QUESTION: My parents are both 76 and live in a rural community. My mom always felt "the cards of life" were stacked in their favor until recently. My dad had an auto accident, and his hospital examination revealed he had a massive stroke. He's now paralyzed on his right side, he's lost the use of both legs, his speech is slurred and he can't feed himself. The hospital recommended that Dad go to a nursing home. My mom feels depressed and guilty about being unable to take care of him. How can I help?
ANSWER: Moving into a nursing home often feels like failure or betrayal to both the family and the patient. This step is almost universally feared by young and old.At present, nursing homes in the United States fall into two general categories: skilled-nursing facilities (SNFs) and intermediate-care facilities (ICFs). The patient's need for medical care determines which type of facility is most appropriate. Sometimes both types are housed in the same building, either in separate wings or on different floors.
SNFs employ licensed nurses on shifts around the clock for people who need a high level of personal and medical care, such as those convalescing after a hospital stay and those with long-term illnesses. SNFs provide care similar to the care in a hospital, where the professional staff carries out physicians' orders. Although these facilities are identified by their medical and nursing care, they offer other specialized treatment as well, such as speech, physical and occupational therapies. If they receive Medicaid and Medicare reimbursements, they are required to maintain a social-service staff and daily social activities for patients.
ICFs accept residents who are not fully capable of living alone or caring for themselves, yet who do not require 24-hour nursing care. These homes provide medical and nursing care, social rehabilitation and room and board. Residents are usually able to feed and dress themselves.
Before your father moves to a nursing home, obtain the advice of a physician or hospital social worker to decide what level of care is most appropriate and affordable.
Even the best institutions, no matter how homelike, warm and caring, run on schedules and provide care differently from home. To set realistic expectations, visit at least three nursing homes before you make up your mind.
In selecting a nursing home, include your father as much as possible. The adjustment will be safer and less emotionally painful if he can visit facilities, have a tour and contribute - even minimally - to choosing the new residence.
Your hospital's social-service department deals with nursing homes regularly and can refer you to homes with openings. Friends, neighbors and clergy may be able to recommend facilities. Your state licensing office should be able to provide you with a list of local facilities.
Your selection will depend primarily on whether your father will have a short stay while recuperating, or whether the home may become a permanent residence. If the stay will be short, you may be more concerned with the home's rehabilitation program than its homey environment. With a long stay anticipated, the nursing home becomes the resident's world, and while the shifts of workers change three times daily, the environment should provide consistency, activity and as much social stimulation as the patient can enjoy.
With your list of possible facilities in hand, begin by screening over the telephone. Find out what level of care the home provides. Is it certified for reimbursement by Medicare or Medicaid? Most people enter nursing homes paying their bills privately and may later need government assistance. Participation in Medicare and Medicaid may have long-range impact on your parents' family finances.
Is the facility within easy traveling distance? Location is important, because visits from friends and relatives become a main link to the outside world for the patient.
Is the home accepting new residents? If not, how long must you wait for an opening?
When you find at least three suitable nursing homes, make appointments to visit. Allow yourself one to two hours for the visit. The nursing-home administration should be able to answer questions about operations, philosophy, financial arrangements and procedures. Meet with the head nurse, social worker, activities director and the president of the residents' council.
If you can arrange to see a meal served, do so. Do the meals look appetizing? Are special diets available? How are residents accommodated who need assistance with eating?
When evaluating a nursing home, let your eyes, ears and impressions be your guide.