By Rita Dichele

At some point in time, caregivers may find themselves faced with choosing a long-term care (LTC) nursing facility.  This can be an overwhelming feat to accomplish, since often the caregiver has limited time to do so.  Also, the caregiver will be faced with choosing a LTC facility that in essence will be the home for their loved one either short term or until death. 

Caregivers need to be consumers and approach their task as if they were making a purchase that will have lasting effects such as buying a house or even choosing a college for their child.

There are many things to consider when making this  important decision.

What is the nursing ratio?   In other words how many  patients does one nurse take care of?

What kind of direct care is provided – nursing assistants, recreational activities directors, physical therapists, occupational therapists, etc.  Have the nursing assistants received education and training and are they certified?

Are private rooms available? If not, can rooms be changed if there is conflict between the roommates?

Are all residents immunized against the flu and pneumonia?

How often do healthcare providers see residents?

Does the LTC facility reframe from using chemical  (medications) and physical restraints?  And if necessary, are they used in extreme situations for medical purposes only?  Will the facility notify family for permission to use chemical restraints as required by law?

Is there an ombudsman you can speak with?  The ombudsman is the person who advocates on behalf of the nursing home resident.  The ombudsman’s job is to gather all  complaints and take appropriate action.  Furthermore, the ombudsman is a good person to consult regarding the nursing home’s quality of care and any registered complaints.  Each state has an ombudsmen department as mandated from The Older American’s Act (1965).

How is the facility accredited?  Is it accredited with the Joint Commission (formerly, JACHO)?

Is the annual National Nursing Survey available to family members to read?  The ombudsman can provide this valuable report.  The report is an important resource to obtain an overview on the strengths and weaknesses of the nursing facility. The results of the surveys provide information on the services, medical care, and residents for all nursing homes nationwide.  The National Nursing Survey is done even if the facility is not funded by Medicare or Medicaid.

Is the nursing home for-profit, not-for-profit or part of an acute hospital facility?  Does it make a difference in care?  Technically it should not.  But it could.  Be aware that many nursing homes are organizations that seek to make a profit are accountable to stakeholders. The goals of the profit organization may differ from the not-for-profit organization’s goals with possible consequences of compromised services given to the residents.

How are financial arrangements coordinated among long-term, self-pay, and Medicaid insurances?  Does the facility take Medicaid?  Because the LTC facilities are privately run, they do not have to accept Medicaid patients. However if the facility does accept Medicaid, it cannot discriminate with its admission policies and procedures and must accept all Medicaid patients.

Finally and most importantly, are there beds available, and if not, is there a waiting list and how long is it?

In the meantime, planning ahead is key so that last minute decisions do not have to be  made.  It is probably best to narrow down your choices to at least three facilities. Take your time and do your homework.  It will be worth the time and effort!!!  But do keep in mind the transition from home to institutional care will not only be difficult for the family but for your loved one as well.  There will be a period of adjustment but don’t doubt your decision about the placement.  Remember, in many instances placement is  for safety reasons. 

Even though the loved one will be living in a new place apart from the caregiver, the caregiver’s responsibilities do not end.  Often caregivers are seen by the nursing facility’s social worker on a regular basis.  The purpose of the meetings is to keep the family updated on medical and social concerns regarding the loved one.

Furthermore, if the loved one becomes ill and needs to be transferred to an acute hospital (short-term hospitals), the caregiver will need to coordinate the care.  Be advised that once the loved one is admitted to the hospital, the costs of the nursing facility automatically becomes self-pay.  Insurance does not pay for two places.  This certainly becomes an inconvenience, especially if left behind in the nursing facility are many personal items that need to be picked up.  Of course, there is always the option to keep the bed and self-pay, but the costs can be very high.  Nursing homes can range from $7,000 to $11,000 per month.

Finally, no matter what nursing facility you picked, it is not home.  There will be problems that may not be able to be resolved immediately.  If the nursing staff is not receptive to fixing the problem, and even is defensive deferring blame to someone else, take action.  Either get the nursing supervisor involved or speak with the facility ombudsman.   The best recourse in the end is to make frequent trips to the nursing facility, question staff regarding your loved one’s care, and understand that you have done the right thing.  Don’t be get guilt ridden with your actions.  If you do, you might find yourself less effectual in your caregiving abilities. Be as gentle with yourself as you are with your loved one.

Rita Dichele holds Masters’ degrees in Counseling and Healthcare Administration.  Currently, she is an advanced doctoral learner at Capella University where she is writing her dissertation on successful aging.  Rita resides in Shrewsbury, Massachusetts and serves as a board member on the Council on Aging. She is a town appointee for the Shrewsbury Cultural Council, facilitates two groups at the Shrewsbury Senior Center, and is a certified SHINE Medicare/Medicaid counselor.  Rita is also a past presenter at the 2009 American Society on Aging Conference.