Evaluating Nursing Homes: Caregiving With Compassion

The nurses in a nursing home very busy. Even they have the best shoes for nurses, their pressure may not reduce. The subject of nursing homes is one most people would just as soon avoid. Yet most adults are likely to be involved in the selection of a nursing home or the best nurses at some time, either for themselves or for an ill or aging relative. Statistically, up to 40 percent of those aged 65 and older will enter a nursing home at least once.

Admittedly, there are reasons for the poor reputation of nursing homes. Studies suggest that a third fail chronically to meet health and safety regulations. But there are also good nursing homes, homes that Dr. Vivian Tellis-Nayak, a sociologist at Chicago’s St. Xavier College who has studied “exemplary” nursing homes, says care for the elderly “with love, dignity, and professionalism.” The task is to find them.

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The First Steps

Experts make two broad recommendations concerning the search for a nursing home. The first is to begin long before a home might actually be needed. The second is to include the potential nursing home resident in the process as much as possible. You should begin with two preliminary steps. One is a careful evaluation of the needs of the person for whom you are considering a nursing home. For someone needing short-term convalescent care upon discharge from a hospital, such an evaluation might be fairly straightforward and the use and choice of a nursing home governed largely by medical considerations.

But more often the need is less clearcut. There are many alternatives to nursing homes, such as Meals-On-Wheels programs, home health care services, and hospices, and it may be that a person’s needs can be met without the use of a nursing home. On the other hand, families can go to such great lengths to keep a member out of a nursing home that family harmony or the physical health of family caregivers can suffer (see Warning: Caregiver Needs Help!). In these cases it is wise to remember, says Dr. Rosalie Kane, a professor of social work and public health at the University of Minnesota and a nationally recognized expert on nursing homes, that the magnitude of a person’s needs for care can make a nursing home the most appropriate of choices.

The financial constraints you will face also need to be considered at the outset so you can limit your search to homes that will be affordable. Individuals and families pay the greatest portion of nursing home expenses. Few insurance policies cover nursing home expenses and Medicare generally pays only for short-term rehabilitative stays. Medicaid does pay for long-term nursing care but there are strict financial eligibility restrictions and a person must first spend his or her assets and become impoverished before the program will provide coverage.

Also see: How Do You Tell If Your Hunting Partner Has A Broken Bone?

Blind Ambition

Choosing The Right One

The first step in the search itself is to compile a list of a half-dozen or so nursing homes that meet such basic criteria as location, the ability to provide key services (e.g., physical therapy), and acceptance of the payment sources you plan on using. Sources for the compilation of this list can include the yellow pages, recommendations from friends and professionals, and lists available from your state or local agency on aging or Nursing Home Ombudsman Program.

The next step is to visit your candidate homes. There are many books on nursing home selection and most have checklists of what to look for. One of the best is The Nursing Home Handbook, by Jo Horne (American Association of Retired Persons). Nursing home ombudsmen and state or local nursing home licensing and certification offices can also often provide information on whether the homes you are interested in have a history of meeting regulatory requirements.

Information from checklists and regulatory agencies should, however, be used with caution. As Rosalie Kane points out, nursing home regulations are “geared more toward ensuring that facilities have the capacity to provide adequate care than that they actually provide it.” Most regulations, and many of the items informal checklists are also biased towards the view that nursing homes are primarily medical facilities, or “mini-hospitals,” instead of homes–places where people may live for many years. This view, says Dr. Kane, emphasizes “physical well-being and safety at the expense of psychological and social well-being and resident satisfaction.”

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As to the characteristics of a nursing home that do increase “psychological and social well-being and resident satisfaction,” a recent study by Dr. Kane offers some clues. Feelings of independence and control are central to the quality of life in a nursing home and Kane’s work suggests these can be increased through policies that promote privacy, that allow residents to choose their roommates, to decide on their own wake-up times and to make use of off-premise passes.

Dr. Tellis-Nayak also believes that the better nursing homes are those that are less “medicalized.” In such homes, he says, the residents do not line the halls restrained or slumped over in wheelchairs. The residents seem well groomed and are encouraged to make choices in matters such as food and scheduling. There is ample opportunity and space for families and friends to visit and volunteers are ever present.

He offers no checklist for identifying such a home, but he does recount the advice given him by the administrator of an “exemplary” nursing home: “Go and ask the residents. Find out how happy they are with the care they receive. Ask their families. And you will know.”

Warning: Caregiver Needs Help!

In an effort to keep a loved one out of a nursing home, families often adopt strategies such as daily visiting (which can lengthen an already too long workday) or having the relative move in with them. Laudable though they are, such efforts don’t always work.

Many caregivers would rather endure unbearable conditions than admit they need help. Unfortunately, the caregivers’ health can decline and eventually they themselves can need care. Others simply don’t realize they’ve taken on too much until it’s too late.

If you notice any of these danger signals, it may be time to consider alternatives to your current arrangements–perhaps even a nursing home:

* You no longer have any time to be alone for even a brief respite.

* Things you did occasionally to help out are now part of your daily routine.

* Family relationships are breaking down because of caregiving pressures.

* Your caregiving duties are interfering with your work and social life to an
unacceptable degree.

* Your coping methods have become destructive: You’re overeating or
undereating, abusing drugs or alcohol, or taking it out of your relative.

* Loving and caring have given way to exhaustion and resentment, and you
no longer feel good about yourself or take pride in what you’re doing.

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