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YOU
HEAR THE DREADED NEWS from your mother's doctor, and
you know deep down it's true. Your mother cannot live alone any more.
Her medical and physical care needs are too great. You see her several
times a week and call every day. You do her shopping and take her to
appointments, but you have your career and your own family to take
care of. You cannot be there 24 hours a day, seven days a week and she
is not safe alone at night. Your mother needs skilled nursing care but
does not want to move. Now what?
You and other family members are thrust into
the confusing world of long-term care. There are 34 skilled-nursing
facilities in Monroe County alone. Some are for-profit and others
non-profit. Many accept long-term care Medicaid as payment, but some
do not.
In addition, some nursing homes are a part of
a large continuum of care with different living communities housed in
other buildings. Others are small facilities and provide only
skilled-nursing care. You will also find that some homes are run by
large health care organizations and have affiliations with certain
area hospitals.
How will you find the excellent care your
relative needs and a home you will be comfortable with as well? Where
do you start in assessing long-term care facilities?
Gathering information about the nursing homes
you are considering is the next step. Calling the admissions staff and
asking for written material as well as price lists will start you on
your way. However, a tour or visit to the facilities you are seriously
considering is essential.
Questions you want to ask include what
medical services are included in the cost, how is transportation
arranged, are there "special care" units as for those with
dementia, for example, and can your relative keep her own doctor.
Activities, social events, visiting hours and opportunities for family
involvement are all important areas to ask about, as well as what
happens when your relative's private-pay money runs out. Does the
facility accept long term care Medicaid?
Your powers of observation on your visits are
extremely important as well. Are the residents up and dressed? How
does the staff interact with them? What kinds of activities are they
engaged in?
Visit at mealtime, and notice if the
food looks appealing and if people who need help are receiving it. Is
the environment clean and free of unpleasant odors? Pay attention also
to how the facility feels to you. Is it homey? Does it look more like
a hospital than a residential community? Notice if the staff is
friendly to residents and visitors and if you would feel comfortable
going there to visit frequently.
In addition, talk to friends and
colleagues about their experiences with nursing homes and ask which
ones they would recommend, keeping in mind that every family's
experience is different and unique. A professional elder-care manager
who has experience dealing with local nursing homes can help you
compare the homes and services you are considering.
Finally, trust your instincts. Usually
after visiting several homes (I recommend three to five), one of them
will stand out in your mind as the right place for your relative.
Submit applications to at least three homes, because this will give
you more latitude in terms of bed availability.
Now that you have found the best living
situation for your relative, how can you make the move easier for all
concerned?
One way is to involve your elderly
relative as much as possible in the move. Be aware of your relative's
reluctance and even anger at first, but keep calmly reintroducing the
topic at quiet moments. Take time to listen to your relative's
concerns. Acknowledge his or her feelings of loss and anxiety.
Give your relative as much reassurance,
patience and understanding as you can. Ask your relative's doctor to
talk to your relative or write a "prescription" for a
residential move on a prescription pad so you can refer to it when
needed as "doctor's orders." The decision to move is a
medical one. Involve your relative in decisions about what furniture
to take, clothes to pack and what he wants on the walls of the room.
Consider how it can be decorated to be as comfortable as possible for
your relative.
Once your relative has moved in, it is vital
to share information with the care team in the home. Meet and speak
with the nurse manager, primary nurse, social worker, activities
director and dietitian so you can start to build a working
relationship with them and so they will know your relative better. Let
them know about your relative's work, hobbies, children,
grandchildren, food preferences and schedule preference for bathing
and sleeping. This will assist staff in working with your relative.
Maintaining contacts and friendships with
others is extremely important in residential communities. Interacting
with other people helps your relative stay alert and connected to the
world. By the time a person enters a nursing home, he has lost many
friends and relatives. It is important that your relative get to know
the other residents and the staff.
Encourage your relative to attend activities
and outings planned by the recreation staff. You might go along with
your relative occasionally so you can enjoy the activity together.
Focus on what is going well and on the
positive aspects of the move with your relative. At the same time,
listen to concerns of your relative. If some aspects of the transition
are not going well, do not hesitate to speak to the nurse manager or
social worker. Ask for a team meeting if you feel the entire care team
needs to be involved.
Having something to look forward to often
helps residents through difficult times and lifts their spirits. It
could be lunch out with you or a friend, a visit by grandchildren or a
walk in the garden. Keeping in touch with friends and family can
combat loneliness and bring much joy.
If the person has the ability to write, give
her note cards, stamps, postcards, easy-to-hold pens and large-print
addresses of friends and relatives along with a box of all-occasion
cards. Most people love to get mail that's not bills! For those unable
to write, a taped message can be made and sent.
If your relative is memory-impaired,
keep a "guest book" in the room for visitors to sign. She
can then look back through the book to be reminded that she had
visitors who cared enough to come.
A move to a long-term care facility is
difficult for the family as well. Your life as caregivers is changing.
Sadness, relief, guilt and anger may all be present for a caregiver
who is turning the care of a loved one over to unknown strangers.
Give yourself time to work through your
own emotions and feelings. Talk to a counselor, care manager, friend
or other trusted person. Find out if the facility offers a support
group or counseling for families experiencing this transition.
Assessing and moving your relative to a
long-term care facility can be traumatic for everyone involved.
However, anticipating and planning ahead for your relative's comfort
and for your peace of mind can make the transition easier for all.
Karen Witkowicz is an elder-care manager and consultant with a private-care
management practice in the community and 25 years of experience as an advocate and
social worker. For more information, visit her Web site at
www.rochestereldercare.com.
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