Death and taxes are two things in life we can count on. But while we’re waiting we can be somewhat sure that, 1.) things change, and that, 2.) we will get older. Everyone wants to live a long life, and thanks to medical advances a greater and greater percentage of us are doing just that. Yet nobody wants to age. Not even gracefully, but especially not in a nursing home or assisted-living facility.
Most elderly would vastly prefer what they perceive as the independence and dignity of growing older in their own homes. Most will fight tooth and nail to deny any prospect of losing control of their lives. Much to the dismay of their family, they will also deny their worsening medical situation. Oh that? Never happened, not a problem.
At some point in time, however, the job of care giving an elderly loved one may become physically overwhelming and too much for any one person. The growing reality of requiring 24/7 medical attention becomes obvious to friends and family members long before any Ah-Ha! moment for the would-be patient. Nearly half of elderly folks over 65 suffer some form of mild cognitive impairment (MCI) and nearly half of that group are diagnosed with varying degrees of dementia or Alzheimer´s.
Convincing the elderly that there is no longer any other option but to have 24/7 available care can be a difficult task in itself, one that usually falls to the designated decision-maker in the family. This can be an opportunity to preset brochures with lists of medical services that a prospective facility can provide, services that have become too much for family members.
No matter what the arguments for and against, 40% of us will end up in a long-term health care facility at some point in our lives. Currently, about 1.4 million Americans are paying an average $90,000 per year for a private room in either an assisted-living facility or a nursing home. Semi-private rooms cost slightly less. But patients requiring continual care will pay twice that amount. For many, what was once the unthinkable quickly became the unavoidable.
To begin the selection process, find a facility that you trust on many levels, one that is close enough for regular family visits, and one within budget over the long-term.
- Next, understand that, by law, “assisted-living facilities” are not permitted to provide medical treatments nor care. Get the person in question in to a doctor for a thorough medical exam. A nursing home may be necessary.
- Learn the complicated, sometimes confusing, rules of Medicaid and Medicare. Who qualifies, what each covers, and definitions specific to these insurances. From LongTermCare.gov…Medicaid is a joint federal and state government program that helps people with low income and assets pay for some or all of their health care bills. It covers medical care, like doctor visits and hospital costs, long-term care services in nursing homes, and long-term care services provided at home, such as visiting nurses and assistance with personal care. Unlike Medicare, Medicaid does pay for custodial care in nursing homes and at home.
- Understand that medical care does not take place in an assisted-living facility but at a hospital or in a nursing home, with separate costs, covered by a separate insurance, mostly Medicare.
- Medicaid, not Medicare, will pay for long-term health care, but only if the patient qualifies. To qualify for Medicaid, the elderly must have minimal assets. Assets can be transferred to others to meet this requirement, but only if the transfer takes place five years prior to application. Thus, prior planning is essential.
- Know that once a patient is placed in a facility, supervision and transportation by someone outside the facility are still necessary on a regular basis. Monthly bills, medical treatments, and ongoing care must be monitored.
- Be aware and well-informed. Cases of identity theft, poisoning, beatings, embezzlement, taunting, larceny, and many forms of abuse are reported each year in the full spectrum of facilities. Some families even resort to installing hidden “Granny Cams” or video surveillance systems in the patient`s room in order to detect and record suspected violations and criminal activity.
- Know the differences in service and costs between a “nursing home” and an “assisted-living” facility. Match the services offered with the patient´s needs and prognosis. Exactly how much medical care will be required in the future?
Once these basics are understood, the process of searching for that right facility can begin. Take your time and be methodical. Like a pilot before flying a plane, use a check-list while walking around, checking everything. Someone´s life may depend upon your inspection process. To help organize this daunting task:
The Ten-Step Check-List
To Finding the Right Long-term Health-Care Facility
#1. High Costs and Beautiful Grounds do not always indicate a High Standard of Care. The quality of care can differ widely no matter what the costs. Moreover, there may be a large gap between advertised performance and actual care. Follow this check-list thoroughly and you will expose such gaps. Your diligence will be rewarded. You will find that one facility that is far better than the rest.
#2. Walk Around and Use All Your Senses. Watch as many patient/Staff interactions as possible. Get an overall feel for the facility. Listen for conversation or sounds of patient distress, or happiness. Smell around, sniff for hygiene, poor maintenance, urine and ammonia.
#3. Ask Questions to the Administrators, Talk to the Staff, Talk to Other Families. Get to know the staff. Are staff members happy in their work? Do they show consistent care and respect for the patients? Is there a consistent professional ethic? Mission statement? What are some stated administrative goals and policies, and how are they maintained? How do other families rate the facility? What do they see as strengths and weaknesses?
#4. What are the Specific Safety Precautions at the Facility? What steps are taken to prevent abuse, identity theft, petty theft, embezzlement, poisonings, fire, contagious disease, taunting, and disrespect? What safeguards are in place and does the administration provide regular checks to make sure they are workings? Is the staffing late at night adequate to provide safety and round-the-clock care?
#5. The Physical Plant. Is the Facility More Like a Home or an Institution? Is it close enough for regular visits? Is there natural light? Do sounds echo? Is there access to the outdoors? Does the dining room feel like a cafeteria? How is the food served? Are the meals healthy, balanced, and nutritious? What are the visiting hours? Are there several different common areas? Large enough for group activities?
#6. How are the Patients? Are they dressed appropriately for the activity or time of day? Are they clean, shaven, and well-groomed? Do they appear healthy, active, and socially engaged? Do they appear sedated? or depressed? Are they involved in activities?
Most importantly, how is the soon-to-be patient? In addition to a thorough physical exam, have they had a recent “cognitive assessment”? How is their mental health? Do they have “episodes”? Determining their level of cognitive function and mental health is critical for correct placement and everyday safety.
#7. Medical Emergencies. What is the response time for a medical emergency? How close is the nearest emergency room? Is there a Registered Nurse on-site and on-duty at all times? Is a doctor on-call at all times? What is the nurse to patient ratio? Ask to see credentials. How long do patients wait once they have asked for help? Is the entire staff trained in CPR? Pick any staff member and ask to see their credentials and training certifications. Does their training prepare them for their responsibilities?
#8. What are Policies and Procedures for Sedative and Anti-psychotic Medications? Other Prescription Meds? Are sleeping pills or sedatives given nightly to cut down on staffing? Who prescribes medications? Who administers them? Is there any administrative or doctor oversight for the process? Does the staff check that other medications are taken? How?
#9. Costs, Billings, and, What is Your Budget? Can the costs of this facility be sustained over time? How much of the monthly bill is for a la carte menu ítems? Pharmacology? Laboratory testing? Will Medicaid or Medicare insurance pay these extras? Which expenses must be met out-of-pocket? If this facility proves to be too costly or is consistently over-billing, what is your backup plan?
#10. A Medical Executor, a Medical Power of Attorney, an Advanced Directive, and a Living Will. Although these ítems don’t have much to do with choosing a facility, the facility can make state laws and medical practice more understandable, and smooth out the process of letting go. First, a patient should have a Medical Executor with a medical Power of Attorney. Next, an Advanced Directive and/or a Living Will spells out the patients wishes regarding their death. A medical attorney should review such documents for conflicts with state laws. Some states have standardized forms called “Physicians Orders for Life-Sustaining Treatments” (POLST) which specifically direct the attending physician, “Do Not Attempt Resuscitation/DNR (Allow Natural Death).” Copies of all such forms, directives, and living wills should be posted within the patient´s room in a conspicuous place known by all the staff. The designated medical Executor should know all relevant terminologies, state law, medical protocols, and policies of the facility.
As you can see, choosing the right facility is not the weekend errand families often would like it to be. Methodically going through these steps, asking all the right questions, and getting specific answers will give you peace of mind and confidence in your ultimate decision. In addition, the burden can be lifted fom designated care-givers and your family members can have more relaxed visits without having so much to do once they arrive.
Finding the facility with the right fit will provide that person we care about a higher quality of life, a higher level of care, a greater level of security, and a greater sense of community. They deserve as much dignity and respect as the best facility can offer.