How to Choose the Best Nursing Facility for an Aging Parent
Nobody really wants to think about their parents giving up. If we’re lucky, our parents will select a retirement community well in advance and have the means to pay for it. But for the rest of us, we may well be doing the light work ourselves, either coaxing them into exploring options while they are still healthy, or – in the worst case – frantically looking for a place after they fall. or had a stroke. Either way, finding the right place can be tricky, especially if you’re short on money or time. To get some guidance on how to start the process, I spoke with David Hackerstick, former director of the Lancaster County, PA Agency of Aging Affairs, and administrator of several elderly care communities, now a consultant.
Object types
First of all, a little terminology: there are three levels of service or types of accommodation. There is an independent life (a “retirement care community” or a “life plan community”), an assisted life that helps patients dress, bathe, use the toilet, eat and take medications, and skilled nursing staff or 24-hour patient care. care. Haverstik says, “Usually the transition to skilled care is associated with urinary incontinence” – if your parent can no longer control their bladder or bowels, it’s time for skilled care.
How to find the nearest object
Nursing homes are things that you don’t notice until you want to, so you may not be aware of the facilities in your city. Haverstik says, “Every part of the US will have a regional aging agency , better known as aging offices. In urban states, there may be five or six, and in a larger number of rural states there may be only one for the entire state. Their purpose is to provide information not only to enable people to make decisions, but also to guide people through the process of accessing services and making decisions, such as whether to leave a parent at home or find a place to live. Most aging offices have an effective information and referral program. ” Search the Internet for your area’s website and contact them for a list of resources in your area.
If your parent is in the hospital, a social worker can provide you with a list of facilities in the area, but Haverstik notes that the hospital’s priority is to evict patients, not necessarily help you find the best place for your loved one. …
Another option, if you are willing to pay, is to hire an aged care manager , a social worker who works with seniors to help them get proper care. Haverstik notes that it is more common when parents and their grown children do not live next to each other; you can find it simply by typing “senior care manager” and his staff, and find someone accredited. This New York Times story details what senior care managers do, certification associations, and rates (though take rates with a grain of salt – a fast almost 10 years).
Finally, Nursing Home Compare can help you connect with qualified healthcare providers in your area that are enrolled in Medicare and Medicaid programs. Enter your zip code and a list of properties will appear. Services are rated from 1 to 5 stars; Haverstik says, “Three stars is good, but one or two stars are in question.”
What will you pay
“Grooming is not cheap,” says Haverstik. “Assistance with accommodation [in the northeast or central Atlantic where he lives] is about $ 150 a day, and skilled nursing staff costs $ 300.” Accommodation assistance is usually paid out of pocket : “Since there are no government programs (some states have a subsidy program and some do not), patients are left on their own.”
Long term care insurance is possible, “but these policies are questionable because [insurers] go out of business or premiums are suddenly sky-high.” Medicare will pay for skilled care if your parent qualifies — that is, it must have a “rehabilitated” condition, must have a three-day hospital stay for it, and must go to a Medicare-certified community. … And even that, according to Haverstik, is “fixed in time: 100 days per incident.” So if your parent is just downsizing normally and doesn’t meet these requirements, you will have to pay out of pocket. “There is no special help for living with childcare. It is assumed that they can avoid placement and receive medical attention at home, ”he says.
Haverstik notes, “And then there’s Medical Assistance , a federal program run by the states, for people who need long-term care but don’t have the financial resources. Typically the sequence of actions is this: A RNC will require you to demonstrate that you have significant funds – they will say, “We will not consider you if you do not demonstrate that you have,” for example, “$ 200,000 “. And then you will spend that money on a monthly basis, and when you exhaust all your resources, the salary will go to medical care, and they will continue to take care of you. ”
If your parents don’t have the financial resources to get started, they can start with health care, but not all communities are involved. And, as a rule, the communities that pay for health care in the first place are not of the same quality as the communities that are paid for by the private sector. As Haverstick says, “These are one or two star communities.”
Plan ahead
If you start the process well in advance, Haverstik recommends meeting with an aged care attorney along with your parents to advise them on how to sort out your finances while keeping in mind what lies ahead . He also suggests touring various sites in your area with your mom or dad. “If you’re in the planning business, a lifelong care retirement community can be a good choice. You can look at all the communities in your area and see what they cover and what they don’t – and this is not necessarily out of the question for people of modest means. ” If your parents are in their 60s or in their early 70s, now is the time to start this process .
The actual choice of location
On the smallest details of choosing an institution, Haverstick said he has a personal preference for nonprofit, more mission-oriented (sometimes religious) institutions because he thinks they have a higher standard of care than commercial ones. “While in these places they talk about leaving, this is business. This can be very frustrating for families. “
Haverstik advises you to look out for the following red flags and good signs during your tour and interviews:
- The size of the object. “Less is more,” he says. “There is more personalized care and less institutionalized. These are known as ” greenhouses ” or “home houses”. Most health care facilities are larger and more institutionalized. “
- Human-centered care. Is there an individual approach to classes? Are your food preferences satisfied? Do they let you wake up when you want? This is a big problem: if staff insist on waking your parent at 4 or 5 in the morning, this can greatly interfere with their well-being.
- Communication with the outside world. Is there continuity with their previous life? “Things should happen that connect residents to their usual way of life: speakers, classes. Look at the class calendar: will your parents like it? And notice: is everyone gathered around the TV or at the nurses’ station? If so, it’s a bad sign that this is the only thing going on with them. ”
- Reasonable staffing. How many nurses and assistants are there per shift? How big is the block? “If there is one assistant for ten people, this is too much. Five is about. If two or three, this is an exception. There will be fewer people on the second shift and night shift, but still there should be enough so that people do not lie in wet diapers. ” Watch all three shifts if you can.
- Clean, well appointed. “Did everyone get out of bed and get dressed by the middle of the morning? Do people wear hearing aids and glasses? In many places these things are forgotten. Can you imagine yourself having a cognitive decline and then spending the day without being able to see or hear? Are there smiles on the faces of the residents? On the faces of the employees? If the staff is unhappy, the concern is not strong. ” This Reddit thread weighs in on what else to look out for, including trimmed fingernails and toenails, and residents wearing their own clothing.
- An odorless product. Do you smell urine or feces when entering? Red flag. “Renovation of the building should be less of a concern – it does not necessarily affect the quality of care. I have seen areas that were a little worn out, needed painting or had a little dust, but the care was outstanding. People may admire the newly built, freshly painted spaces, but the care is not up to standard. ”
- Acceptable noise and light levels. A noisy or chaotic nursing home is not something you want to expose your parents to. “When people change activities, there will be some noise, but overall it should be quiet and calm. And people must have access to the street to be able to get out and get some fresh air. “
It is impossible to ignore the fact that this is a painful process for parents and children, and if you are in the thick of things, it can feel like you are reinventing a really dirty wheel. If there is any takeaway here, it’s this: start planning as soon as possible – it will significantly improve the quality of life for your parents and your life.