The decision to move or place a loved one in a nursing home is one of the most difficult decisions.  Everyone’s goal is to remain in their home as long as possible.  However, this is not always a safe and smart choice.

Considerations

There are many reasons to consider nursing home placement.  Perhaps your loved one has been diagnosed with a progressive disease, like Alzheimer’s, and needs assistance remembering to take medications, turning off the stove or being able to remember where her house is if she takes a walk.  Or, if she has mental capacity but has had a stroke or heart attack and needs physical help getting out of bed, taking a shower, and going to the bathroom.

Meeting Your Loved One’s Needs

First look at whether her needs can be met elsewhere.  Below are some options that may assist meeting those needs, alone or in combination:

• Home support through a caregiver agency that can come to the home to help.
• Hospice is an option when a disease is at a point where treatment can no longer cure or control it. In general, hospice care is used when life expectancy is six months or less if the illness runs its usual course.
• Adult day care programs such as LIFE. The LIFE program is a managed care program that provides an all-inclusive package of medical and supportive services including day care at the center (currently under Covid-19 guidelines, these are being provided in the home) during weekdays, all supervised by one physician.
• Home modifications such as a first-floor bathroom, ramps or retrofitting rooms with grab bars are often needed to provide a safe home environment
• Transportation programs are available in various counties. For those living in Lycoming or Clinton counties, STEP (Success Through Engagement & Partnership) provides transportation to the elderly.  A reservation request can be made online.
• In home meal options could be through the Meals on Wheels program. A hot meal is delivered at noon Monday through Friday for those who are home bound, over the age of 60 and are at risk of malnutrition.  Private services also provide in home healthy meals based upon dietary restrictions.

Many of the above and other services are available through STEP.

Complexity of Needs

Are her needs too complex or extensive?  Does she need skilled care, meaning nursing and therapy care that can only be safely and effectively performed by or under the supervision of professionals and technical personnel?  It might be short-term or rehabilitation from an illness or injury, or may be required over the long-term for patients with a chronic medical condition.  Or, does she have 24/7 needs that can only be met in a skilled nursing facility?  Remember, that family caregiver burnout is real for the caretaker of a loved one.  It is emotionally and physically tiring and often leaves a toll on the caretaker’s body.

Payment Options

Choosing a nursing home also means examining payment sources.  Does the facility accept Medicare and Medicaid?  As of January 2021, the average cost of nursing home care in Pennsylvania exceeds $133,000.00 annually.  Most, but not all, facilities accept Medicare and Medicaid.  Other payment methods include Veteran’s benefits, private payment, and long-term care insurance.

Assessing the nursing home

Don’t judge on the appearance of the building alone.  The people – management and staff – are what will determine if your loved one is receiving good care.  Develop your own checklist before you visit in person or remotely.

• Are there adequate staff on duty?
• Are staff members interacting with the residents?
• Are they friendly and respectful?
• Do staff members knock on doors before entering rooms?
• Do they address residents by their names?
• Does the facility look and smell clean?
• Try to talk to members on floor staff. Ask how long they have been employed at the facility. If a long time, this is a positive sign as nursing facility staff turnover is very high.
• Is the philosophy of care resident-centered?
• Observe other residents. Do they interact & seem happy?
• Try and talk to other residents. Ask how long they have been at the facility.  What activities do they like?  How’s the food?
• Is a safe outdoor space provided for residents?
• Are residents dressed appropriately for the weather?
• Are residents wearing jewelry, makeup, and are men clean shaven?
• Are residents participating in activities?
• Are common rooms being used?
• Are in person visits permitted and under what circumstances? If not, what methods of communication are available?

Location

Loneliness and boredom are significant problems for residents.  If possible, consider a facility that is convenient for family and friends to visit.  If there are residents that your loved one already knows at the facility, that is a bonus.

Reports & Ratings

Go online and enter your zip code to compare nursing homes in your area.  The Covid-19 long-term care facilities data can be found here.

Ask Questions!

Do not hesitate to ask any and all questions that you think are necessary for you to feel comfortable.

Start Before a Crisis

Planning ahead is best.  You may need follow-up visits.  You will make a better decision if you have done some homework before the crisis hits.  Employ a professional care manager to assist you.  Talk to friends and family about their recommendations.

 If you’d like more detail about shopping for a nursing home, view How to Shop for the Right Nursing Home.