As the population in the US continues to age, skilled nursing facilities, group homes, assisted living and other care facilities are seeing a huge increase in residents. It's never an easy decision to place a loved one in a group care setting, but whether they require rehabilitation, wound care, or are simply unable to manage their activities of daily living, there are several factors that should be taken into consideration before placement.
1. The Staff
This may be the most important factor in choosing any facility. After all, these are the people that are going to be caring for your family member, interacting with them on a daily basis. They will be passing their medications, assisting with activities such as eating and using the bathroom, and ensuring your family member is receiving the daily care they need. Think of all the people you interact with on a daily basis. At work, while commuting, the stores you shop at. If you don't like someone, or if they are rude, you have the option to walk away. Your loved one won't have the same luxury.
Meet the staff, walk around and introduce yourself. If possible, watch how they interact with other residents at the facility. Try and visit during different shifts to get a more complete picture of who will be there through the course of the day. At a good facility, the staff will be happy to meet family members, and frequently go out of their way to keep you informed and involved with the family member they are caring for.
Also keep in mind that while there are standards for education and staffing, every facility is different. What is the nurse/patient ratio? How do they access higher care levels in the event of an emergency? Are there registered nurses, licensed practical nurses and nurse aides available at all hours? The skill and training of the nursing and allied health staff is the first line of defense in your family member's safety. Don't be afraid to ask about education and past work history, most employees will be happy to share the experience they earned getting to their current job. A few courteous questions could give you a lot of insight into the staff that has direct, daily contact with your family member. You can even access their state license history and see if there have been any suspensions or disciplinary action.
2. The Facility
While working as an EMT, I would frequently transfer residents to and from a variety of skilled nursing facilities. The variance in standards and upkeep was staggering. From huge open floor plans and beautiful architecture to cold tile hallways and dingy paint jobs. Each home has different rules for bedding arrangements; and I'll never forget when I saw 4 residents crammed into a room that was smaller than my bedroom at home. If you wouldn't want to live there, why on earth would you place grandma there by herself?
The grounds outside the facility are important as well. Do they have parks, walkways and benches? Scenic views or nothing but drab parking lots? Make sure the building is well kept and safe. Ask if they have on-site maintenance and janitors. Is the inside clean and homey? You may only be there for visits, but to your loved one, this will be home for as long as they need care. A cold, plain environment doesn't promote health and wellness.
What about the arrangement of the building? How far will grandpa have to walk to get to breakfast every day? Are there common rooms for relaxation and entertainment? Is the dining room organized to promote interaction or does it resemble a high school cafeteria where people can be shuttled through at breakneck speed? Do the rooms promote privacy? Safety is also a big concern. The distance to the bathroom and the nurses station should be easily navigable. Are there an abundance of fall hazards? Many of the patients we treat from nursing homes have falls that result in injuries worse than what placed them there in the first place. Finding the perfect facility can be extremely difficult, but your family member will thrive in the proper environment. One of my favorite facilities had a cafe designed to look like a street scene, where residents could sit and chat while being served. This facility even painted the walls around each individuals door to resemble a house or cottage, with the residents name painted on the mailbox. It was nice to see the residents smile and joke as they compared "houses."
Well. That's a broad one. Distance from what? From everything. From you, from the nearest hospital, from the the nearest trauma center, from family doctors, pharmacies, entertainment, everything. I've been to facilities so far off the grid that the last leg of the journey had to be completed by 4-wheeler. OK, not really, but it was extremely remote and my ambulance DID get stuck. I even asked a staff member there how often family members came to visit. Yeah. Too sad to answer. The point is, your loved one will do much better if they know they have access to the things they need and care about, yourself included. Finding a facility within a 10-minute drive will negate a lot of excuses when it comes time to visit and check up on them. And again, consider safety. Long-term care workers can be excellent, but their training tends not to focus on emergency medicine, and if it takes you 20 minutes to navigate the back roads to the facility, it will take an ambulance 20 minutes as well.
Most facilities have reviews up on their website, but let's be honest, truly negative ones just won't make it up there. Luckily there are many websites available where people can get their rants and raves out in the open. cms.gov has implemented an improved 5-star rating system for healthcare facilities. Most states also have multiple websites for rating and checking anything from licensing to building codes on almost all healthcare facilities. Usually similar to this - Michigan.gov site. After you've narrowed it down, head over to the facilities and chat with other family members and residents. You'll never get a better preview of what living there might be like.
This is the hardest part. You may find a facility that you absolutely love and then find you are unable to afford it. Try and get all costs and fees explained up front. Certain healthcare plans cover short-term stays but long-term care frequently isn't covered. Many facilities will accept someone with limited financial means, but require them to hand over their assets first. Know what you're getting into and plan accordingly. For many elderly folks, a year in a facility that charges thousands a month will completely wipe out their life savings, leaving much of the financial burden to the family. Sometimes it's possible to negotiate with the facility. Taking responsibility for certain aspects of your loved ones care can defray some of the expense. It might even been a good idea to look into "nursing home insurance." It's expensive to buy up front, but I promise you it comes nowhere near the cost of an extended stay facility. Planning ahead is always your best option and will definitely benefit you and your loved ones in the future.
Jonathan Parker is an EMT-Paramedic and Preparedness Instructor with a love for emergency medicine, self-sufficiency and homesteading. His goal is to empower people towards a natural and sustainable lifestyle.