WASHINGTON — Ideally, selecting a nursing home should be a careful, deliberate process carried out by a patient and family members who already have a good sense of the patient’s wishes.
In reality, families often have 48 hours or less to explore nursing-home options when a loved one is about to be discharged from a hospital — the most typical path to nursing-home care.
The issue is neither exclusively for the old — nearly 14 percent of the more than 3.2 million Americans who enter a nursing home each year are under 65 -- nor only for those whose health is in chronic decline, as more than two-thirds of nursing-home stays last three months or less.
Experts say communication among family and caregivers and some basic planning are the foundation for a smooth transition if and when nursing-home care becomes necessary.
“We encourage family members of all ages to discuss what they want out of health care if they become unable to care for themselves at any stage in life,” said Sarah Wells, executive director of NCCNHR (formerly the National Citizens’ Coalition for Nursing Home Reform, a nonprofit organization based in Washington that represents consumers of long-term care. “You need to talk about what component of the day matters most — music, meals, accessibility to visitors.’’
Advocates say finding a nursing home close enough to allow regular visits by at least a few close family members and friends is among the most important criteria. Not only are the visits themselves important to residents, but staff notice who gets regular visits and tend to give those patients more time and care.
Wells pointed out that most decisions about nursing-home care tend to be made in a matter of days, not weeks.
“It’s really difficult when you’re faced with a long-term-care decision,” she said. “It can be a time of chaos, often fast and furious. But even when you’re suddenly discharged from the hospital, you have a choice of where you go. Don’t let you or your loved one be forced into a hasty decision.”
Resources like the federal government’s Nursing Home Compare Web site (www.medicare.gov/NHCompare) and state nursing-home ombudsmen and advocacy groups offer advice and quality data, but they only go so far.
“There is no one-stop shopping,” Wells added. “We encourage everyone, if possible, to go visit a home, more than once if you can, and compare the ratings and reports to what you actually see.”
John Birch, a nursing-care planner and president of a family council at a nursing facility in the Northern Virginia suburbs of Washington, says families should try to make at least two visits to a nursing facility they’re considering.
“One during a time when you would expect the staff to be overworked, like at mealtime, and another, say in the evening after dinner, when there should not be any manning issues.”
He feels people need to start considering their wishes and options for disability “when you’re 21, at the latest. That’s when you need to develop ‘emergency change in health’ documents and plans and update them at least every five years.
“I encourage people to plan and consider what gives them a sense of control and prepare for events that they know will eventually happen,’’ Birch added.
Most of the stress families encounter from the sudden disability of a loved one comes from not having a clear idea of the patient’s preferences and priorities, experts in the field say.
“Some folks may say they don’t want to talk about it, but most will if you explain that you want to be able to respect their wishes,” said Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, which represents more than 5,000 mostly nonprofit nursing homes and other long-term-care providers. “Most of the time, seniors have given some thought to where they might want to go for long-term care, they’ve talked to friends, heard through word of mouth where the best places are nearby.
“Then, whenever you have a list and make visits, you have to trust your five senses and ask good questions of the administrator — how many hours of nursing care are provided every 24 hours (three and a half to four hours are highly desirable), how much turnover in staff is there — 25 percent or less is a pretty good indicator of a well-managed facility.”
Gerald Kasunic, long-term-care ombudsman for the District of Columbia, said that in addition to basic issues of cleanliness and adequate care, “You need to consider whether this feels like a home. Are residents able to have their own furnishings, artwork in their room? Is their privacy respected? Are there a lot of activities offered, or is the television in the day room the main focus?
“My basic rule of thumb is that the more a place feels like a hospital, the less resident-focused it is.”
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Editor’s note: First of a two-day series. Coming Sunday to naplesnews.com: How good is the care at Naples-area nursing homes?
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