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Message #681 Nursing homes: How to choose

mp3 #681 How To Choose A Nursing Home (mp3 file)

Americans are living longer. The number of citizens 65 years and over in California in 1979 totals more than 3 million, and 12.4% of Americans are 65 or older.

And because we are living longer, more and more of us are finding a time comes when we either no longer want to - or can - live completely on our own.

Unfortunately, in the past the words "nursing home" often brought to mind images of impersonal, lonely places. But conditions in nursing homes can vary tremendously. Some homes may be very good, while others may be just the opposite. Because the condition of the elderly is no longer ignored to the extent it once was, regulations regarding nursing homes are becoming stricter, and it is possible to find nursing homes which can be positive places to reside.

But at the same time, the sad fact remains that even though nursing homes are licensed by the state, unclean and unhealthy conditions can still be found. And even if the homes follow the licensing procedures perfectly, the law does not guarantee a warm, friendly staff or atmosphere.

So, it is very important that you take the time to carefully check out the nursing homes you are considering. If you cannot carry out all of the steps suggested here, have a friend or relative find out the answers for you. Too often patients go to homes in a time of crisis, with not enough planning.

When looking at nursing homes, you should decide what qualities are important to you. And remember as you look that the attitude toward patients - the morale and the personal contact can be just as important as brand new buildings.

Not everyone who is in a nursing home requires 24 hour skilled care offered there. Many residents are in nursing homes because they can no longer care for themselves at home, and have nowhere else to go. But alternatives to nursing homes do exist for people who need less care.

Home care services, which allow you to stay in your own home and a familiar environment rather than being placed in a nursing home, can be good if you need only limited help, since home care causes far less disruption to your normal life. Home care services are provided by a variety of public, voluntary and private agencies.

Some of the services available include physical, speech and occupational therapy; nursing care provided by or under the supervision of a registered nurse; and services of medical social workers, home health aides, and homemakers (who can bring or prepare meals, and help with cleaning and shopping).

The cost of home health services is sometimes covered by private health insurance, prepaid health plans, Medicare or Medi-Cal. However, these plans often require a doctor's orders to get services and include strict limitations about what services and costs can be covered, so you should check the restrictions.

If you are interested in finding out about home services in your community, you should contact the Public Health Nurse (look in the phone book under your County Health Department, Nursing Division), your area Agency on Aging, the Visiting Nurse Association, local hospitals or home health agencies.

If you need more than home care, the level of care selected should depend on your health and ability to participate in your own care. Three levels are available: residential, intermediate, and skilled nursing home care.

I. Residential care may be the correct level of out-of-home care if you don't require professional nursing care but are unable or do not wish to live alone. Residential care homes provide room and board, help with personal hygiene, and bedside care during times of minor illness. These homes also provide social and recreational activities. Many of these facilities are quite small, with only three or four beds, and often have a more home-like atmosphere than nursing homes.

2. Intermediate Care Facilities offer social and recreational activities plus intermittent professional nursing care for individuals who need only intermittent, not continuous, professional nursing care or supervision. These homes usually cost less than nursing homes because of the nature and ex tent of the services provided.

3. Nursing home care is for people who require the continuous nursing supervision of a registered nurse or a licensed vocational nurse, as well as help in daily living. These homes are called Skilled Nursing Facilities.

Admission to either an Intermediate Care Facility or a Skilled Nursing Facility requires a doctor's order. Both types of nursing homes are required to provide medical, nursing, dietary, and pharmaceutical services, as well as social and recreational activities for their residents.

Paying The Bills

If you expect Medicare or Medi-Cal to pay for the cost of nursing home care, you should carefully check into the eligibility requirements. For instance, Medicare will only cover 100 days in a nursing home and only after 3 days in an acute care hospital. Similarly, make sure that the facility you choose is certified for either Medicare or Medi-Cal – otherwise you will not be reimbursed.

You should also find out whether you can switch from one form of payment to another. In addition, make sure that you receive itemized bills, so that you know exactly for what you are being charged.

What to look for.

May things must be kept in mind when selecting a nursing home, but you shouldn’t let the following list overwhelm you. If you take your time and observe carefully, you should get a pretty good idea about the homes you are considering. In addition, don’t be afraid to ask questions, and ask them of more people than only the administrator.

You should begin by getting the names of nursing homes in your area – you can ask friends, doctors, clergymen, relatives and your local senior citizen center for suggestions. You should also go to the California Department of Health Services Licensing and Certification Division, district offices and ask to see their files. For general information, the website is You can discuss the information in these files with the office supervisor. In addition, the location of the home should be convenient for your friends, relatives and doctor, and should appeal to you. The home should also be close to a hospital.

You do not need to check each home, but first phone and eliminate those homes which do not have the services you need. When you do visit a home, check for its license as well as the administrator’s name, license number and date of employment which must be posted. If either of them don’t have licenses, do not use the home. Also, a listing of all other skilled nursing and intermediate care facilities owned by the same person or corporation must be posted.

In addition, you should also:

Consider the facility’s size. A large home may have more activities, while a smaller home might be more personal. But you should also consider the quality – not just the quantity of services and activities offered. A listing of all services and special programs provided in the facility and those provided through written contracts must be posted. Decide which is best for your needs.

Find out whether the visiting hours are convenient. Often the best arrangement is one which allows visitors to come any time.

Make sure you find out what extra costs are involved in addition to the basic daily room rate. Usually extra charges are made for all processional services beyond basic nursing care (also for things such as televisions, toiletries). Medicare/Medi-Cal reimbursement to the homes is so low that most homes only provide the bare minimum in the way of services.

Find out whether attention is paid to roommate and room selection – two factors which can be very important to your happiness. You don’t need to feel committed to your first roommate. If you are dissatisfied, see if you can change. Also, see if you can bring some of your own furniture.

Find out if your valuables are protected. Theft is one of the biggest problems in nursing homes. If at all possible, you should leave valuable items with friends or relatives.

Ask whether residents have some sort of grievance procedure. Find out if there is a resident government, and a way that residents can be involved in decision-making.

If your plan of care includes physical therapy, find out if facilities are available for these services. Ask to see the therapy room and inquire how often it is used.

Find out if community volunteers are used at the home. Active community involvement by individuals and groups of volunteers can greatly extend the amount of resident services available, and helps reduce the isolation and loneliness that many nursing home residents feel.

And finally, find out how well the nursing home meets state licensing regulations and inspections. For more information about Nursing Homes and state regulation, be sure to review SmartLaw message 682.

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