Family Living Focus: Choosing Well: Long term care facilities

One of the hardest things a caregiver will ever have to do is to know when it’s time for their loved one to go into a long-term care facility. Often, caregivers will go long past the point of when they should have incorporated help from the outside. Sometimes, it’s their own fear of failing as a caregiver and the fear of letting someone down that stands between themselves, their loved ones, and an improved quality of life for both. Identifying some of the following may help make the decision process a little easier and define certain things a little more clearly for the caregiver.

A long-term care facility may be needed if:

• Your relative’s condition keeps getting worse and is becoming too much for you to handle on your own;

• No matter how hard you try to give care to your loved one, it’s just not enough;

• You feel as if you are the only one around who is having to care for someone who is ill or elderly;

• You’re not receiving any type of respite, and it doesn’t look like anything can be arranged for you to get much-needed time away or rest;

• Relationships with other family members are breaking down because of the time you must dedicate to caring for one person;

• Your caregiving responsibilities are beginning to greatly interfere with your work and personal life;

• You have feelings of guilt when it comes to taking care of yourself;

• Your coping skills are beginning to include self-destructive behavior, such as eating too much or too little, increased drug use or alcohol use, or losing emotional control too often;

• You rarely experience any moments of happiness, but have too many real moments of exhaustion, anger, and resentment;

• You hold your feelings in, never allowing them to be shared with a friend or with a professional.

As a caregiver, you may very well have experienced many, if not all of these things from time-to-time, or you may now be starting to experience these things constantly. In order to conquer your fears of placing a loved one into a long-term care facility, you need to understand more about some of the facilities nearest to you.

 As a caregiver, you may wonder how to go about finding what’s available to your loved one in and around the area in which they live, and how to decide upon what type of facility will be best for them.

A few people you may want to ask are: your family physician; hospital discharge planners; social workers; home healthcare nurses; friends and/or neighbors who have been through similar experiences; your religious leader; geriatric screening programs through a local hospital or community center; and finally, government agencies such as the federal Area Agencies on Aging, or local county public health and family services.

If there is a professional familiar with your loved one’s condition, ask them about what kind of facility would be best in matching and meeting particular needs. These people may be able to help you base a decision upon specific medical considerations and information, such as conditions like Alzheimer’s or Parkinson’s, mental health and awareness of the person, and their physical and mobility factors.

When deciding on a few places to check out, first call them and ask if there is a waiting list for the facility, what the cost might be, and what types of insurance or supplements, if any, are accepted. The answers you receive from these phone calls should help you narrow down your list of possible places.

When you’ve selected a few places, make sure you ask even more questions to help you better assess the quality of each facility. Also, listen to your “gut” feelings when you begin each tour, and it may be helpful to bring along a friend or other family member in order to get some other forms of input regarding each facility.

Some general questions to ask each place can include:

Location – Is the facility conveniently located to where you live? Will it be easy for you to get to in order to visit? Is public transportation available nearby?

Appearance/Atmosphere – Are the kitchen, day rooms and bedrooms clean? Is there good natural and artificial lighting?  How is the temperature?  Are there any unpleasant odors?  Does the facility meet your standards of cleanliness?  Is the facility wheelchair and walker friendly? Are there handrails to help with walking?

Menus – Is the menu varied and nutritious? Will the facility accommodate special dietary needs? Is food available throughout the day? Are people allowed to snack? Are mealtimes flexible and varied? How is the food? Visit facilities at mealtime. Does the food look appetizing? Do residents appear to be enjoying their meals? Is there adequate assistance and supervision for those residents who need it? Ask if you can sample the food. What do you think of it?

Bathrooms – Are they private? Are they clean? Are they easy to find? Are they close to where your loved one will be? Do they have grab bars and other safety devices installed?

Alzheimer’s-friendly – If your loved one has Alzheimer’s, is the staff specially trained to care for someone with this condition or other forms of dementia? Is there a separate unit for Alzheimer’s residents? Are Alzheimer residents able to wander safely indoors and outside?

Resident-to-staff ratio – What is the resident-to-staff ratio? How many residents have Alzheimer’s disease? Does the staff provide enough care throughout the disease process, no matter what the disease and/or condition?

Interaction – Do all staff interact with residents on a regular basis, and in a friendly and personable manner?

Activities – Are there meaningful activities for groups and individuals? Are there therapeutic activities, like music, pet, or plant therapy? Are there opportunities for your loved one to socialize? Are the routines flexible and offer variety?

Visiting – When are you allowed to visit? Can you have privacy with the resident when visiting? Can you take the resident on outings, such as to a park, a restaurant, or to a family function?

Behavior Management – How are different types of behaviors handled? Are restraints used? (Physical restraints like straps, chemical restraints like sedatives, or restraints to the environment, like a locked door.) Don’t be afraid to ask what portion of the residents has to be “medicated” or have to have physical restraints. Also, try noticing these things yourself.

Safety – Are there smoke detectors? Are there slip-proof mats in the baths, grab rails, bed rails, etc.?

Medical Care – Can you continue to use members of your loved one’s healthcare team? Is there a doctor always available or on call in case of emergencies? How often does a doctor visit? Can you meet the doctor?

Philosophy of Care – Does the facility focus on the needs of the individual resident? Can flexibility in routines be accommodated? Are there regular care planning meetings regarding your loved one? Will these meetings include you and other family members as well?

Individualized Care – Is consideration given to individual cultural, religious or spiritual needs? Are other languages spoken? Is the facility “home-like”?

Atmosphere – What is the atmosphere like? Are residents up and about? Are they socializing with one another? Is the staff actively engaged with residents?  Does staff treat residents with respect?

Outdoor Areas – Is there a nice spacious outdoor area for residents?  Is there a covered outdoor area in case of rain?

Another great way to obtain information is to speak directly to the residents. Ask them how they like living there and let them know that you are considering the facility for a family member. Larger facilities may offer an opportunity for you to speak with residents in a more private setting, enabling you to get more candid answers and information. You may find residents at smaller facilities to be a little less comfortable speaking about their experiences, since they have less privacy. If this is the case, don’t push the issue.

After you’ve had the “official” tour, you may want to walk around the facility by yourself, unaccompanied. Just remember not to enter any of the residents’ rooms or areas without receiving permission first. When making your final decision, take into consideration not only the services your loved one will need right now, but what they may need in the way of care further down the line. Make sure the facility you decide upon has services that you may also need in the future.

Before making your decision, carefully review the entire admissions packet, especially the section that covers fees and services with a complete schedule. Will Medicare be accepted? Will Medicare be willing to cover the chosen facility? Will Medicaid be accepted if personal funds run out?

Even after doing all your homework and visiting several facilities, you may not find exactly what you’re looking for. Keep your options open and flexible. You can help promote quality-of-care for your loved one by staying actively connected to them as much as possible, no matter what type of facility is decided upon.


Information adapted from article by Hilary Gibson, Staff Writer in Today’s Caregiver Newsletter, January 30, 2014 – Issue #684.


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