Reality has hit home and the alternatives are complicated. Options are limited and uncertain. Time may be of the essence. Motivation for such a move may be the inability or the unwillingness to provide the necessary care. Both justifications come with guilt.
Placing someone you love in a nursing home, into the custody and care of an unknown—to be cared for 24/7 by persons never seen—demands trust and understanding.
How will you approach the decision? With confidence or confusion? With anxiety or relief? With generosity or selfishness? Haste or with deliberation? As a challenge or an annoyance?
Emotions drain you. You’re surrendering total care and control of a loved one to the unknown, untried, and unproven. You want to—you have to—make the right decision for the loved one and yourself.
Nursing homes know you’re in a vulnerable position. They emphasize the positives and ignore the negatives. They want you to make hasty decisions based on first impressions, and imprecise, flexible language.
It’s quite possibly the last destination before the funeral home for a loved one, and their techniques are very similar. Nursing homes are intent on making a positive first impression. They are selling the unknown to the uninformed.
Many questions go through your mind when making the decision. How will my loved one be treated? What type of care will they receive? What is the quality of the medical staff? What is the availability of trained personnel to meet particular needs? Is emergency care available (defibrillators) on site or do they use outside first responders (911)? How safe will my loved one be?
Your choice of a nursing home is a quality of life and death decision for a loved one.
Appearing too firm can lead to an awkward relationship with the nursing home. A relationship filled with the fear of reprisals, payback, and guilt. Fear of the unknown settles over you.
What happens in nursing homes, far too often, stays in nursing homes.
Nursing homes have the upper hand, and they know it. Complaints are trivialized, ignored, forgotten, or buried under bureaucratic mountains of paperwork and delays. Residents are viewed as bewildered, confused, or having hallucinations….Conditions brought on by dementia or medications.
The Virginia Department of Health, the investigating body, tells you it takes twelve to fifteen months to investigate a complaint, depending on the severity. Some residents in nursing homes would be fortunate to have twelve to fifteen months remaining.
The demand for quality nursing homes far outweighs the supply and continues to grow while quality management and accountability go unchanged or worsens.
Nursing homes do everything to control the resident. It is, after all, their responsibility to provide care, comfort, and safety to those under their protection. They have little flexibility in accommodating individual preferences regarding the personal activities of those under their purview. Personal dignity and respect yield to satisfying the needs of the majority and what is necessary for the nursing home to meet its financial and administrative goals.
Know their business! Do your research. Ask detailed questions, and know the answers beforehand. Nursing homes have strict federal guidelines that must be followed. The Centers for Medicare/Medicaid Services (CMS) manual is online:
Know it! Take your time, be thorough, and take notes! Search using keywords identifying areas of concern geared to your individual needs.
Nursing homes don’t follow the guidelines. Nursing homes take shortcuts, speak in generalities, and make vague, yet plausible excuses for deficiencies.
Health inspections: Federal law requires that the most recent annual health department survey be available for public examination. Request the health department surveys for the previous two years. That’s the only way to determine if the nursing home has a history of deficiencies. If they shy away, ask why! Question their refusal.
Don’t go by the sanitized survey results found online. The surveys online don’t specify deficiencies and omit much of the critical details. You’re making decisions for your loved one, and you have the right to make an informed choice.
Resident Assessment: CMS Manual §483.20(k) Comprehensive Care Plan. The Minimum Data Set (MDS) is a comprehensive resident assessment required by federal law under strict guidelines. This evaluation is lengthy (30 to 40 pages in some cases) and must be reviewed with the interdisciplinary team from the nursing home. The nursing home may have its self-interests, may not be informed, or final instructions may be unclear. Do your homework and be prepared. Once again, it’s important to take notes. Don’t yield to pressure from the nursing home and don’t gloss over the importance of this meeting. The responsible party must be given the opportunity to review this assessment in detail prior to the meeting to prepare questions and to correct errors. A simple entry error of “DNR” (do not resuscitate) in place of “FULL” will have consequences.
The MDS reviews all aspects of the resident’s care and treatment including mental acuity or a cognition evaluation. This document may have legal importance if future decisions are challenged by family members regarding end of life wishes, advance care planning or advanced directives. Caution is advised; preparation and participation are mandatory for an interdisciplinary care plan meeting. Allow enough time and remember this is the final care plan for the one you love.
Security of personal items: Nursing homes advise residents to keep a limited amount of cash (no more than $10.00) in their rooms. But they make no guarantees and do very little to stem the threat of theft. I have been robbed four times by employees to a total of $141.00. According to their guiding principle, I should have been robbed a fraction over 14 times.
Photograph valuable items where they are placed in the room: i.e., electronics, memorabilia, and other irreplaceable personal items. Download pictures to a remote computer. Lock up everything else.
Medications: Med mistakes are a persistent problem in nursing homes. Be sure to ask about the med error percentage. The federal guideline is less than 5%. Know the answer before asking the question (15%). Ask why it’s so high and what’s being done to lower this number.
It’s preferred that the resident be able to count! The residents should, from time to time, count the medications dispensed to them. If there is a discrepancy, call the nurse supervisor and report it. Follow up to make sure it’s noted on the resident’s medical chart. The responsible party or the resident have the right and obligation to report med errors to the attending physician and the Office of Licensure and Certification at the Department of Health.
Get a list of all medication to be administered, know what each is for and the side effects.
Personnel: An inspection of employee licenses, background checks, and police records are part of the annual survey done by the health department. Don’t take the word of the nursing home. Nursing homes don’t follow the minimum standards regarding hiring practices. Licenses for healthcare workers in Virginia are online at:
A search can be done with just the first and last name. It shows violations listed with the licensing agency, but only if offenses are reported.
There are many lists available online to use as a guide for choosing a nursing home. Use them; they are helpful.
However, not to be overlooked is the reality that this is an end of life decision. Checklists are sterile and impersonal. Don’t ignore the personal aspects that shape the end of life experience for a loved one.
The decisions you make have a profound effect on the memories that your loved one takes on the final journey. Do your part. It’s through your involvement, knowledge, and understanding that you will find the peace and comfort you want.
Listen to your loved one—believe in your loved one—and be a strong advocate. Do your research, take your time, and make it a comfortable, peaceful passage for the one you love.