Is Your Elder Getting Good Care in that Nursing Home?

When a parent needs nursing home care, overseeing that care usually falls on whichever child happens to live in the same area. This article is for that “responsible” child who just happens to live here.

The first question one must ask is whether any patient can receive quality care in a nursing home. We’ve all heard the horror stories about the warehousing of nursing home patients, who are just waiting to die.

Although nursing home care is often less than adequate, It is possible for nursing home patients to receive quality care. However, in order to receive that level of care, patients must have a knowledgeable advocate.

Nursing Home Advocacy 101

Nursing home advocacy doesn’t require a degree in nursing or medicine, just time, tenacity, and a little information.

Communication is the First Lesson

One of the major problems in the nursing home is lack of communication between and among families, nursing staff, and physicians.
So how do you, as the patient’s advocate open channels of communication?

Become Aware of the Patient’s Needs

Become aware of your loved one’s needs. Are they bed bound? Can they feed themselves? Are they taking a new medication?

Communication Just Doesn’t Happen by Itself

Nursing Home CareVery few families understand that they have to become involved in facilitating communication within the nursing home.

Families are led to believe that the nursing staff will provide the physician with all the information about the patients. Families are also led to believe that the nursing staff will provide all the nursing care the patient requires. Unfortunately, both of these assumptions are not correct.

Nurses and nurses’ aides are short staffed in nursing homes and are unable to provide all the necessary care the patients require. Physicians, who are responsible for the care of patients at nursing homes, rely too heavily on the nursing staff to follow physician orders or to perform adequate nursing care.

Meet with the Patient’s Nursing Home Physician

Discuss your loved one’s needs, in person, with the nursing home’s primary care physician. Find out when the physician plans to be at the facility for his regular visits with the patients, and meet him there.

Patient advocates must take steps to encourage physicians to personally take a close look at their loved one’s condition and ensure that the nursing staff is functioning as intended.

So, when meeting with physicians at the nursing home, ask them to check the condition of the patient. For example, if the patient appears to be losing weight, ask the physician to weigh the patient. If the patient has in fact lost weight, ask the physician to meet with you, the dietitian, and the nursing staff to discuss how to encourage weight gain.

The advocate may become a “pest”, but the physician won’t be able to say that he had no idea that his orders weren’t being followed or that he was unaware that the patient’s condition has changed.

Nursing HomeIt is the primary physician’s responsibility to know the care your loved one is receiving at the nursing home. If the patient is losing weight, the physician should determine why the patient is losing weight. The physician must ensure that his patient is eating his meals and if not, the reason why not. The physician must then take action to ensure adequate nutrition.

If the patient is bed bound, the physician needs to examine the patient’s skin in order to determine whether his patient is developing pressure ulcers (bed sores). And, if the patient has pressure ulcers, the physician must ensure that his patient is being turned and repositioned regularly and is also receiving adequate nutrition.

The advocate must be the vehicle by which the physician is encouraged to completely check the patient’s status, during each visit, and not merely rely on what he is being told or not being told by the nursing staff.

Make Regular Visits to the Nursing Home

When you visit your loved one in the nursing home, visit during the morning, lunch, and evening meals which are the busiest times of the day. This will give you the opportunity to determine whether the nursing staff is able to attend to patient needs during stressful situations.

During your visits, check the following and report any changes you observe to the nursing staff and the patient’s physician:

  1. Patient’s weight.
  2. The percentage of breakfast, lunch and dinner the patient has eaten.
  3. The patient’s skin condition (twice a week) for signs of red, blistered, or broken skin on hips, buttocks, shoulders, or any place that comes into contact with the mattress or wheel chair cushion.
  4. The patient’s medication record documenting medications that were supposed to be given.
  5. Look for any change in the patient’s condition including eating patterns, sleep patterns, falls, bowel movements, agitation, etc.

Meet the Director of Nursing

Long Term CareThe Director of Nursing (DON) is the highest level of nurse management in the nursing home. Introduce yourself to the DON and explain what you know about your loved one’s needs, likes, and dislikes. The DON is responsible for making sure there are enough nursing staff at the facility and is the “go to” person when nursing care isn’t up to par.

If, as a result of your observations, the patient is not receiving adequate care, speak with the DON and the patient’s physician.
If matters don’t improve, speak with the Administrator, who is the general manager of the nursing home.

If there still is no improvement, consider moving the resident to another facility. If matters are such that you decide to move the patient, you should inform the Department of Health Services (ADHS) which is the regulatory agency responsible for overseeing nursing homes.

The patient advocate is the additional oil that keeps the nursing home engine running well. When the oil is low and the engine spurts, the advocate is there to move things along.

It is unfortunate that nursing home patients need an outside observer and facilitator to get the care that Medicare and Long Term Care have paid for, and that patients are entitled to receive.

 

What is Assisted-Living?

While assisted living centers have been available the United States for many years, the growth and availability of assisted living has had a dramatic increase since the early 1990s. Assisted living centers are a residential alternative which promote maximum independence for each resident through a combination of supportive services and assistance. The definition of assisted living from one state to another may vary and so will the cost and types of service.

Assisted living centers vary in size, style and the optional services they may offer. Small family style living or the larger complex of units can be found in the United States. Some facilities are operated by nonprofit organizations, while others are proprietary. In addition, some facilities may be co-located or affiliated with a hospital or nursing facility.

assisted living centers

An assisted living center is any institution, rest home, boarding home, place, building or agency that is maintained and operated to provide personal care and services which meet some need beyond basic provision of food, shelter and laundry in a free standing, physically separate facility which is not otherwise required to be licensed.

In general terms, an assisted living center is required to provide assistance with daily living activities, including eating, bathing, dressing and personal hygiene; three meals a day; supervision of self-administration of medications; laundry service including personal laundry; housekeeping; and 24 hour staffing.

Housing Highlights – Assisted Living

Senior Living communities are designed for individuals who cannot function in an independent living environment, but do not need nursing care on a daily basis. Assisted living communities usually offer help with bathing, dressing, meals, and housekeeping.

Assisted living residences are:

  • Housing environments which provide individualized health and personal care assistance in a home-like setting. The level of care available is between that provided in congregate housing (housing with meal service) and a skilled nursing facility. In these settings:
    – Residents are semi-independent physically or mentally, or frail persons who need frequent assistance;
    – Services offered include, personal care assistance, health care monitoring, limited health care services and/or the dispensing of medications;
    – State licensing and regulation by state social welfare agencies is required.
  • Important because they promote independence by meeting residents’ supportive needs while preventing inappropriate institutionalization.
  • Known by various other names. The most common are: personal care homes, sheltered housing, residential care, homes for adults, managed care, catered living, board and care, and domiciliary care.

senior assisted livingWho Resides In Assisted Living Residences?

Assisted living housing is often deemed necessary when you have difficulty performing daily tasks and have no one to help you. Some indicators are:

  • Needing help preparing meals, bathing, dressing, toileting, or taking medication
  • Needing assistance with housekeeping chores or laundry
  • Requiring some health care assistance or monitoring
  • Needing transportation to doctors, shopping, and personal business
  • Feeling frequently confused or experiencing memory problems

Your loved ones need time to adjust to the new places. So it is best to start the search and inquiry early and be prepared. Further more websites like care.com offer great references on senior care and senior living in your local community.