Caregiving

When is It Time to Move a Loved One to Assisted Living or a Nursing Home?

Jacqueline Marcell Health Guide March 08, 2007
  • It’s time to consider placing a loved one in a care facility when safety is in question and the ability to perform Activities of Daily Living (ADL’s) is severely impaired: getting in or out of bed or a chair, using the toilet, bathing or showering, dressing and eating. When fears that an elderly person may leave the stove on, get lost, fall down stairs or get hurt in any way, and family helpers or in-home caregivers are not an option–it is time to act.


    Planned Move: Start the discussion of end-of-life living options early, prior to illness, to discover what the wishes really are. By revealing what your own preferences are and sharing where your Will and legal papers can be found, if is easier to ask where their documents are, what you should know, and how they want to be cared for when the time comes.


    * Stay at home with caregivers who will come in as needed, or live-in, to help with care.


    * Move to Assisted Living. Consider a "multi-level" facility that offers senior apartments, increasing levels of assistance, all the way to full skilled nursing and dementia care. This way, as more services are needed another move is not necessary, and the friends made along the way often progress with them.


    * Consider buying a comprehensive Long-term Care Insurance policy prior to illness, which would cover the cost of the long-term care options. Buy it as a gift.


    * Consult an Elder Law Attorney to get Durable Power of Attorney for Health and Financial in place, so if your loved one becomes incapacitated, you can make decisions for them. Realize that without the DPOA it is very hard to move someone out of their home against their will, which can occur when trying to reason with someone starting to get dementia.


    * Become familiar with local services ahead: senior centers, Adult Day Care and Adult Day HEATH Care centers (for those with dementia), multi-level assisted living facilities, skilled/nursing homes and those with full dementia care, local Alzheimer’s Association.


    * Try a facility by using it for a short-term respite stay so all the details can be evaluated prior to full time placement and commitment.


    Unplanned Move: Usually occurs after a crisis such as a stroke or broken hip, often after a hospital stay, when 24-hour care is needed for patient safety in a skilled nursing facility.


    * The hospital discharge planner will help with location options. Call your local Area Agency on Aging or Department of Aging for available options. It needs to be close enough to family for visiting/monitoring often. Ask to speak with the Ombudsman who monitors the facilities in that area to ask if there are any pending/past lawsuits on the places you are considering.


    * Visit facilities on the weekend and talk to numerous families who have loved ones living there and ask for their opinions. What do they wish they knew before they moved their loved one in, and what do they recommend you check into prior to placement.


    * Ask the administrator and get in writing:


  • o What is their patient to staff ratio?
    o Are they hiring right now and how many people are needed?
    o What training has their staff had and what on-going education do they get?
    o How many RN’s are on staff?
    o Is there a doctor on staff or how far away?
    o How many hours of direct care is done?
    o Who is the temporary staffing agency used in an emergency?
    o Have criminal checks been run on all employees?
    o Are there any residents with communicable diseases?
    o Is transportation available to get a paralyzed loved one to the doctor?
    o What is covered and what are considered extra charges?
    o Do they offer support groups for the family?
    o What are their state inspection results? Ask to see them.
    o Are their any liens, complaints of abuse, or citations against the facility?


    * Observe how the staff treats the residents and how they talk to them–with respect or not, or like they are children. Notice if the residents are cleanly dressed, hair combed.


    * Visit the kitchen, observe cleanliness, eat a meal or two, evaluate the monthly menu for variety and nutrition, what/when snacks available, can family bring food in.


    * Talk with the Activity Director to evaluate what is offered: Exercise, singing, cooking, dancing, bingo, games, crafts, movies, current events, parties, field trips, etc.


    * Drop in unannounced often and at odd hours, and even during the middle of the night to observe the level of care and attentiveness.



    You can learn more about Jacqueline and find information about her book at ElderRage.com.

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