We aren't exactly looking into a nursing home for my grandma yet but we know that eventually the time might come. We are going to visit one near my house this afternoon and are so overwhelmed by the idea. Does anyone know what kinds of questions are important to ask just so we would feel more prepared if the situation ever arises?
but it seems that you have time to do it and make a good decision. good luck
Ask also, what happens if the patient doesn't make it to the dining room for a meal? Does the staff come to get them so they don't go hungry?
Can your grandma keep her own Drs.? Most NHs require the patient to become the patient of the NH's Dr. They assume the responsibility for all medical care of your loved one. I my experience, 90% of the time this new Dr. doesn't even bother to come and meet and examine your loved one for 48hrs or so. They simply "rubber stamp" the incoming notes and meds. at admission. At that point, medicines should be ordered. There may be delays in getting them so be prepared with backup meds. You will be asked to turn those over to the nurse at the facility but at the very least they should be labeled with grandma's name, etc and help prevent a delay in getting her the medicine she is supposed to get. Nursing homes order their own supply for economic reasons and there is almost always delays and substitutions. Be aware of those and what she is being given. It can make a difference in her health! Not all medicines are equal in terms of efficacy.
I don't want to scare you but DONT BECOME COMPLACENT!!! Quality facilities are out there but there are MANY more bad ones. A lot of which are camouflaged by pretty furniture and a slick brochure. Don't be fooled. What really matters is ratio of staff to patients and cleanliness of the facility as well as general level of contentment of other residents. Don't hesitate to stop and ask residents and their families how they feel about the place and staff etc. the time to ask and investigate is BEFOREHAND not after you admit your grandma.
Best of luck. This is a difficult decision for most families. Nothing is perfect but just know that you are going to make the most educated and compassionate choice you can. Good luck. Keep posting!
Also, make sure that if you are looking at definitions of levels of care that you are looking at a site that is specific to Connecticut, as regulations vary. For example, in NYS, where Mom lived, being a "two person assist" (meaning that it takes two staff members to get you out of bed, to the toilet, etc) is only available in a NH, while in the State of Connecticut, this is allowed in Assisted Living.
You guys are SO smart to look ahead! Better to do this kind of looking when NOT in emergency mode.
The staff matters much more than the surroundings. I always watch to see if the interaction between staff and residents seems genuine. Taking into consideration issues that can't be changed (such as paranoia with dementia) how does the staff handle difficult residents? How do residents look when a staff member approaches? Is there a level of trust and comfort overall?
In the end much of this is about the "vibes" that you get when you visit. As has been mentioned, look for official reports such as the one that Medicare puts out and try to talk to other family members if you can.
Beautiful surroundings are nice but people are what matter. You're smart to start asking questions early. Good luck.
Carol
Rita
The first thing I would do if you haven't already is to study dementia and what it brings to a person. I would read a lot about the phases and progression of the disease so you know what phases your grandmother will be facing. Once you know this, you will know what features the facility needs to have to care for your mom.
Don't be turned off to a facility because the residents in the memory care seem severely affected by dementia. That is the normal progression of the disease. My loved one will eventually be that way too. That was something I had to process. Being with those patients does not disturb my loved one, but seems to make her comfortable.
What impressed me with the Memory Care facilities that I toured were the ability of the place to care for her for the rest of her life. They are trained to work with the patient, even after the patient loses their ability to function on many ways. They understand why it's happening and they handle it. Some places don't seem to know how to handle dementia very well and it shows.
I would have a good discussion with the director of the place and let them share with you what options there are for those with dementia and what their experience has been in caring for dementia patients. They should share their philosophy and goals. See if you think it's a good match. They know a lot about dementia. I would make sure I was well read on it too when you meet. Also make sure you have a realistic description of your grandmother's abilities and needs, understanding that those will change over time.
I agree about not getting distracted with fancy furniture. With dementia patients, I've learned all the fancy stuff is for the family and visitors. The patients aren't impressed with that stuff They need compassion, time, care and attention.
I actually ran into a couple of family members in the parking lots of the places I visited. I asked them what they though of the place. I think I got candid responses. Still, your experience is very individual. Your loved one may need a different level of care than their loved one needs.
I would have a backup facility in mind in case the first place doesn't work out. If she gets settled into one place and it isn't working out, I would relocate her. I had to do that and it was the right decision. Even places that are highly rated are not for all patients.
Also, note that most Memory care facilities have a mandated staff/patient ratio that is lower than most other facilities, but you would need to check with your state regulations on that.
Do you research early. Don't wait until your grandmother is in crisis and you desperately need to place her immediately. Most of the places encourage you to place the resident while she is still able to communicate and get used to her surroundings. That way they get a chance to know her likes, personality, etc., before it is very affected by dementia.
Great idea to try to ask family members who you see what they think. I think you will get a better idea from them.
One issue we didn't find out about until my mother was in a nh was how often they shower. Once a week where she is which I think is not enough.
Also, we found many memory care homes or assisted living won't take people if they have certain health issues.
Ask the family members for both the good and the bad. Quality nursing home care depends largely upon the staff, and how they interact with the patient. Ask which caregivers are best. That may start a very worthwhile conversation.
And remember, a nursing home is a business, so you can ask all the questions you wish, you'll get canned answers because they are selling a product.
The rehab where my mother is also serves as a 'nursing home' (I say this because very few nursing homes have nurses anymore). This particular one got a three star rating by Medicare but I think it's great, the CNA's are wonderful, helpful, and my mother loves the place. Lots of activities, clean, etc.
Quite frankly, I think it's a crap shoot, no pun intended.
Many nursing homes have problems and the average person does not have the funds to pay their way in a nursing home for more than a year of so. At that point they will be placed in a Medicaid nursing home placement. Medicaid is not Medicare, but it is the health plan for the elderly who have no money left. Many nursing homes limit the beds for this funding.
In short, I found it best to keep my elderly father at home. Having a home health aide who we paid and who only cared for my father--worked. He got to stay in his home where he was very comfortable. He was happy with the arrangement. Having purchased him a long term care policy made it possible.
Good luck.
....new Dr. doesn't even bother to come and meet and examine your loved one for 48hrs or so. They simply "rubber stamp" the incoming notes and meds. at admission....
if the clients are drugged if everyone is in wheelchair and falling asleep walk away. ask how many clients an aide has.........
Nursing homes order their own supply for economic reasons and there is almost always delays and substitutions. Be aware of those and what she is being given
....... Get a list of the activities provided, talk with the social worker, find out who the docs are and how often they come in
....ask the nurse question if he/she is to busy and rude most likely they will be to busy later when your loved one is there
.......... Some places don't seem to know how to handle dementia very well and it shows. ....my test question is to ask them how they handle confabulation.........
Some places don't seem to know how to handle dementia very well and it shows.
...Words that should be banned
All you need to do is ask;
Just ask ….
We have that up stairs ...
I'm not your ...
I'll get your ,,,, she's busy ..
Look for simple patient friendly actions
Does staff Introduce themselves every time
On serving food
just putting food in front of person is not a friendly practice
Do they Ask if they need anything else
Do they ask if meal is OK while they are eating
Do the staff say hello to visitors and patients
Is there a photo gallery along the entry way walls with every day carer's- Staff, all department heads and the administrators
Do managers have business cards and email addresses?
read the previous post they are very helpful
I guess if I have to ask a question it's: "How do I keep my phone number out of your system?"
It is a situation that needs monitoring consistently and frequently because of new residents.
I did all of the things mentioned above. I just "dropped" in on the facilities and noticed how I was treated and who took the time to give me a tour. I used my nose to detect odors. I looked staff in the eye in the halls, etc and noticed who said hello or smiled. I watched the staff interact with the patients. I looked in patient's rooms. I noticed who was in the hall by the nurses desk in wheelchairs
( a horrible thing)
I did go on line and look at ratings. I contacted a social worker friend and read her the list of the 50 facilities I was given and asked her opinion. i talked to everyone I knew who had placed a relative in a facility.
I finally chose 3 ( I had to give the hospital social worker three names). The one at the top of my list had a bed for sub acute and worked with me to keep my mom in the same room, with the same caregivers if she needed long term care, which she did. She has been there for 7 weeks now. In the meantime everyone I have spoken with (nurses, lawyer who deals with elder care issues, social workers, hospice nurses, therapists) have said that they view this facility as one of
the best in our area
Mom's care has been phenomenol and they are on top of everything. The nurses give us updates whenever we go in. They even call me at home in the evening after the doctor has visited to tell me about changes in her meds, etc. The staffing ratio on days is 6 care givers for 14 patients, on evenings there are 5 staffers. We lucked out. It was a lot of time and energy spent in a short time. By the way, the facility is beautifully furnished, which I know can just be "window dressing". Many of the staff, (activities people, secretaries, hair dresser, house keeping) know my mom's name and address her personally when we pass them in the hall.
My advice is look as hard as you can, talk to others who have loved ones in facilities and ask their opinion, talk to the social worker at the hospital if your loved one is being transferred from a hospital. Do look at ratings, altho they can be misleading.
The best time to do this, of course, isn't when you are under the gun and have to make a quick decision. This whole experience has taught me that, altho we don't
want to admit it, you need to be prepared. WE knew mom was failing but didn't think things would happen so quickly.
My mom was briefly in a rehab place/nursing home. It smelled okay, but they ignored two very important things (you can always nitpick about minor things):
1. She had severe arthritis and they would provide sandwiches so tightly wrapped in Saran wrap that even I had trouble unwrapping it for her. What would've happened if I didn't visit? Stay hungry and just stare at the sandwich she couldn't eat?
2. My mom was also a smoker. Non-smokers won't understand this but the lack of nicotine causes a huge amount of anxiety. I made sure her file said to give her a nicotine patch daily. They would use a magic marker/sharpie to note the date/time applied directly on the patch. I noticed she was missing a patch. Again, no big whoop to a non-smoker but a HUGE big whoop to someone who is. I spoke to the nurse in charge and she didn't think it was "necessary." WHAT???? If Coumadin (blood thinner) was also listed in her file would it be okay if she thought that wasn't necessary? Insane. We got her out of there quick smart.
This was a number of years back - I think they know more now. But smoking would be much the same. People need to be treated and weaned when possible.
Good point about the tightly wrapped sandwiches - Duh! Someone should figure that out.
About the smell - I know that people talk about nursing home smells and I'm sure it happens, but the only time there was a smell issue at the home where my parents were at the end of their lives (or any of our community NHs that I've visited) was/is if there had been an "accident" just prior to my arrival. They kept that place clean and under nearly all circumstances it smelled just fine. My point being that people should judge immediately until they know if the smell is constant or circumstantial.
Great observations, everyone!
Carol
My mom's name was Carol-Ann, so that makes me smile. Not many Carols around are there?
Anyway, thanks for your response. It's a good thing your elderly neighbor wasn't truly addicted to alcohol. I minored in psych, so you are smarter than I but even I know someone who is truly addicted and then cut off could die.
When I spoke of smell it = the smell of urine for the most part - not just "old people" smell. And, yes, I agree....the "smell" should be taken into context. Things do happen, often right before a visitor arrives. Murphy's Law?