Perhaps you’ve just begun your search for suitable, affordable long-term care for yourself or a family member. If so, you are probably envisioning a number of possibilities including lack of privacy, bad smells, poor food, inadequate staff, and separation from friends and family. The chances are also high that you are currently in the midst of a family medical emergency and never imagined that you would be searching for “one of those places” for yourself or a loved one. Quality care is available and affordable.
A whole new generation of nursing homes has appeared. These “new” nursing homes are moving away from the institutionalized, hospital-like settings of the past to offer more homelike, personalized care. In these new nursing homes, staff are more visible and attentive, family members are more involved, and facilities are cleaner and friendlier.
"No one knows more than Marilyn Rantz and Mary Zwygart-Stauffacher about understanding what makes up quality eldercare. In this volume, they translate extensive research into a user-friendly format that is valuable to both seniors and their caregivers."
A nursing home is not the only option for long-term care, nor is it always the best place for you or your loved one. From Meals-on-Wheels to skilled nursing, a variety of long-term care options exist for people in different situations. Selecting the best option depends on many factors: whether or not you have someone who can assist you in your home, how much personal and medical care you need, where you live, what community services are available, and what financial resources you have access to.
Some of the more common long-term care options in addition to nursing home care include senior services, homecare, live-in help, senior housing with services, subsidized senior housing, and assisted living (or residential care).
Senior centers offer meal programs for seniors who are able to come to a meal site. For those who can’t come to the center site, many communities offer a Meals-on-Wheels program. In many communities, transportation is available for older adults who can no longer drive. This basic service is crucial in helping people remain in their own homes. Some communities have private case management, or care coordination, available through private companies or community service agencies. Case managers find local services, coordinate medical care, and obtain financial assistance. Area Agencies on Aging, established by the Federal Older Americans Act, coordinate funding for senior services and centers. They provide information about local services that help older adults remain healthy and independent in their own homes as long as possible.
After a hospitalization for illness or injury, many people hire a licensed homecare agency to help the individual recuperate at home. Usually, Medicare will pay for some homecare services. A nurse or physical therapist may come to the house to help manage the illness or to assist the individual in regaining his or her mobility or strength. A nursing assistant may come to help with bathing and personal care. Homecare services may also assist with housekeeping, shopping, and other household chores.
Some homecare agencies specialize in finding workers to live with older adults and provide basic housekeeping, meal preparation, and assistance with personal care. These workers are available around the clock and are paid by-the-day out of personal funds.
Federal and state programs subsidize housing for older and disabled adults with low and moderate incomes. Residents generally live independently in an apartment within a senior housing complex. Some offer assistance with shopping, laundry, or other tasks. Individuals may hire a home health agency to help with healthcare or personal care needs; government funds usually do not cover the cost of these services. As an individual’s care needs increase, nursing home placement becomes a viable alternative to the high cost of extensive in-home services.
Assisted living is a rapidly growing option for older adults who need some assistance with personal care, such as bathing, meals, laundry, medications, and housekeeping. In assisted living, residents generally live in private apartments while sharing meals and activities with the other residents. Assisted living facilities are similar to nursing homes, except they provide less care and have fewer workers on staff. If you or your loved one will require round-the-clock nursing care or rehabilitation therapy, you may be able to use a home health agency to supplement the care you receive from the facility, but you will likely have to pay for homecare services yourself. In this case, a nursing home may be a more suitable, less costly option.
Research on nursing homes conducted by the MU MDS and Quality Research Team identified Seven Key Aspects of Quality Care: Home, Care, Family Involvement, Environment, Communication, Staff, and Central Focus.
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A nursing home should feel like a home, not like an institution or hospital. It should have the look and feel of an active place where people live and where they receive the care they need. It should be buzzing with life, hope, activity, and caring individuals. Each room should have plants and personal items so the resident can regard the room as his or her own. Local community groups should visit residents.
A high–quality nursing home is one where the staff stays on top of the fundamentals of care, including:
Communication is crucial. It’s important that staff members hear (perhaps more than once) each resident’s needs, likes, dislikes, and habits. There should be positive verbal and nonverbal communication between staff and residents. Good staff members will talk with residents and listen to what they have to say.
Staff are the most important sign of quality care. Good staff are responsive and compassionate, clean and well groomed, with the same staff caring for the same residents each day. Make sure that a Registered Nurse is on duty at all times. The presence of an RN is essential for quality care; they make the medical assessments that are the basis for the care residents receive.
Good nursing homes encourage families to get involved with their loved ones’ care. And family members say that spending time at the nursing home ensures that residents are fed, exercised, and medicated properly and in a timely fashion.
A nursing home should feel like a pleasant place to live. It should be clean and odor-free, spacious, and not too noisy. The grounds should be inviting and accessible. The building should be well lit with lots of windows so that residents can see outdoors. Beds should be low enough to minimize falls; tables are the right height for eating comfortably; and chairs are sturdy with arms to help people stand up easily and safely. Floors should be nonslip and without glare. In general, the environment should be safe and free from obvious hazards.
Central focus means the facility has set the right priorities. The facilities focus on the residents, their families, and the community and they participate in local events and solicit community support.
The Consumer’s Guide to Quality Care offers advice for families searching for quality nursing
home care. In it, consumers will find suggestions about what to look for inside nursing facilities,
how to identify quality nursing staff, and links to other resources on the web.