Questions About Nursing Homes Answered

"Don't ever put me in a nursing home!"

How often have we heard that? And how many of us have fallen prey to making a promise not to let this happen?

Generally, the elder asking you to make this promise is remembering a visit to a friend or relative, often years back, and has decided all nursing homes are dreadful places. Unfortunately, some still are. But nursing homes, originally modeled after military hospitals and - yes - prisons, were arranged for efficiency of staff. They were set up to take care of people with as little staff time as possible. People have had good reason to fear living in a nursing home.

Yet, for some, there isn't much choice. And it is far wiser for the caregiver to say, "I'll always take care of you in the best way that I can," than to make that promise. Because the day could come when the best way to care for a loved one is to share the care with a nursing home. You will still be honoring the promise.

And nursing homes are changing. Too, slowly, for our liking, but most are changing. 

The new model for nursing homes is resident oriented. Laws in most states prevent restraints, sometimes to the dismay of family members more worried about a broken bone than a broken spirit. Studies show anti-psychotics are still overused in many facilities, and some nursing homes are still not much above the standards of a prison hospital from the 40s. However, on the whole, most homes have greatly improved.

If you want to read a wonderful book on the transformation devoted people are pushing through the nursing home industry, read Beth Baker's "Old Age in a New Age," which I reviewed on this site.

Improvements aside, there is still a long way to go before most nursing homes are what they should be. Five of the seven elders I cared for lived in a nursing home, with their time there ranging from a few weeks to over ten years. For the most part, it was a very good home. I visited Rosewood to see my loved ones nearly every day for over 15 years and I saw the center change ownership three times.

I've got some good personal feelings about nursing homes, but I've also heard horror stories about them. There are some that are splendid, some that should be immediately shut down while the owners are prosecuted, and most - well, most are mediocre, but trying to improve. Resources are limited. Staffing is a huge issue. But they are trying.

Here, I'll answer some of the questions I've encountered about nursing homes. However, as with any agency that cares for vulnerable people, there is nothing that will substitute for in-person visits.

Q. I've always heard the "smell test" is a good way to choose a home. Is it?

A. That's an old adage, and may have had some validity at one time. Of course, if you go into a home and it always smells either like human waste or antiseptic, you may want look further. But please be fair to any center. If you go in a morning while they are cleaning people up (and I advise visiting at different times of the day), you may find the hallway doesn't smell very good. A good center will be getting the dirty laundry out of the way quickly. Things will be clean and soon smell fresh, but early morning cleanup, getting diapers and/or dirty sheets changed and people bathed, takes time.  Also, consider that a person near you, as your visit in the afternoon, could have had an "accident." The smell test is okay, but don't make it your first rule.