An RN Speaks Out On Nursing Facilities-What To Ask and What to Look Out For!

We talk with a lot of clients about nursing homes. I have asked a licensed RN who visits multiple nursing homes to share with us her observations and thoughts on care in these facilities. Very inciteful.

I hope this is helpful to you as you care for your parents. As always, please share any comments you have below. Thanks to my friend for her great contribution.

This is in response to a request I've gotten to post my ad hoc observations about nursing homes and how they differ, and how to know if your loved one is getting the appropriate care.

First, I strongly recommend the Medicare website, which has a Nursing Home Compare section with a ton of information.

Next, keep in mind that I am still very new to working with nursing homes, so my observations have their limits. I welcome input/comments from anyone who can expand, elaborate, contradict, or otherwise enhance these comments. For example, I don't actually know what regulations nursing homes have to follow, and what information they are required to provide to the public. With all that said, here we go.

Here's what I like to see:

-- Nurses who know the patients well, and can easily talk about their eating habits, the "as needed" medications they've had to take, and their physical status without having to look something up.

-- Patients who need to be fed actually being fed, instead of having their tray sit in front of them untouched for 45 minutes without anything to keep the food warm, or any indication that they DO get fed -- at all. (TIP: schedule a stealth visit at mealtime.)

-- Patients with significant debilities nonetheless being encouraged and helped to get out of bed and into some sort of chair if at all possible.

-- Clear, detailed documentation of any wounds and their treatment (including measurements) that is (1) easy to access, and (2) updated AT LEAST weekly (you'll only be able to legally access records for your own family members).

-- Appropriate use of "as needed" medication for pain, agitation, or other distressing symptoms.

-- A clean, bright environment with no evidence of broken equipment.

-- A low pressure ulcer acquisition rate, and someone who can tell you what it is.

-- Activities for residents.

-- A wide variety of services provided by the facility (not contracted), including physical therapy, speech therapy, occupational therapy, behavioral therapy, dieticians, and so on.

-- Staff that clearly enjoys working together and at the facility

That's a start. I'm sure there are folks reading this who could add more.

Please add any thoughts or comments below. Especially if you are an RN, please share with us your insights. If you are looking for a nursing facility, keep these and other facts discussed below in other posts in mind as you search for a facility. Take great care of your parents in this area and the reward will be tremendous!

Blessings, Jane Allison

Just Published on American Chronicle

Just published -- American Chronicle Gifting to Qualify for MediCal - Medicaid Eligibility - Unfair For Seniors? - Part 1 Medicaid Eligibility

My Mother's Homecoming

Coming Home

Bringing a family member home after a stay in a skilled nursing facility (SNF) or rehabilitation center, or directly from the hospital, can be an overwhelming challenge emotionally and physically. If you are going to be a caregiver either in your own home or your parent's, to minimize emotional overload you need a plan. I'm going to give you one. First, let me share my story, and then I'll recommend what to do.

My Mother's coming home tomorrow at 2 p.m. "Home" I've learned over the last three years is wherever your loved ones are. I have been traveling from my "grown-up" home in Virginia to my "childhood" home in California, looking after my 86-year-old Mother (only child of only children). It's been a joy, but whenever I leave one place, I say "I'm going home." This last trip I decided both are home -- so I now refer to them as "the ocean" and "the farm."
My mother's coming home tomorrow at 2 p.m. is real for her. This has been her main residence or second home in California for over 30 years. I've been a nomad in it as I have come and gone to look over her care and be with her in a beautiful (we have been blessed) skilled nursing facility close by. But it struck me one night as I lay in my nomad state watching TV that she was doing the same thing several miles away, so why shouldn't we be doing it together? She has been in the facility for three years. They had taken great care of her. When I left to go to the farm after her first hospitalization, I worked hard to get caregivers for her at home who would care for her in my absence. She wasn't really sick, just immobile and afraid to be touched. She graciously growled at every lovely lady who came in, and I again knew in that moment, if I left, she'd kick them all out, so it was back to the facility, which kindly took us in.

Fast forward three years and she's been well cared for. Her mind is still sharp. Yet, she had come to the point where all she wanted was to lie in bed, be left alone, not eat (except for the chocolate I brought ever day) and said repeatedly she was living too long. In our care plan discussion, the lovely hospice social services lady, Paula, told me to be prepared, that it was not unusual for women to just start shutting down until they pass away.
Then a funny thing happened on the way to "home." My mother rallied. Three days before the scheduled departure I get a call from wonderful, Kit, the Head of Nursing. "I've got the greatest news. Mom has been up in her wheelchair, sitting in the Activities Room, taking all three meals in the dining room" -- which she had always called the "old people's room" and refused to go into, preferring meals in her room. I'm told the staff in amazement is calling this the "Awakening of Mrs. Lee."

Her front room with the ocean view is all ready to go, new bed (not a hospital bed, you need a special bed~more later), a lovely sofa bed to sit in by day and hang out with her all night if necessary, all my "little girl" furniture of which I was most proud has been taken away to make room for this new era in our lives.

My mother's coming home tomorrow at 2 p.m. -- from now on that's where I'll be hanging with one-half of my family at "the ocean." What joy.

I want you to have the same experience -- with or without the ocean. Here's what you need to do:

1. If your loved one is in a SNF, hospital, or rehabilitation facility, sit down about a week before you are planning to bring your parent home, listen and ask lots of questions!

2. If your parent is on hospice, hospice will offer a hospital bed at no charge. The standard in the industry says they are unbearably uncomfortable. If finances are an issue, you may have to take the bed. It is a blessing hospice even provides all that they do. If you are able to spend some money, I recommend checking into a nursing home bed distributor. Some of those beds are better than others. I worked directly with my "team" at the nursing facility (they have connections, you just have to ask and push) to arrange for a top-of-the-line bed to rent for $150 per month. The bed can also be purchased. The IMPORTANCE of this type of bed is that it moves the body in all different positions, crucial to prevent bedsores, and allows the bed to go all the way to the floor if your parent has a tendency to fall. Hospital beds don't go to the floor.

3. Hospice will also provide an eating table that goes over the bed for meals and holds drinks during the day, a wheelchair, oxygen, and a hoyer lift, which takes us to #4.

4. There are different sizes and kinds of hoyer lifts. You will want to talk to hospice about what they can provide, or check on your own -- Google "hoyer lifts" -- to find the right one for you. They will aid you in lifting Mom or Dad out of the bed and putting them in an armchair or wheel chair. You need practice, so ask the facility to show you how it works and practice with your Mom or Dad before they come home.

5. Finally, but equally important, finding caregivers to support YOU! You cannot take care of your parent 24 hours a day -- it is a physical and emotional impossibility. Watch out or the bed your Mom or Dad vacated might soon be yours! Reputable, trustworthy, bonded caregivers are the key. Ask your facility for whom they know to be the most trustworthy caregiving agencies. You will want to interview the caregivers and introduce them to Mom or Dad. If one doesn't work out, don't hesitate to ask for another. This is the most important step--you are entrusting your parent's life to another so that you can get out and have some recreation time, etc., AND you want someone in your house you can trust while you're gone. Put any valuables away. No matter how great we believe someone to be, we never truly, truly know them, especially in this setting.

You can do it. Loving your parent through this difficult time is a challenge, but will give you those special moments you will treasure forever. Corny to say, but love is a powerful thing, and serving your Mom or Dad at this time in your life is healing to them and a gift to you.

Help! My Parent's in the Hospital! Five Things You Must Do IMMEDIATELY!

Have you gotten that call in the middle of the night telling you that your mother who is 2,000 miles away has fallen and is in the hospital? Has your father come for a visit and had a slight stroke? These circumstances can interrupt your everyday life and send you into a state of panic and fear. THE MOST IMPORTANT THING TO DO WHEN YOUR PARENT IS HOSPITALIZED IS TO PUT YOUR PANIC AND WORRY ASIDE AND SHIFT INTO WARRIOR MODE. Here's what you need to do.

1. Don't panic. It is natural to be fearful and overwhelmed when your mother or dad is rushed to the hospital. Accept your feelings as natural, but put them aside right away. YOU ARE YOUR PARENT'S BEST ADVOCATE. If you live far away, immediately call a friend who can go to the hospital and be your liaison on the ground until you get there. You will quickly get frustrated and angry trying to get information about what's happening with Mom or Dad unless you have someone on the scene looking out for YOU and letting you know what's going on. If you can't get to the hospital, there are also elder care advocates like myself who can be your eyes and ears and fight through the system so your parent gets the best care.

2. Contact your mother or dad's physician immediately. As a side note here, it is very important that your parent have a general internist physician (preferably a gerontologist if you can find one) WHO IS WILLING TO FOLLOW YOUR PARENT TO THE HOSPITAL IF NECESSARY. This is obviously something to arrange now, before any unforeseen hospitalization occurs.

Many hospitals now promote to patients a new system of "hospitalists" -- these are physicians who only work at the hospital and don't have a private practice. The problem with this is that your parent will be a new patient to the hospitalist and you might not have the same hospitalist every day. WHAT YOU WANT IS YOUR PARENT'S PHYSICIAN WHO KNOWS YOUR PARENT'S HISTORY TO VISIT THE HOSPITAL EVERY DAY AND DIRECT YOUR PARENT'S CARE! This is very important for the continuity of care for your mom or dad and for your comfort. A hospitalist might not pick up on something about your parent that his or her own physician would because of their history together.

3. Don't be intimidated by the hospital system. The reality is that hospitals have their own protocols and systems which may work for them, but may not necessarily work for you! You land in a place that's all new to you -- and they've got the advantage. Do not be afraid to ask questions of the nurses, other staff or the physicians. Hospitals tell us that their mission is to take the best care of their patients, but the reality is the only person who will be looking out for the best interests of your parent is YOU or YOUR ADVOCATE.

When my mother was in the hospital, I walked up to the nurses' station behind which about 10 people were chatting away, and the one who was sitting at the desk right in front of me refused to look up. I finally called out, Hello, anybody home? And they all turned in disbelief, but I got what I needed.

4. If possible, keep your parent in the hospital for THREE OVERNIGHTS. True, you do not have complete control over this, that's why the presence of your parent's own physician can be so important, but if your parent will have to go to a rehab facility or go home for therapy, and he or she is on Medicare, Medicare will only pay for follow-up treatment if your parent has spent three full overnights in the hospital. Not days, but overnights.

Don't let them try to push Mom or Dad out too early. If it's legitimate for them to stay in the hospital, make sure they stay. I had a friend who unfortunately did not know the three-day rule at the time, and her mother wanted to leave the hospital early. She needed therapy at home as the doctor prescribed but had to pay for it herself because she did not meet the three-overnight rule.

5. Manage the hospital's discharge planner. Within a day or two of your parent's admission, you will meet the discharge planner, whose job it is to arrange for where Mom or Dad goes and what help they need after the hospital. THIS IS VERY KEY -- if your parent is going to have to go to a rehab facility, a skilled nursing facility, and the three-day rule is met, Medicare will pay for the best or worst facility. IT IS YOUR JOB AS ADVOCATE TO FIND OUT THE BEST FACILITY AND GET MOM OR DAD IN THERE! This will make a world of difference in their aftercare.

The discharge planner will give you a list of facilities in the area. They are not ethically allowed to tell you what the best ones are. Typically, they will ask you to pick three, and then whichever of those three facilities has a bed on the day Mom or Dad is discharged from the hospital, that's where they'll go.

BUT HERE'S THE CATCH -- THERE MAY ONLY BE ONE GREAT FACILITY IN THE AREA. SO HOW TO GET THERE? First, you have to find it. Ask friends, families, colleagues. If you've hired an advocate, they'll be able to guide you. If you're on the ground, go visit the facilities. Ask for a tour of the skilled nursing facility. Talk to the admissions officer at the facilities you like. If one stands out above the rest, keep talking to the Admissions officer at that facility (you won't know exactly what day your parent will be discharged) and tell the hospital's discharge planner that you want your parent to go there.

This is so important and the trickiest part. When you find out (usually the day before) when Mom or Dad is to be discharged, call the facility (or facilities if you're blessed to have several you like) and ask if they will have a bed open the next day. Some hospital discharge planners are wonderful, others are annoying and territorial. They may see you as interfering with "their" job. But put any concerns about that aside, and recognize that they are treading on YOUR territory, where Mom or Dad goes will make no difference to them, it will make all the difference to you. If there's a bed open where you want to go, tell the discharge planner that day -- tell them you've talked to the admissions representative at the facility, there's a bed available, and you want Mom or Dad to go there. DO NOT GIVE IN AT ANY POINT AT THIS STAGE. YOU'VE DONE THE HARD WORK, IT'S TIME FOR MOM OR DAD (AND YOU) TO REAP THE BENEFITS OF YOUR INVESTIGATIONS AND ADVOCACY!

Remember, regardless of your past history, fighting for your parent at this time in his or her life when they may need you most, can become the most rewarding time of togetherness for both of you and lead to great healing, if needed, and joy. It won't be easy, but it will be worth it. Hopefully, with these tips in mind, you can focus on loving your parent to the best of your ability and not on the frustrations that come from navigating unknown waters.

Blessings, Jane Allison
http://yourelderlawadvocate.com/
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