Sooner or later we might be better off, or inevitably simply need, to live in an independent-living, assisted-living or nursing home facility. Yes, you already know it’s a tough reality to accept.
Actually, many still-healthy folks enthusiastically welcome the move to the unstressed, comfortable and pleasant life of an independent-living community. They anticipate moving up the care-level scale over the years ahead to assisted living, then through the five nursing-home levels and, finally, to hospice at end-stage.
Long-term care institutions work together with, and often are owned by, health care systems, serving the routine activities of daily living (ADLs). Comprehensive, centrally managed and financed continuing care retirement communities offer every care level, starting with fully independent living units.
Independent living facility means just that: one’s own unit, with available, optional services and activities. It’s like simply moving to another house that’s designed and equipped to enable unassisted, self-reliant ADLs. Assisted living facility, the next step up, does, too, plus ADL assistance, such as community meal service, housekeeping, exercise therapy and some health-care services.
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Nursing centers offer custodial care, all needed full-time ADL assistance in up to five progressive care levels. Skilled nursing facilities do, too, plus full-scale, licensed and accredited, in-house physician and professional nursing, paraprofessional, rehabilitation, dietary and therapy specialties.
My thoughts about preparing, to add to yours:
If you’re shopping, be thorough about it, of course. Consult your community’s senior-living advisers, knowledgeable and objective, experienced family members and friends, and professional caregivers. Half-truths and misperceptions abound, so focus on advisers who are really knowledgeable and objective. Avoid crisis; start early.
Coordinate with family members. Whether it’s about you or your Loved One, invite their input, and teamwork with them, to work with you instead of against you. Encourage them to participate and not to feel “stonewalled.” They can contribute valuable information, time, judgment, teamwork — and money.
Long-term care facilities vary widely and should be selected according to how well they fit the person’s unique needs. Sorry, the fact that one is convenient to you or will cost you less isn’t good enough if it’s not a good fit.
To convince the family and Loved One to accept the idea of institutional living, we must conquer fear, denial, stigma, rigidity and pride. The strategy is gently to guide Loved One to accept the idea of change, then to build confidence and positive feelings about the move and to decide to try it.
Encouragement from trusted advisers is a powerful influence — so is family unity. Mom or Dad saying, “I hear such good things about it, and everyone thinks I should try it, so I will,” is far more welcome than, “They don’t like you trying to stick me away in ‘that place,’ so I won’t go!” You surely don’t need an influential family member or friend destroying your well-meaning and desirable efforts, right?
Of course, Loved One’s wishes and sensitivities are paramount. They deserve to be understood, sympathized with, respected and honored unless, of course, they’d be harmful. How often we hear agonized reports like, “We announced to Mom that we’ve decided to put her in ‘the home’ for her own good, and she angrily and stubbornly refused!” Of course she did, because the family trashed her remaining, precious bits of self-esteem, feeling of secure comfort at home, sense of independence and self-determination, pride and her druthers.
Certainly, Loved One will be more willing, and hopefully happy to try it and to accept the necessary and intimidating disruption to familiar and comfortable life at home, if encouraged to participate fully in the process and shape the decisions. Unless beyond clear cognizance ability, Loved One is entitled to a decisive decision vote, right? How would you feel if the family arrogated, without considering your feelings, to “put you away in ‘the home’”?
Another desirable strategy, if possible, is gently to introduce Loved One to the joys and benefits of life surrounded by peers in a pleasant and comfortable house full of enjoyable living. Take Loved One on happy fun outings to carefully selected prospective facilities that suit his or her style and needs, for eyes-on, hands-on participation and impressions. Accept the offered tours and lunches, to gain (hopefully favorable) impressions of the home’s facilities, their staff and residents, atmosphere, cleanliness, activities and food.
You also can gain a feel for whether the residents and activities are Loved One’s kind of folks and social environment. Does a welcoming good friend or relative live there? Impressions, however subjective, assert a powerful influence on our feelings and judgment.
These are vital, permanent factors in your person’s well-being and happiness for the rest of life.
Offering multiple choices, a motivating technique, guides us to decisions about “Which one?” rather than “yes or no.”
Take advantage also of “third-party influence,” another motivator: encouragement and endorsement from folks whose opinions Loved One respects, especially ones who already are residents.
Some business aspects to consider:
• The costs — not cheap, anywhere! — payment terms, the home’s eligibility for philanthropic and public-funds subsidies, and its eligibility for long-term care insurance benefits and entitlements. Many are “equity,” or “buy-in,” ventures, requiring major up-front capital commitments in return for lifetime care guarantees, with “opt-out” refund features in event of move out or early death.
• Fine-tooth the contract that’s required for admission.
• Check the home’s licensing, inspection, accreditation and community ombundsmen’s health, sanitation inspection and rating agency scores.
• Is the facility privately owned, profit-seeking or nonprofit? To us, it doesn’t matter, but pricing and delivery of care certainly do. Pricing must earn a profit for for-profit investors in addition to covering the costs. Nonprofits must cut costs, struggling with deficits. Is it fundamental policy to maximize quality patient services regardless of profit or loss, rather than to limit the services to balance the facility’s budget?
Does the skilled nursing facility offer alternative Medicare plans, called “Medicare advantage plans,” designed to emphasize benefits for residents’ unique, in-house health-care patterns?
• Is the home’s facilities, staff and professionals adequate and specialized for your person’s particular, individual needs? What about morale, caring, turnover rates, staff-patient ratios, patient ombundsman representation to management and security? Get acquainted with some to judge their compatibility.
• Do the facilities welcome and encourage hands-on observation and volunteer help with activities, or do the staff consider “nosy visitors” a nuisance?
• Is there an adequate system for adjusting the person’s care level when inevitably needed, including transfers to higher care levels or to more specialized facilities?
• Cleanliness is a vital criterion. It’s OK to sniff, poke, look and ask around in the building. Desirable institutions’ staffs will welcome that, not resent it.
• How long is the admission waiting list? Should you join several well in advance of need?
• Does the nursing home offer in-house hospice, for the inevitable need?
• Visit with residents’ family members and ask about their loved ones’ care. To get a valid sampling, talk with several, not merely one or two. Evaluating their comments, allow for the phenomenon that many family members’ complaints are over-reactive, uninformed or unsupportable perceptions, driven by emotion and anxiety over their loved ones’ care. Obviously, the home’s interests are best served by delivering top-quality service, but screw-ups do happen. How successfully does it maximize the pluses and reduce the minuses?
Aren’t these techniques are just common sense? Absolutely, but uncommonly revealing. Let’s hope they help you.
Your comments are always welcome!