Archive for Monday, January 3, 2011

A nursing home experience–from an outsider’s point of view

January 3, 2011

Being 28 years old, I can’t say that I’ve put much thought into nursing home or assisted living facilities — and prior to last year I had never even been inside either. I didn’t know how much research it takes or what is involved in selecting a suitable home until I had to do it for my wife’s grandmother. During that experience, I learned that there is more to choosing a care facility than a nice building and well-manicured landscaping. I want to share my experience and help provide a starting point in case you would ever find yourself in a similar situation.

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After a fall left my wife’s 83-year-old grandmother (let’s call her Anne) with a broken hip, we remodeled our basement to be accessible for her as she recovered. The intention was for her to move back into her own home eventually. Because Anne was from out of town and my in-laws live out of state, we thought this would be a great solution. Anne could heal and save some money at the same time. We also thought it would be beneficial for her to be around family and to have more personal interaction than she would have received in a care facility. My wife was completing her graduate degree and would be able to devote time to taking care of Anne.

Subsequent to moving Anne into our home, we began to realize that her dementia had progressed further that we originally believed. Apparently when we visited Anne at her home before the accident, it was always on a “good day.” But the longer she stayed with us, the more it appeared that her bad days outnumbered the good. She was constantly in a state of confusion and paranoia. For example, she suspected that people were coming into her bedroom to steal money out of her purse. She was also prone to extraordinary delusions. Anne would forget that she was staying with us, thinking she was in a hotel. She would criticize the food and talk about how terrible “the help” was. I found it a little humorous; however, my wife did not.

After a few months, we began to realize we could not provide the level of care Anne needed. Our hearts were in the right place, but we were not properly trained to treat and deal with all of her symptoms. We needed to find a facility with staff trained to deal with dementia.

Reluctantly, we temporarily moved her back to the nursing home where she had stayed while recovering from her knee injury. We felt that moving her to a place she was familiar with would give us time to find a suitable facility close to us.

When we started looking for a new facility for Anne, we didn’t know where to begin. All we knew was that she needed a facility that specialized in dementia patients. We began our search as most people would — through the Internet. The first Web site we found was Johnson County Human Services. Its site was very helpful, with information on housing, nutrition, senior activities, and other resources that are available.

Another helpful site was the Medicare Nursing Home Compare page. There you can search Medicare-rated facilities by name, city, state, and distance. You can also sort facilities by ratings and view any deficiencies a facility may have. If a facility is private-pay and not Medicare rated, then it is overseen by the state in which it is located. Several of the facilities we visited were private-pay and overseen by the State of Kansas. Kansas does not rate facilities; instead it only lists deficiencies, which later proved difficult when trying to compare Medicare ratings to Kansas reviews.

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An important step in finding a suitable home is deciding the level of care you need. Facilities range from retirement communities, where seniors live in their own apartments and generally do not receive specialized or medical care, to nursing homes, where residents are monitored 24 hours a day and are under the care of trained medical personnel. Assisted living centers, which are somewhere between, generally allow you to pay according to the level of care you need. Amenities can include prepared meals and snacks, laundry services, entertainment, medication monitoring, transportation, and other daily living activities such as bathing and changing clothes.

Another difference is the coverage by medically trained staff on site. In nursing homes, medical staff are on duty 24 hours a day. Assisted living centers typically have nurses and certified nursing assistants during business hours throughout the week and on-call on weekends and after hours. Anne’s needs were between a nursing home and an assisted living center because of her fracture, macular degeneration, and dementia.

While looking for care facilities, we found several that specialized in treating specific types of residents. For example, we toured a nursing home that specialized in dementia and people who are sight-challenged. While that facility was equipped to address Anne’s needs, the building and the living conditions were not a good fit. The facility was given 4- and 5-star ratings by Medicare in several categories, but the building was run down and she would have had a roommate — a resident who cried for help non-stop.

Another facility we toured was a private-pay assisted living center. That facility was gorgeous and immaculate and could easily be mistaken for a high-end hotel, but it did not have the level of care Anne needed. Most of the residents were there for senior companionship rather than for care. The facility was on multiple levels and had a big, unattended staircase. Even though the center had many elevators, we thought Anne might forget her condition and try to use the stairs. The facility was also an “open facility” that allowed residents to come and go as they pleased. We needed a locked facility that prevented residents from mistakenly walking out. We also feared that in the facility’s less-regimented atmosphere she would be forgotten at meal times and would not have enough people checking on her throughout the day.

Despite the fact that the second facility we toured was private-pay and not rated by Medicare, we were able to obtain its most recent State of Kansas review. I cannot stress enough the importance of reviewing deficiency findings. This particular facility was cited for having four incidents of the same resident falling within one month. We also found issues with the facility not reporting sores and seizures to residents’ families or doctors.

Facilities that are state-regulated are required to provide their most current review; ask for a copy! Medicare-regulated facilities are given star ratings for different criteria along with deficiency findings. The criteria are health inspections, nursing home staffing, and quality measures. It is important to do your due diligence, review any deficiency findings, and see how they were addressed before even considering a care facility. It’s just like buying a used car; you have to kick the tires and see what’s under the hood.

We ended up touring seven facilities and were able to find one that offered the amenities Anne liked, could provide the level of care she needed, and was deficiency free in its last three annual reviews. The facility we chose is an assisted living center that has more care available than the standard assisted living center. She has her own apartment that was unfurnished, her own bathroom, mini-kitchen, and a small living room. She has three prepared meals a day, recreation, medication monitoring, and help with daily living activities. We were able to bring her belongings from her home to furnish it, and she is settling in nicely.

In the end, we moved Anne from the temporary nursing home that cost approximately $6,200 a month to an assisted living facility costing $3,200 a month. Yes, it is nice to save Anne the money — but more important, she is in a facility that is close to our home, provides the level of care she needs, and offers a high level of social interaction.

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Finding a suitable care facility can be a long and frustrating process, but if you look hard enough you’ll find the one that fits your needs. Make sure you do the research, and use as many resources available to you as you can. Moving family to a care facility is never easy, but once you find the right place, you’ll know that your loved one will be safe and well-cared-for.

Toan Nguyen (pronounced Tawn Win) is director of operations with Integrity Investment Advisors, LLC, in Overland Park.

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