Despite all your best efforts, you may find that a senior you care for is in a nursing home that is not meeting your expectations. What do you do? This article examines the questions about when, and how, to choose a new nursing home
Admitting someone in your care to a nursing home may be one of the most emotionally traumatic things you ever do. You and the senior will go through an adjustment period that may last several weeks before you reach some sort of equilibrium.
The same thing happens to all of us when our social situation changes. If you think back in your life you may remember starting school, moving away to college, or starting a new job. You may also remember advice you received from your parents and later gave to your children, such as “stick with it,” or “You don’t want to be a quitter.”
It is also important to recognize that situations where everyone is happy are rare. Be realistic in your expectations. For example, you must have a quality facility that treats people with dignity; but don’t expect rave reviews from the senior. For most people, being in a nursing home is what they had feared and hoped to avoid.
Beware of Judging the Facility Based on Traumatic Reaction to the Move
With that in mind, remember to “Stick with it.” Especially in the beginning, there will most likely be a traumatic initial adjustment to even the best facility. So don’t make the mistake of evaluating a nursing home based on your own emotional state rather than an honest appraisal of the care and attention the senior is receiving. Remember that building a relationship with the staff of the new facility is the best way to assure that they understand the needs of the senior and for you to get timely, honest information back. Also, bear in mind that staff in a nursing home work efficiently because of routines and standardization. This means they may not provide care exactly the way you do. In fact, they probably cannot provide care the way you do.
Keep the Senior Involved in the Decision Making Process
However, there are times when an honest appraisal of your situation demands that you seriously consider moving the senior to a new facility. As we explore this idea we will look at some of the issues and even warning signs that indicate you should consider a change. We will also discuss the down side of moving and the effects that a change may have on the senior. All in all, the placement decision should be dictated by what is in the senior’s best interest, and should be made by those who are most qualified to understand and interpret his wishes. The senior should always be kept informed and involved in the decision-making process unless a physical or mental condition precludes it.
The best advice, of course, is to carefully select the right nursing home for the initial placement. But, even if you did all your homework, some placements may not be permanent for a variety of reasons. What are some valid reasons to consider a move, and how do you go about arranging it?
Improvement in Condition Is a Good Reason to Move
The most positive reason for changing placements is that the senior improves in health to a point that certain skilled services are no longer needed. Many more people enter nursing homes for rehabilitation today than just a few years ago. Many, if not most, placements are seen as temporary because of a physical condition such as a stroke or fracture.
Medical Concerns and Uncaring Staff Can Be Reasons to Move
Of the negative reasons to change placements, quality of care is the most important. Medical signs that are the most telling include:
Significant weight loss
However, you should ask to discuss your concerns with the director of nurses before drawing conclusions since there may be a valid medical reason for all of these conditions becoming unavoidable. You might want to back this up by discussing it with the physician or facility medical director. Other questions you want to ask yourself and the senior include:
Does the senior feel comfortable discussing concerns with the staff?
Are management staff receptive to your concerns?
Do the staff, in general, seem to care about the senior?
Remember, one employee doesn’t represent the whole facility. Report any behavior that does not meet your expectations.
Moving Can Be Traumatic; Try Every Reasonable Way to Resolve the Problem First
Stability is important for a senior’s sense of well being. When a problem comes up, consider whether you are dealing with a minor annoyance or a real issue. Communicate your concern to a management level person and give them a chance to explain or resolve it. Do what you can reasonably do to try to avoid moving the senior.
The potential burdens of relocation include relocation trauma, which in some cases may be fatal to a frail elderly person, especially someone who has been in one location for a long time or is significantly confused. The very frail do not have the inner reserves to handle physical or emotional stress as well as they did when they were healthier. All moves, even those carefully planned for very good reasons, entail a certain amount of stress. As many as 10 percent of people moved from a skilled care facility will die from a range of causes which can include depression, loss of appetite, and onset of pneumonia.
Another, much less severe side effect of relocation is simply that you and your senior will experience another adjustment period in the new facility. There are times, however, when the potential benefits outweigh the risks.
Moving Will Require Coordination; the Current Facility Should Help You
If, after careful consideration, you and the senior decide it is necessary to move, how do you go about it? The process of relocating is as simple as notifying the current facility that you wish to move. Nursing homes are obligated to assist you in the relocation process, which is usually handled through the social services director.
The amount and kind of help the nursing home provides can vary significantly, depending on your needs and the senior’s needs. You may wish to choose the new facility yourself; however, the discharge planner can also make all the calls and find a suitable new placement. Bear in mind that if the senior entered the current facility as a self-paying resident and converted to Medicaid while there, in searching for a new facility, you will be limited to those which accept Medicaid. The discharge planner can also arrange for an ambulance to move your senior, if necessary, and for someone to pack up and move personal possessions.
When and if you decide to change nursing homes you should be as thorough in your search for a new home as you were in your original search. Involve the senior in the decision-making process and make the move if it is in her best interest.