Sometimes the needs of a family member are more comprehensive than the family or caregiver can provide. In-Home Care may be an answer. But if it is not, the caregiver must make decisions about the future living arrangements.
There are two main types of long-term care residential facilities:
- Assisted Living, and
- Nursing Home Care
Nursing homes are primarily designed to meet the needs of persons convalescing from illness or to provide long-term nursing supervision for persons with chronic medical problems. Nursing homes are not hospitals and do not provide acute care. Residents are admitted by a physician’s order.
The discussion of nursing homes below is based on North Carolina law. It may be similar in your state. Check with your Ombudsman Program if you have any questions.
There are three types:
Skilled Nursing Facility
They are required to provide continuous nursing supervision by registered or licensed nurses. Typically, they care for the incapacitated person in need of assistance with many aspects of daily living (walking, bathing, dressing, eating, etc.). At a minimum, they provide medical, nursing, dietary, pharmacy, recreational activities and social services.
Intermediate Care Facility
They are required to provide 8 hours of nursing supervision per day. This type care is less extensive than skilled nursing care and generally serves patients who are ambulatory and need less supervision and care. Licensed nurses are not always immediately available. At a minimum, they provide medical, intermittent nursing, dietary, pharmacy, and activity services.
A facility that provides a "protective" and secure (locked) environment for people who have Alzheimer’s disease or other types of dementia that might cause them to be a danger to themselves or others.
Nursing homes are licensed by the NC Division of Health Service Regulation.
If it has become evident that your family member needs more oversight and nursing care than can be provided at home, a nursing home may be the best option. If you are undecided about whether or not making that move is the right decision, contact your local caregiver specialist. He or she can go over your options and can guide you related to what questions to ask of yourself and your family as you make this important decision.
Many Area Agencies on Aging maintain lists of long-term care facilities to assist caregivers and older adults as they make these life changing decisions. The Ombudsman (usually part of the Area Agency on Aging) can be very helpful in helping you to ask the right questions as you begin to look at facilities.
None of us enjoys thinking about the possibility that we may need nursing home care. Often, the selection of a nursing home is made during a family crisis or right after a serious illness. There is little time to explore all the options before making a decision. But, if you have the opportunity, it is important to try to evaluate a facility beforehand.
Keep in mind that you are evaluating the facility for its ability to offer acceptable quality of life and quality of care. Often your five senses provide a good yardstick for quality of life and quality of care. Be aware of what you experience when you visit a facility. This may be your future home or the home of your family member. You want to make the best choice you can.
Remember to visit the potential home several times, at different times of the day and night. Talk to residents, staff, and other visitors. Don’t feel bashful about asking questions.
Check with your Ombudsman Program and/or your state aging agency for information on recent citations and complaints for a facility being considered. In NC, contact the NC Division of Health Service Regulation for this information.
|Find My State Aging Agency|
|Find My Ombudsman|
|NC Division of Health Service Regulation|
|Find My Ombudsman|
|Ensuring Quality Care in a Nursing Home|
|Ensuring Quality Care in a Nursing Home|
to help you evaluate each facility.
Our checklist is an adaptation of one available in a booklet on choosing a nursing home by the United States Department of Health and Human Services Health Care Financing Administration which may be read online, requested, or downloaded.
The United States Medicare website has a feature called "Nursing Home Compare". This feature allows a review of the state survey reports for a facility. These reports now indicate when updating last occurred which is very important. After reviewing this information, it may still be prudent to check with your Ombudsman and/or appropriate state agency to see what information they have on the facility(s) in which you have interest. Also check out the Five Star Rating System.
Remember that you may choose a home that suits you but the home may not be an option for you.
You may be paying for care in a way that is not accepted by the home, they may not have enough beds assigned for the type payment you can provide (i.e. facilities often say that "x" number of beds are for patients who are "private pay", "x" number are for those paid for by Medicaid, etc.), all their beds may be full, or other issues may be involved.
Your local Ombudsmen can help you understand what has happened if the home you have chosen is not available to you.
Consumer Reports offers information on choosing a nursing home that may be useful. The information is part of a publication by Consumer Reports called "Complete Guide to Health Services for Seniors" that is available for purchase in bookstores and by phone at 1-800-500-9760. They also offer a Nursing Home Watch List which identifies facilities with the most questionable patterns of deficiencies on state inspection surveys.
|When you have selected a home and/or found a home, there are many things to consider to help ease the transition to the home for both you and your family member. Click below for helpful hints to make this transition smooth and as stress-free as it can be.|
Making the Transition to Nursing Facility Life (see below for more links from this site)
Moving Into a Nursing Home: A Guide for Families
Moving a family member to a nursing home can be stressful on the caregiver from both the emotional aspect and the practical. Not only do you have to be concerned with how to pay for extended care, the caregiver now must deal with the emotional consequences of placement which are not always ones of relief and release. Quite often, the feelings revolve around guilt and sorrow. Additionally, the caregiver responsibilities don't just end. The caregiver now is responsible for ensuring that the care provided is quality care and responsive care and, hopefully, person-centered care. The caregiver must also continue to deal with the feelings and emotions of the care recipient as they make their adjustment to facility life. Some get angry. Some want to give up. Whatever the response, the caregiver is still involved.
|Don't be afraid to continue to rely on friends and family for support. The support you require may change. But, having a network of people you can rely on and lean on may still help you to continue your caregiving journey.|
Help for the Family Caregiver After the Move
Person Centered Care
Visiting in a Nursing Home - How to Have a Successful Visit
Volunteer Help for the Family Caregiver
The American Health Care Association (AHCA) is a national non-profit federation of affiliated state health organizations, that represents for-profit assisted living, nursing facility, developmentally-disabled, and subacute care providers that care for elderly and disabled individuals. Their stated focus is to facilitate the provision of quality care to the nation's frail, elderly and disabled, who are served by the long-term care professionals who comprise AHCA's membership. They advocate for both patients and the long-term care industry, according to their literature. The National Center for Assisted Living is the assisted living section of the AHCA. Together, they have compiled excellent online guidance for patients and families facing the transition from home to either an assisted living facility or to a nursing home.
Caring for Someone With Alzheimer's
Family Questions: The First Thirty Days
Guide to Homes and Residential Services for Persons with Developmental Disabilities
Living in a Nursing Home: Myths vs. Reality
Long-Term Care Living Website
Making the Transition to Nursing Facility Life
National Center for Assisted Living
Tips on Visiting Friends and Relatives
If you haven't done so already, ensuring that you know the end-of-life wishes of the care recipient would be helpful. It may seem disrespectful to inquire what your family member would appreciate in the way of end-of-life care at the time of facility placement. However, the reverse is actually true. Knowing what your family member prefers should they have a stroke or a further downturn in their condition could actually provide them comfort. Let us help you both have the discussions if you have not already done so and help you understand end-of-life issues and resources. You don't have to face this alone.
End-of-Life Planning and Information
Recognize the Signs and Implications of Caregiver Stress
|Your Ombudsmen understand the issues you are facing. If you need help or are feeling overwhelmed, contact them for advice and assistance. There is no need to handle this alone.|
|Sometimes, caregivers of family members residing in nursing homes are not satisfied with the care their loved one is receiving, the condition of the facility, or other areas of concern. Your long-term care Ombudsman Program can be a great help.|