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 What do you say when your elderly patient's daughter asks, "What shall I do about Mother? She's not taking her medicines right, and her apartment is a mess?"
There are several important factors in counseling families dealing with elder care issues, particularly regarding the type of long-term care their loved one may need, such as custodial care, skilled care or assisted living.
Nurses can advise families unsure of the proper level of care to best meet their loved ones' needs.
Types of Care
Custodial care is supportive nursing service to patients with long-term health problems that prevent them from living independently. No significant improvement in their conditions is expected. Unlike skilled care, custodial care is not covered by Medicare or Medigap insurances.1
Skilled care refers to short-term care in a rehabilitation center or nursing home. The focus is rehabilitation. If consistent improvement in the patient's condition is documented, Medicare can pay for up to 100 days of service if there has been a 3-day hospitalization.2
Assisted living candidates are unable to perform most instrumental activities of daily living (IADLs), which include telephoning, independent travel, shopping, meal preparation, housework, medication administration and money management. They usually need assistance with activities of daily living (ADLs), such as bathing, toileting, feeding and mobility.3
The living arrangement can be a semiprivate room, a single room, a studio apartment, or a one- to two-bedroom apartment. Three daily meals are provided. Some clients hire private aides for more individualized assistance.4
Dementia-care programs can operate in standalone buildings or be housed in separate sections of assisted living centers. These programs may include a locked unit, reality orientation classes, and staff trained in handling dementia-related behaviors.5
Nursing home care is for individuals incapable of managing IADLs and largely dependent on others for assistance with ADLs. Often, much of these patients' time is spent in either a bed or wheelchair. Rooms may be semiprivate or private.6
Considerations
Families have a lot to do when evaluating long-term care facilities for their loved one. First, they should check with their state's Department of Health to ascertain a home is properly licensed and accredited and has passed state inspections.
When visiting a facility, they should note if staff follow the patient's Bill of Rights, which should be posted in the lobby. A professional should be in charge of assessing the patient's mental and physical status. Nursing homes use the Minimum Data Set Assessment tool (MDA).5 Advise families to talk with an administrator or supervisor, not just marketing personnel.
They should make two or more evaluation visits, one unannounced and another at mealtime. At these visits they can obtain feedback from patients and visitors.1,2,6
Medical & Nursing Care
Of paramount importance is how a facility manages patients' medical and nursing needs.
Factors to consider are the ability of patients to keep their primary physicians, whether a physician, RN or LPN is on-site or on call; who distributes medications; and the ratio of staff to patients.
In addition, families should examine any rehabilitative and therapeutic services that may be provided. Are individualized plans of care developed and regular case conferences involving family held? What information is charted on a regular basis? What hospital is used for emergencies? Can private personal aides be hired to supplement staff?
Personal Touch
When evaluating the atmosphere, families should observe the cleanliness of the facility and note the presence of unpleasant odors. Are bathrooms individual or shared? Can residents bring their own furniture? Do the residents socialize with one another and appear to be appropriate housemates for the client? Does the staff act professionally?
A facility's policy and regulations on personal care is important to consider. Questions to ask include: Are aides certified? How often are patients showered or bathed? What is the toileting policy? How often are bedbound patients turned and transferred to wheelchairs? Do residents wear their own street clothes during the day?
Proper nutrition is essential for elders, and potential clients should check if dietitians are on staff and if special diet accommodations and snacks are available. Where patients eat also is key: can they eat in their rooms or must they eat in the dining room at set times?
Families should compare costs, services and waiting periods at different facilities, and obtain written documentation of expenses, transfer options, refund and contract termination policies and any extra fees for services like laundry, medication administration and meal reminders.
Other issues to consider:
Safety - Are handrails in the hallways and call lights by beds and in the bathrooms? Is the floor clean, free of litter and made of non-skid materials? Are doorways wheelchair-accessible? Are heating and cooling systems adequate?
Visitors - Are there restrictions? Are pets/children welcome? Can overnight visits outside the facility be easily arranged?
Activities - Are organized activities planned and daily schedules clearly posted? Is there a recreation room with a recreational therapist? Are there regular services for various religions?1,2,6
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