Choosing and Evaluating a Nursing Home
Can there be a more difficult job than finding a nursing home for a parent or spouse? No one wants to live in a nursing home. They serve as institutions of last resort when it’s impossible to provide the necessary care in any other setting. And, typically, the search takes place under the gun when a hospital or rehabilitation center is threatening discharge or it’s no longer possible for the loved one to live at home. Finally, in most cases, finding the right nursing home is a once-in-a-lifetime task, one you’re taking on without the experience of having done it before.
That said, there are a few rules of thumb that can help you:
Talking With Family About Placement
Few decisions are more difficult than the one to place a spouse or parent in a nursing home. Since nursing homes are seen as a last resort, the decision is generally overlaid by a sense of guilt. Most families try to care for loved ones at home for as long as (or longer than) possible, only accepting the inevitable when no other alternative is available.
The difficulty of making the decision can be compounded when family members disagree on whether the step is necessary. This is true whether the person disagreeing is the person who needs help, his or her spouse, or a child.
The placement decision can be less difficult if, to the extent possible, all family members are included in the process, including the senior in question, and if everyone is comfortable that all other options have been explored. This will not ensure unanimity in the decision, but it should help.
Consider the following steps:
These steps cannot make the decision easy, but they can help make it less difficult.
While residents in nursing homes have no fewer rights than anyone else, the combination of an institutional setting and the disability that put the person in the facility in the first place often results in a loss of dignity and the absence of proper care.
As a result, in 1987, Congress enacted the Nursing Home Reform Law that has since been incorporated into the Medicare and Medicaid regulations. In its broadest terms, it requires that every nursing home resident be given whatever services are necessary to function at the highest level possible. The law gives residents a number of specific rights:
Disagreements with a nursing home can come up regarding any number of topics, and almost none is trivial because they involve the day-to-day life of the resident. Among other issues, disputes can arise about the quality of food, the level of assistance in feeding, troublesome roommates, disrespect or lack of privacy, insufficient occupational therapy, or a level and quality of activities that doesn’t match what was promised.
The nursing homes that live up to the ideal of what we would want for our parents or ourselves are few and far between. The question is how far you can push them towards that ideal; what steps should be taken in such process; and at what stage does the care become not only less than ideal, but so inadequate as to require legal or other intervention. This can be a hard determination to make and in some cases needs the involvement of a geriatric care manager who can make an independent evaluation of the resident and who has a sufficient knowledge of nursing homes to know whether the one in question is meeting the appropriate standard of care.
Following is a list of the interventions a family member may take, in ascending order of degree. Move down the list as the severity of the problem increases or the facility does not respond to the less drastic actions you take. In all cases, take detailed notes of your contacts with facility staff and descriptions of your family member and his or her care. Always note the date and the full name of the person with whom you communicate.