One of the most difficult transitions we may have to face as
we age is the change from independent living in our own home to living in a
long term care facility, or “nursing home”. There are many reasons why this
transition is so difficult. One is the loss of a home...a home where we may
have lived for many years and where our loved ones may still reside. Another is
the loss of independence. Still another is the loss of the level of privacy we
enjoy at home, since nursing home living is often shared with a roommate.
Most people
who make the decision to move to a nursing home do so during a time of great
stress. Some have been hospitalized after a stroke, some have fallen and broken
a hip, still others have a progressive dementia like Alzheimer’s and can no
longer be cared for in their own homes.
Whatever
the reason, the spouse or relative who helps a person transition into a nursing
home during a time of stress faces the immediate dilemma of how to find the
right nursing home. This task is no small one, and a huge sigh of relief can be
heard when the right home is found and the move is successfully accomplished.
But the most difficult task may just be beginning: How do you make sure you get good care in a
nursing home?
How to Get Good Care - Tips from an Elder Law Attorney
There will always be issues and problems with how care is delivered in a nursing
home. No one is going to be able to take care of you or your loved one exactly
the way you think it should be done. The question is how to deal with these
inevitable problems. Nine times out
of ten, a solution can be found if one is polite and persistent. Solutions come
from people, not paperwork. Don’t assume a hostile attitude, it just makes
matters worse. A worker who is treated with respect and kindness is more apt to
treat you or your loved one the same way.
The Transition
For the
caregiver, the best way to help your loved one get good care in a nursing home
is to make a transition yourself. It is
time for you to move from the role of caregiver to the role of care advocate.
In this advocacy
role, while you may continue to do a variety of things for your spouse or
relative, your main job is to ensure that the nursing home staff provides good
care. You cannot be at the nursing home 24 hours a day, so you want to know
that the staff is caring for your loved one as it should.
The single
best method to ensure that your loved one receives good care is to understand the care planning process and
to become consistently involved in it. The care plan is a blueprint that
outlines such things as physical and speech therapy, range-of-motion exercises,
nutrition requirements, and other appropriate activities required for optimum
functioning. This plan, which must be reviewed every three months (or more
often if there is a major change in condition), works like this:
The Baseline Assessment.
During the first few days after
admission to the nursing home, each resident undergoes a thorough assessment by
the facility’s multi-disciplinary staff, a team that includes physicians,
nurses, dietitians, physical or occupational therapists, recreation therapists
and social workers. (The nursing home calls this assessment the MDS, which
stands for Minimum Data Set.) Together this team gathers information from both
the resident and the family about the medical and psycho-social (i.e.
emotional/ lifestyle) needs of the resident. The team has two weeks to complete
this assessment. At that time, a formal care plan must be put in place.
Your
role:
As care advocate, you
should contribute the information you possess about your loved one’s medical,
psychological, spiritual and social needs, as well as information the staff
should know about your loved one’s preferences. For example, “Dad likes to
watch the news and then read for a while each night. He also likes to have a
snack of graham crackers and milk. This has been his routine for years and
helps him relax before going to sleep.” This helps the staff get to know your
Dad and allows him to maintain routines that are familiar and comforting.
The Care Plan.
The care
plan is also written by the team. The purpose of the care plan is to spell out
the areas in which care is needed by the resident and to spell out the manner
in which the staff plans to address and meet these needs. For example, your
Mother has suffered a stroke with resulting paralysis on one side of her body.
She needs to learn to accomplish the independent activities of daily living,
including hygiene needs and dressing herself, with the use of only one side of
her body. The plan might be to work with physical and occupational therapy five
times each week to recover independent functioning in these activities.
Your
role:
As care advocate, you
will want to make a list of all problems
and needs that affect your loved one. This is important because you may be
aware of a need that the staff may not uncover during its assessment. Give this
list to a nurse or social worker in the early days when the assessment is being
done, then bring your list to the care planning meeting.
The Care Planning Meeting.
No later
than three weeks after admission, the facility is required to have the first
care planning meeting. You should receive written notice of the date and time.
The staff who attends these meetings usually includes the Director of Nursing
or the Assistant Director, often another staff nurse, a social worker, a
dietitian, a physical or occupational therapist if appropriate, and a
recreation or activities therapist. The staff will discuss the needs of the
resident and the team’s specific plan to meet those needs. It is the job of the
nursing home staff to maintain or improve functioning by your loved one, when
improvement is possible, and to slow the loss of functioning, when improvement
is not possible. For example, if your Father is able to walk independently when
he goes to a nursing home, the staff must work hard to assure his continued
ability to walk, barring some medical event that changes this ability.
Your
role:
As care advocate,
attend the care planning meeting and bring the list of needs you compiled and
gave to the staff during the assessment period. Also be sure your loved one
attends the meeting if he or she is able to participate. Your role at this
meeting is critical, because you are in a position to monitor whether all problems and needs are being addressed. If something
has been missed, you or your loved one can add that information now so that a
comprehensive care plan is put in place.
Care
Plan Updates.
The nursing
home is required to evaluate each resident’s care plan on a quarterly basis, or
at any time there is a significant change in the resident’s status. For
example, your Mother has been in the nursing home four months when she has a
stroke that leaves her barely able to speak. This represents a significant
change in her status and requires the staff to develop a new care plan to
address her current needs. There should also be a care planning meeting to
review the new plan.
Your
role:
As care advocate, you
should attend all care planning meetings to be sure your loved one’s needs are
being addressed. Throughout this on-going process, you should provide input
that contributes to good care for your spouse or loved one. It is widely
recognized that the residents who receive the best care in nursing homes are
those whose spouse and/or families consistently attend care planning meetings
and communicate with staff on a regular basis. The nursing home is obligated to
try its best to provide individualized care that will achieve and maintain the
highest level of well-being for your spouse or loved one. In your new role of
care advocate, use the care planning forum to bring your questions to the
table, to identify your loved one’s needs, and to work with the staff to formulate
solutions to any problems that may
arise.
