Transitioning to Long Term Care
~ By Eileen Doherty ~
DENVER, CO – Moving a loved one to an assisted living residence or a nursing home brings multiple emotions and feelings to your loved one, other family members and yourself. The transition to long term care maybe met with resistance by your loved one, as well as some family members.
When moving a loved one to long term care, expect that your loved one will resist the move and indicate the need for more care and assistance is not necessary. The loved one may also engage other family members and friends in believing that the need for care is not necessary.
It is important to try to provide as many facts as possible to other family members and friends such as a) medication non-compliance; b) failure to thrive because of poor nutrition; c) safety concerns arising from falls, use of the stove, and mobility on stairs; and d) lack of cognitive ability to take care of personal needs such as hygiene, cleaning the home, and laundry. The facts can include dates and times of medication non-compliance and falls. Letters from the physician and other medical documentation may also be beneficial to helping family members understand the concerns.
When having the discussion with a loved one, try to stay positive and couch the conversations in safety and well-being concerns that you have identified. Do not be disappointed if your loved one refuses to participate in the decision making in a positive way. Sometimes you have to wait for a crises such as a) a visit to the hospital or emergency room or b) a housing inspection that does not meet safety standards before a change in residence can occur. Often a fall or a hospitalization provides the basis for transitioning to a long term care residence.
At last resort, some families may find themselves faced with taking a loved one to court to seek a guardianship. The guardianship may be handled through a private attorney or through Adult Protective Services at the county department of human services. At a guardianship hearing, the loved one is declared incompetent by the courts and the court-appointed guardian is given the legal authority to make a placement, even against the individual’s will.
Selecting a long term care facility is one of the most difficult decisions. The first resources to guide the decision is to review the surveys that are conducted by state and federal officials to determine compliance with state and federal standards. Nursing home surveys can be found at Nursing Home Compare at www.medicare.gov and nursing home and assisted living surveys can be found at www.healthfacilities.info.
Reports on the website for nursing homes include a) findings of the most recent survey; b) data on staffing ratios of nurses and certified nursing assistants compared to state and national standards, and c) quality of care based on such needs as infections, wound care, restraints and hydration. Based on these criteria, nursing homes are rated using a five-star rating system. A five-star facility has been deemed to be giving good care and providing good quality of life for the residents.
Assisted living residences are regulated by the State of Colorado. The state uses a Quality Management Program (QMP) to survey assisted living residences. The QMP program is designed to identify areas of improvement based on policies and procedures that are developed in accordance with state statutes and regulations.
The second resource is to consult with the ombudsman assigned to the long term care residence. Ombudsman are required to visit assisted living residences quarterly and nursing homes monthly. The ombudsman is able to share information about quality of care, residents’ rights, and quality of life based on their experiences.
The third resource if for family members and friends to visit the long term care residences that are being considered. Residences specialize in providing care to different population groups with different types of needs. Some residences are large; others are small. Some residences have physicians and nurse practitioners who visit residents on a regular basis. Some residences are very formal; while others are more informal in décor, attitude and operations. This provides for residences that meet the wide variety of needs of a loved one, depending on their personal preferences and special needs.
Placements are determined by the type and level of care that is needed by the individual. Both nursing homes and assisted living residences do an assessment based on the current strengths of the individuals, the areas of need, and the types of services that can be provided.
The last major factor that is involved in making a decision is payment. Care can be paid for privately, with long term care insurance, or Medicaid depending on the individual’s income and resources. Some rehab services are paid through Medicare as well.
For other information or assistance, call 303-333-3482 to discuss placement in a long term care residence for a loved one.
Eileen Doherty, MS has been the Executive Director of the Colorado Gerontological Society since 1982. She has almost 40 years of experience in education and training, advocacy, clinical practice, and research in the field of gerontology. She is an adjunct instructor at Fort Hays Stat University teaching non-profit management. She can be reached at 303-333-3482 or at email@example.com