Choosing Appropriate and Acceptable
Care
Recent implementation of
federal star ratings for nursing homes and state star ratings for adult care
homes provide a “snapshot view” of facilities as a great starting place
to provide consumers with information with which to make informed choices about
placement. However, it cannot be
emphasized enough the need for consumers to ALWAYS visit facilities, observe
how residents are treated, speak with staff, ask questions and use their five
senses when evaluating a facility.
With so many options, listed below are other considerations for choosing
the best place to live.
Consult your physician
Along with your physician,
you must decide what type of care is needed...and what you can afford. If your family member is being
discharged from the hospital or a rehabilitation center, the care team,
including the physician, the case manager, nurses and rehabilitation therapies,
should point you in the right direction. If your family physician suggests
in-home or other community-based care, you can contact your county agency on
aging, which should have a resource guide that contains a listing of the
available services in your county.
Examine your finances
With the exception of a few
government programs for low-income seniors, most in-home and community-based
services are paid for privately by the senior or disabled adult, their family
members or through long-term care insurance. There are some programs available
for seniors who have limited incomes to assist with care in the home setting,
or in the community, thus allowing living at home for as long as possible.
Research
Places that you can go to
learn about services your area include:
·
Your county
department on aging http://www.ncdhhs.gov/aging/services/svcdir.pdf
or area agency on aging (AAA) http://www.ncdhhs.gov/aging/aaa.htm
·
North Carolina
Division of Aging and Adult Services http://www.ncdhhs.gov/aging/
Many services are regulated
and monitored by state and county agencies, so it is important to explore these
resources before making a decision.
Resources include:
·
The State
Long-Term Care Ombudsman Program http://www.ncdhhs.gov/aging/ombud.htm
·
The Medicare
Star Rating System for Nursing Homes website www.medicare.gov/NHcompare
·
The
State Adult Care Home Star Rating System http://www.ncdhhs.gov/dhsr/acls/star/index.html
·
Friends of
Residents in Long Term Care www.forltc.org
Visit
The best gauge for choosing
any service is to visit it more than once, eat a meal there, talk to residents
and other family caregivers, as well as staff members. If you are searching for an assisted
living residence or a nursing home, begin your search early. While changes can
and do occur quickly, if it looks as if an assisted living residence or nursing
home is in a relative’s future, begin your search before that person
moves into a crisis mode, and be sure to include the person requiring care in
your search.
Make sure that you meet the
other staff including the administrator and the director of nursing. These are
the people in charge of the residence and who will oversee the care that your
loved one receives. Talk to them and express your relative’s needs. Talk
to other residents and staff. If you see a staff member in the hall, ask the
person how he or she likes working at the residence. You may also want to eat a
meal at the residence to taste the food and observe how the staff interact with
the residents. You should also examine a copy of the most recent state survey.
It should be posted in a prominent place. If you don’t see it, ask for
it.
According to the AARP
publication, “Choosing Good Care: A Family Guide to Finding a Nursing
Home,” things to look for that may be a sign of good care include:
·
Cleanliness
·
Staff treating
residents with dignity, respect and patience
·
Activity level
– look both for organized activities taking place and for people (staff and
visitors) walking around the hallways and interacting with the residents
·
Good food
·
Staff
responsiveness to residents’ needs
·
Home-like
environment – are there furniture and decorations in residents’
rooms and common areas? Are there pets?
Things to look for that may
be a sign of inappropriate care include:
·
Bad odors
·
Residents in
physical restraints
·
Lack of privacy
– staff should not be caring for residents when their doors are open;
residents should be clothed and clean
·
Staff treating
residents with disrespect
·
Unanswered calls
for help
·
Loneliness,
boredom and inactivity among the residents
·
Lack of
assistance with eating – residents who cannot feed themselves should not
spend the meal time with full trays in front of them
AARP offers a Nursing Home
Evaluation Checklist at the website: http://www.aarp.org/families/housing_choices/assisted_living/.
They also offer an Assisted
Living Residence Evaluation Checklist to use while visiting a residence at the
website: http://www.aarp.org/families/housing_choices/nursing_homes/a2004-02-27-nuringchecklist.html.
The National Adult Day
Services Association offers an evaluation checklist to use when considering
enrollment in adult day services: http://www.nadsa.org/caregivers_info.asp
Remain Visible
Once your relative begins receiving
care—whether at home, in the community or in residential care, your role
as a caregiver does not end. Be prepared to: