As dementia progresses, a patient’s increasing dependence and need for supervision may make it impossible for family members to provide all necessary care. Nursing home placement may be in the patient’s best interest.
The decision to place a family member in a nursing home is often very difficult and may be accompanied by feelings of guilt, sadness and anger. In addition, the bad publicity some nursing homes have received for providing inadequate and sometimes dangerous care can add to the anxiety. But with thorough research, you should be able to find a suitable facility.
Before deciding on a nursing home, you may want to explore other residential care programs, such as assisted-living facilities, which provide a combination of housing, personalized assistance and medical care. Those facilities vary in size, cost, services, location and quality; whether a particular facility is appropriate for a person with Alzheimer’s disease depends on the level of care needed.
If you determine that a nursing home is the best option, the first step toward finding a good one is to talk to as many people as possible. Helpful information may come from the patient’s doctor, from friends and acquaintances who have a family member in a home, and from the nursing home ombudsperson (a staff member who is responsible for investigating complaints). In addition, your local chapter of the Alzhiemer's Association may have a list of recommended homes or personal references. Visit any nursing homes under consideration several times before making a final decision. Here are eight factors to consider during those visits:
1. Licensing and regulations
Be sure the nursing home meets basic safety requirements. The home and its administrator should have current licenses from the state, and the facility should meet state fire regulations, which include sprinkler systems and fire doors. Consider asking to see the latest state survey and/or monitoring report. (This report, which comes from the state licensing agency, should be kept in a public place.) Medicare has developed a ranking system that looks at quality of care markers and provides comparative data on all licensed nursing homes.
2. Care and services
It is important for the staff to be familiar with common issues arising from dementia. Ask whether the staff is continually trained in dementia care, what kinds of programs are offered to the residents, how individual care plans are developed and how different levels of functioning are supported. Give specific examples of behaviors or challenges caused by Alzheimer’s to find out how difficult situations might be handled. Be sure the facility provides for the special needs of each resident.
Talk with the staff members who work directly with residents to see if they are competent, friendly and content in their jobs. Does the nursing home conduct background checks on the staff? Observe how residents are treated and whether they receive help when they ask for it. Note whether the person giving you a tour of the home knows the residents by name and is recognized by them. Also, meet with the administrator and directors of nursing and social services. Ask about such things as the number of people each aide takes care of and how the facility is staffed on weekends and in the evenings.
Find out if the staff has received any special training in caring for people with Alzheimer’s disease. The Alzheimer’s Association provides training for nursing home staff. Also, ask whether there are licensed nursing staff 24 hours a day, including a registered nurse at least eight hours every day. Do the nurses and certified nursing assistants work with the same residents four to five days per week? Is there a licensed doctor on staff daily who can be reached at all times?
Nursing home care is expensive. Be sure all costs are clearly outlined and understood before you make a decision. Address how costs will be met and whether paying for them will create a financial burden for family members. Because the laws regarding payment for nursing home care can be complex and vary from state to state, be sure to contact a reliable source for accurate information. The Alzheimer’s Association, insurance companies, attorneys who specialize in financial planning, Medicare representatives and some staff members of in-home care programs may be well informed on payment options. Important questions to ask include: Does the home accept the patient’s funding sources (for example, Medicare or Medicaid)?
Will the resident receive a refund of advance payments if he or she leaves the facility? How does the home protect cash and assets that are entrusted to it? How are withdrawals noted to keep track of the account? What charges are extra (for example, television, telephone, laundry, personal-care supplies, special nursing procedures)?
5. Cleanliness and safety
Be sure the nursing home is clean and safe, especially the kitchen and bathroom. Note unpleasant odors, such as mold, garbage or urine. Odors that persist on return visits may indicate poor patient care or poor housekeeping. Make sure that the bathrooms have handrails and nonskid floors, the furniture is sturdy, the doors to the outside are secure and the facility protects the safety of people who wander. Find out whether there are policies to protect residents’ possessions. Does the home replace items that are lost? Is there an emergency evacuation plan, and are regular fire drills held? Does the home have an arrangement with a hospital for emergencies?
Spend time observing everyday life. Ask residents and visitors their opinions of the facility and its staff. Do the residents look happy, relaxed and involved in activities? Are residents clean, appropriately dressed, and well-groomed? Ask yourself: Is the facility relatively quiet, well-lit and pleasant to be in? Is there a well-planned indoor or outdoor wandering path? Are there familiar elements, such as home-like furnishings?
7. Visiting policy
Be sure the home is close enough so that family members can visit regularly. Confirm that the home has convenient visiting hours and that the resident can have privacy with visitors. Are there quiet areas where residents can chat with family members and friends?
8. Meals and activities
Check whether the food is wholesome, appealing, and suitable for older persons. Can residents choose their meals? Are nutritious snacks available? Does the staff assist the residents with eating and drinking if necessary? Find out which services and activities are included in the fee. Also, be sure there are creative social activities in addition to supervised daily exercise. Are there outdoor areas designed for residents’ use? Find more information from on how to choose a nursing home from Medicare.