacilities. The Nevada Long Term Care Ombudsman Program can be found at adsd.nv.gov under “programs for seniors” and can provide resources regarding the search for a nursing home. The Medicare Nursing Home Compare is accessible at www.medicare.gov/nursinghomecompare/search.html LeadingAge, at leadingage.org, also provides information on how to choose long-term care.