How to Start
The decision to place a loved one in a nursing home can be an incredibly difficult and emotional decision. Even though your goal is to protect your loved one’s health and safety, it is normal to feel guilty or anxious about removing them from the familiar home environment they are used to. Although educating yourself about nursing homes may not eliminate the stress involved with this decision, it can help both you and your loved one become more comfortable with the process and more confident in identifying a nursing home that will provide your loved one with the highest level of care in an environment that best fits their personal preferences as well as their health care needs.
This guide includes a Nursing Home Evaluation Form that you can take with you as you visit
potential nursing homes. You can make copies of this form so that you can bring a copy with you to every facility you visit. Read over the form ahead of time so you are familiar with the things to look for when you visit. Also, take a moment to write down any questions or considerations that are particularly important to you or your loved one that may not be included on the form. If possible, have a discussion with your loved one about what is important to them and what factors (e.g. location, proximity to family, physicians on staff, specialty programs) you want to prioritize during your search. This way, you will be able to identify and consider nursing homes that are most likely to be a good match for your family’s individual situation.
Most importantly, you do not have to feel powerless in this process! There is no question that placing a loved one in a nursing home can be overwhelming. However, it does not mean that your loved one cannot continue to enjoy a full and satisfying life. As your loved one’s advocate, there is still a lot you can do to ensure that your loved one receives the level of care they deserve while continuing to pursue the activities and interests that they enjoy.
Identifying Potential Nursing Homes
There are many ways you can go about familiarizing yourself with nursing homes in your area that meet the criteria that your family and your loved one have identified as most important to you. You can begin your investigation by contacting local organizations that serve the elderly. For example, Connecticut has five Area Agencies on Aging that serve the entire state. You can contact the North Central Area Agency on Aging at (860) 724-6443 or go to their website at www.NCAAACT.org. Contact information for the other CT Area Agencies on Aging can be found at www.ctagenciesonaging.org. Another potential source of information is the Connecticut chapter of the Alzheimer’s Association; you can reach their main office at (860) 828-2828. You may also want to ask your loved one’s doctor if he or she provides care at any of the nursing homes in your area. If your loved one trusts and feels comfortable with his or her doctor, this may be a consideration to factor into your decision. Even if your loved one’s doctor does not provide care at any local nursing homes, he may work with another doctor who does. You may also wish to seek advice or recommendations from friends or members of local community or religious groups you or your loved one are affiliated with.
Additionally, there are many resources available on the internet. One of the most comprehensive resources is Medicare’s Nursing Home Compare website, www.medicare.gov/NHCompare. Here, you can search for nursing homes by location and access quality data about each facility based on their most recent state inspections, staffing levels, and quality measures of their residents’ health and well-being. Once you have a list of potential nursing homes, you can also use the Nursing Home Compare website to search by name and pull up information about specific nursing homes.
Lastly, you may want to contact your local or state ombudsman. An ombudsman is an advocate that protects the rights of residents in long-term care facilities. Your local ombudsman can help you identify local facilities and, once your loved one moves into a nursing home, your ombudsman can also help ensure his or her rights are protected and address any concerns or complaints you or your loved one might have. You can find contact information for your local ombudsman by going to www.ltcombudsman.org, clicking on “Locate an Ombudsman” in the top right corner, and then selecting Connecticut on the map, or going to www.ct.gov/ltcop, selecting “Regions” from the list on the left, and selecting the appropriate region from the CT map.
Choosing the Right Facility
When making a list of nursing homes to consider, think about what factors are most important to your family and your loved one. Is it important that the nursing home be close to where family members live so it is easy for them to visit? Is it important that the nursing home have a specialty program or a secure Alzheimer’s unit? Does your loved one particularly desire available outdoor space or is he or she particularly social and wants to live somewhere with a busy calendar of events and activities?
If you have time, call any nursing homes you are considering and request an informational packet, an activity calendar, and a menu. This can give you a sense of the types of services a nursing home offers and whether it might meet your loved one’s needs. If, after some preliminary research, you think a particular nursing home might be a good fit, it is very important that you visit in person. Do not call ahead to schedule a tour - if you show up unannounced you will be able to get a better sense of what the atmosphere at the facility is like on a day to day basis. If possible, visit facilities you like a second time in the evening or on a weekend to make sure that there is no change in the friendliness of the environment or the level of care during these times. Make sure to visit at least two facilities so you have a point of comparison when deciding whether a place would be a comfortable fit for your loved one.
When you visit, you should take a copy of the Nursing Home Evaluation Form from this guide. Make sure to write your observations down. You might forget what you liked and disliked about different facilities if you tour more than one (which you should!). Ask your loved one to come with you to see potential facilities if possible. They might have a different perspective than you do and you want to make sure to take their opinions into account. Pay attention not only to the more obvious considerations - Were there any strong odors? Was the facility clean? (See Nursing Home Evaluation Form Section 5. Building and Environmental Concerns), but also be aware of more subtle indicators of quality - Is there training available to keep staff up to date on new medical developments and standards of care? What are the facility’s policies for preventing the spread of infection? (See Nursing Home Evaluation Form Section 2. Staffing and Care Considerations). You should feel free to ask any questions that come to mind.
This is a big decision and you should not be made to feel rushed or silly. Some potential questions you might want to ask include:
• How many direct care staff members do you have on each shift? Does this number
exceed the minimum state staffing requirements?
• What is your policy on family care planning conferences? Will you be able and willing
to schedule these conferences so that I am able to attend?
• Who is your medical director and how long has he/she been with your facility?
• Can residents use any pharmacy?
• How long is your waiting list and what does your application process look like?
• Would my loved one be able to come in and have a meal here to see if he/she is
comfortable with the facility before we make a decision?
• Do you have references I can speak to about their experiences here?
The following form will help you keep track of potential questions you may want to ask. Not all of the questions will be important to you and your loved one and not every facility will have a perfect answer to every question. However, this form can be a very useful tool for helping you and your loved one reflect on what is most important to you and make an informed decision.
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Admission and Transition
Once you have chosen a nursing home, you must go through the correct procedures to move your loved one into the facility. Stay organized by keeping a designated folder or binder for all of the necessary documents you might need. Complete any admissions paperwork before the day of admission so that you are able to get any lingering questions answered ahead of time. Make sure you have discussed all costs, including any additional fees (e.g. for medications, cable, etc.) with the admissions staff and that you know the acceptable methods of payment (e.g. personal check, long-term care insurance, Medicaid). Familiarize yourself with the requirements of Medicare and Medicaid. These requirements should be discussed with a Medicare and Medicaid specialist, not just the admissions staff. Nursing home admissions staff are NOT Medicare and Medicaid specialists. Government benefits can be complicated and you need to know the requirements for these benefits as they apply to your loved one’s unique situation. It is critical that you consult a trusted advisor for information about these benefits so that you ensure that you do not accidentally disqualify your loved one for the benefit or create a penalty period.
Keep in mind that the staff at the facility are meeting your loved one for the first time. Therefore, they are not going to be as familiar with his or her preferences and habits as you are. The biggest way you can help your loved one during the transition into the nursing home is to give the staff as much information as possible about your loved one in writing, including his or her likes and dislikes, typical daily schedule, hobbies and interests, pet peeves, and anything else that may come to mind (You can use the form for communicating your loved one’s habits and needs included in this booklet, which will be discussed in a later section). You should also get to know the staff members yourself. Introduce yourself. Be friendly and show your appreciation for the care they are providing for your loved one, but also do not be afraid to speak up for your loved one if something doesn’t seem right.
When planning for the move, help your loved one pick out some favorite items from home to bring to the facility, but limit the number of things and make sure the items are appropriate. You may want to discuss with the staff ahead of time what would be appropriate to bring (e.g. a small piece of furniture, pictures, a favorite lamp or quilt). It is best not to bring items that are extremely valuable, but if your loved one wants to bring something that has high monetary value discuss with the staff the best way to store and use the item safely. Advise your loved one to leave expensive jewelry with family instead of bringing it to the nursing home. Small items can easily go missing and, with changes in physical condition due to aging (e.g. fluid gain and weight loss), pieces of jewelry such as watches or rings may slip off or require removal and get misplaced.
Even if you are doing your loved one’s laundry, mark every piece of clothing with a permanent marker. When the facility is doing laundry for a large number of residents, it is normal for some pieces of clothing to be misplaced or mixed up on occasion. If you do want to do your loved one’s laundry yourself, post a sign on the closet door to notify staff and provide a laundry bag for placing and transporting dirty clothes.
The Care Planning Process
The care planning process will usually begin as soon as your loved one is admitted into the nursing home. The staff will begin to do a baseline assessment and a team from the nursing home, which may include a doctor, nurse, social worker, dietician, and/or physical, occupational or recreational therapist, will collect information through their own observations, from the resident’s medical records, and from the resident and his or her family members (you!) about the resident’s level of function, medical needs, and other needs. This baseline assessment then gives the staff something to measure the resident’s progress and well-being against.
The care team focuses not just on the resident’s medical needs but also their spiritual, emotional, and social needs. Sharing information about your loved one’s preferences and habits can help the care team form a more complete picture. You can make your own list of your loved one’s needs and give this list to the care team. To make this list, you can use the form included in this booklet for Resident’s Habits and Needs, which has space for you to write down any observations or information you know about your loved one that might be useful for the care team or the nursing home staff in general to know.
During the first month of your loved one’s stay, the care team will meet at a care planning meeting, which you and your loved one should be invited to attend. Make an effort to attend this meeting and bring a copy of the information you provided to the care team earlier regarding your loved one’s daily habits and needs. This meeting is where you can discuss your loved one’s needs and make sure that issues that might have been overlooked are addressed. In this meeting, the care team should come up with a care plan that details the resident’s needs, and set out how the facility will go about trying to improve (where possible) or maintain your loved one’s health and level of function. According to federal law, care plans must be reviewed every three months and/or whenever the resident’s condition changes. The nursing home must also perform an annual care plan reassessment. You should try to attend all care plan meetings, as this is an excellent way to ensure your loved one’s needs are being met.
Ensuring Quality Care After Admission
Even though you will no longer be providing direct care to your loved one, this does not mean that you will no longer be involved in their care. You still know your loved one best and this makes you an invaluable advocate for him or her. Cultivate a positive relationship with nursing home staff. You should be able to communicate openly with them about your loved one’s needs and preferences, but also make sure to show appreciation when they have done something that affects your loved one in a positive way. Communication with nursing home staff should not only occur when something negative has happened.
The most important thing you can do for your loved one is remain involved throughout his or her stay in a nursing home. Frequent visits do not just allow you to communicate with nursing home staff and ensure that your loved one is receiving quality care, but they help you and your loved one to remain connected and give you the opportunity to simply enjoy each other’s company now that you have the peace of mind that comes from knowing your loved one is in an appropriate and safe environment.
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