It has often been fairly and accurately observed that a good elder law attorney is also part social worker and part family friend. With that in mind, we offer the following “do’s and don’ts” toward assuring that, if your loved one needs nursing home care, he or she will have the best possible nursing home experience.
The Do’s and Don’ts
of assuring the best possible nursing home experience for your loved one
Do keep an open mind and positive attitude. It’s true. Our life’s experiences are as good or bad as we expect or allow them to be, and attitude is (almost) everything.
Don’t make the wrong promise. It’s unnecessary and unwise to promise a loved one that “I will never put you in a nursing home.” Hopefully that promise would be set aside if your failure to place your loved one in a nursing home would endanger her life, health or safety. Make these promises instead: “I’ll do all I reasonably can to help you stay at home,” “No matter what happens, I’ll always be there for you,” and “Whatever I do, I’ll do it out of love.”
Do visit some nursing homes early “just in case.” Even if you don’t intend to place your loved one in a nursing home, you don’t want to be stuck in a position of choosing one on a last-minute emergency basis. Visiting some nursing homes in advance isn’t any sort of concession that you’ll later choose nursing home care.
Don’t poison the experience before it happens. If you keep telling your loved one in advance that “nursing homes are terrible places and people who go there aren’t treated well,” you will make him apprehensive of the experience and predispose him toward having a poor one. Do your homework and think about the discussions with your elder loved one before you have them. Find positive and reassuring things to say, and make sure you share them.
Do plan out the transition as best possible. Talk to your loved one’s doctor, hospital discharge planner or other social worker, the nursing home admissions counselor, the Alzheimer’s Association (whether your loved one has that disease or not) and your loved one (if having a conversation is realistically possible) about what can be done to make the transition go as smoothly and positively as possible.
Don’t apply a superficial standard in choosing a nursing home. The nursing home with the glitziest front lobby isn’t always the best choice. You need to take time to educate yourself about things like resident-to-staff ratios, both in general and as to skilled nursing staff; how long the current administrator has been in place; and the facility’s record of violations, both in terms of type and frequency, and how they have responded. Buildings don’t care for residents, the nursing home staff does.
Do choose a facility that is a good match for your family member. Whether a nursing home is the best one for your loved one depends not only on general quality issues, but also on matters personal to your loved one. For instance, the fact that a nursing home has an excellent reputation for its physical therapy programs could be of great importance if your loved one is post-stroke, or of no importance if she has Alzheimer’s and does not need and would not
benefit from therapy. Similarly, the quality of social programs, food and dining options, or the availability of daily religious services, may matter a lot, a little or not at all in the case of your loved one.
Do include your elder loved one as much as possible in the decision. Just because an elder may understandably resist and oppose the idea of nursing home placement, even when it is the best or necessary choice, that’s not a reason to exclude him from the process of choosing a nursing home. Part of that resistance reflects the elder’s sense of a loss of control over his future life; perhaps like a 4-year-old choosing which healthy (but, to her, “yucky”) vegetable to eat, even being able to choose “the best of the bad choices” restores some sense of control. Of course, your loved one’s mental status may limit her decision-making capacity. If so, figure out how she might be meaningfully included in the process at some level.
Do put the “home” in nursing home. One of the very first things people do when they move into a new home is to “make it their own,” by putting up family photos and decorating it to their personal tastes. This should be no exception. Ask the nursing home staff, in advance, what you can permissibly do to personalize your loved one’s room (or half of the room) and do it with style.
Don’t be afraid to speak up. We tell our clients’ family advocates to announce the following on the day of admission and at the care conference: “Our mom deserves the best care you’re capable of giving, and we’ll do all we can to make sure she receives it. If there are any times you start to fall short of that, we aren’t going to yell and rant, but you need to know and expect that we will insist on talking to you about what went wrong and what you’re going to do to make sure that it doesn’t happen again.” Do that, and follow through consistently. Be a strong advocate for your loved one.
Do visit frequently, and vary the days and times of your visits. Studies have shown that the greater the presence of a nursing home resident’s family, the more likely she will receive consistently good care. The logic is simple: the more you show that you care, and the more often you show it, the more likely your attitude will be shared by nursing home staff. By varying the days and times of your visits, you’ll create the sense that your expectations should be met at all times – no slacking on Tuesdays and Thursdays because you never visit those days.
Do show appreciation to the nursing home staff. People who work at nursing homes have difficult (on many levels) jobs that, in most cases, don’t pay all that well. You can score a lot of “brownie points” for the benefit of your loved one by treating them well. It seems that almost every nursing home resident has someone on staff who shows special interest in him or her and becomes his or her “guardian angel.” Thank that person again and again, and let it be known how much the special interest and concern for your loved one is appreciated. Buy that staff member flowers, candy, birthday cards, you name it. And just to make sure that the rest of the staff doesn’t get jealous, keep in mind that $20 worth of $5 pizzas delivered with a note of thanks to the entire staff is worth its weight in gold for the goodwill it can generate.
Do you have other ideas for making sure your loved one has the best possible nursing home experience? If you have been through the process, are there things you’re glad you did that you’d like to share? Did you make a few mistakes along the way that you could help others avoid? If you’re a health care professional, what tips can you offer from your experience? We’d love to know – and we’d love to pass your recommendations along to our newsletter readers in an upcoming newsletter. E-mail us at firstname.lastname@example.org with your suggestions and ideas.