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Elder Law and Estate Planning Blog - Lancaster, PA

Thursday, June 28, 2012

Moving to a Nursing Home

Whether you have hours, weeks, or months to find a nursing home for an elderly loved one, the task is going to be daunting.  But this will be the task for a majority of the population, as two-thirds of people over 65 will need the care given by a nursing home, according to AARP.  Just as you wouldn't move into a new house without visiting and inspecting it, you should do research on nursing facilities ahead of time if possible.  And when researching, there are several key considerations you should take.

First, look at the official stats.  Medicare rates and compares nursing homes on their website (medicare.gov/nhcompare).  Some facilities are even certified by Medicare, meaning they are inspected every year and all complaints are investigated.  Read these ratings and recent inspection reports, but don't just take them at face value.  Check out the ratings for health inspections and for staffing and see if you can find why they rank as they do.  What are the citations for and how often do they occur?  One patient accident isn't a big deal, but frequent falls could be a red flag.  If you want more opinions on the nursing home, your local Area Agency on Aging (the Lancaster County Office of Aging) or a hospital discharge planner can give you referrals on nursing homes.  Furthermore, the state's ombudsman and licensing agency should be able to tell you about consumer complaints.

Check to see how staffing is at the nursing home.  How much time are residents receiving with the nurses?  The Centers for Medicare and Medicaid Services (CMS) recommends at least 2.8 hours a day of nursing aide time and 1.3 hours with an RN or licensed practical nurse.  Ask specific questions of the staff and about care, ask how personal preferences are accommodated.  Also see whether staff work with the same patients each day because when staffers know the patients better, the quality of care is higher.  Finally, make sure to ask how the staff will deal with an unexpected event, like a power loss or a situation which requires evacuation.

Visit the nursing homes you are considering, and visit more than once.  Observe lifestyle details, like do the nurses greet patients in the hall?  Are meal eaten in the dining room and are residents enjoying the meal?  Does it smell pleasant and homey and are residents smiling?  Check rooms for cheerfulness and safety, use the bathroom to check for hot water, and inspect the kitchen for cleanliness.   Ask about anything that could affect the well being and happiness of your loved one, like are there organized outings and visits?  What activities are listed on the bulletin board?  Are there stimulating offerings like exercise classes and a library?  Snoop around (and be wary of any place that objects) and try visiting unannounced on a weekend when staffing is likely to be tighter.

Another important consideration is how close the nursing home is to you.  The biggest influence on care quality is the frequency of visits by friends and family.  Make sure you're allowed to visit when you want to fit your schedule, and to monitor care at different times.  Drop by often and sometimes without notice.  Stay late sometimes after your loved one has fallen asleep.  By coming at different times, you can see how quickly a staff member respondes to a ring for assistance, whether residents are enjoying interesting activities together in the afternoon or staying cooped up in their rooms and how much your mom or dad eats at meals.

One of the biggest factors in your decision will be cost.  The median annual rate for a semi-private room in Pennsylvania last year was $89,425.  If the move is years away, consider getting long-term care insurance.  If your loved one already has long term care insurance, find out the daily rate it covers.  This could be far less than your preferred homes and most policies don't kick in until after a 60 or 90 day "elimination period."  To keep costs down, determine if it's possible to keep your loved one at home a bit longer through a combination of health aides, adult day care, and family help.  You can also consult an elder law attorney for help with nursing home planning.  The Law Office of Shawn Pierson can help with the planning and can help get you qualified for Medicaid, known as Medical Assistance in Pennsylvania.  However, not all facilities accept Medical Assistance, so make sure your preferred facilities accept payment or else you might have to move when payments switch.

If you find that your loved one is not receiving the care he or she deserves, don't hesitate to move him or her.

For more ideas on what to look for in a nursing home or long term care facility, use the checklist found here by AARP.

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