Finding the best possible nursing home care, Projo

Finding the best possible care for loved ones in nursing homes
Rita ‍Watson
When their mother became a nursing home escapee, her helicopter daughters realized that they could not stop the memory thief nor prevent behavior expected from teenagers. But, what they could do was to find a nursing home where their mother was happier. In addition to manuals, such as the comprehensive 72-page “Your Guide To Choosing A Nursing Home — Medicare.gov,” getting a sense and feel of a home by visiting more than once will make the difference between sleepless nights and peace of mind.
Questions to admission directors are important, but observation is often a better predictor of how well a person will adjust to the new environment. Answers from staff may dramatically clash with the reality of ratings, atmosphere, activities, patient rights and physician availability.
Oftentimes a nursing home placement is made hastily because of a hospital’s “time’s up” policy.

Patricia L. McGinnis, executive director of California Advocates for Nursing Home Reform, said: “Contradictory to their role — appropriate placement — discharge planners are often pressured to get patients out of the hospital because of billing issues.”

As such, families often find themselves in search of a different nursing home.
Here are some helpful resources keyed to quality of care, nursing staff, health inspections and safety issues.
1)  Medicare.gov – Nursing Home Overview  found at medicare.  gov/nursing/overview.asp.
2)  Nursing Home Compare – Medicare.gov directs one to state sites and phone numbers,
3)  America’s Best Nursing Homes – News – US News and World Report, is a star-rated overview, and
4)  Nursing Home Inspect, makes nursing home inspection reports available at www.projects.propublica.org
    Atmosphere is important
With nursing homes, beautiful furniture and new curtains do not necessarily translate into good care. You may see a facility that has a 4 or 5 star rating, but the atmosphere or patient population may not be well suited for a potential resident.
Always look at dining rooms at lunchtime to see how many residents are there instead of eating alone in their rooms.
Ask to look at activity charts to determine how those requiring various levels of care may participate and benefit. While Wii Bowling sounds good on paper, residents with dementia will not be able to remember the steps involved for knocking down the pins.  On the other hand, BINGO plays an important role in routine and socialization.
Music in nursing homes should be more than just recreation; it should be therapy, even for residents who are cognitively challenged. “Music-making is a protective factor against dementia,” was a presentation at the 2012 Annual Scientific Meeting of the Gerontological Society of America. Also, “Alive Inside,” a documentary screened at the GSA, explores how patients are transformed by listening to iPods. In a nursing home there can never be too much music.
    Patient rights and physicians
From small issues to more substantive ones, patient rights versus the best interest of a patient is tricky. Be certain to ask about patient choice issues ranging from dining room seating charts and room changes to showers and changes to incontinence pull-ups. Make certain you are permitted to be involved with helping a person with dementia make appropriate choices.
Ask how a facility handles conflict. A well-trained staff can often coax even the most belligerent resident into complying with a health issue. Hydration and frequent diaper changes are key to preventing a common and potentially serious disorder — urinary tract infections. In the elderly, a UTI can create agitation and delirium that leads to hospitalization. This just one reason why having a full-time physician or nurse practitioners on staff makes good sense.
Despite your best efforts, if nursing home issues concern you, contact the ombudsman.

However, keep in mind what Donna McCormick, managing attorney for the Elder, Health & Disability Unit at Greater Boston Legal Services, explained: “In theory all nursing homes should have ombudsmen, but the challenge takes place when they become so intertwined with management that they don’t always advocate effectively for residents.”

The other alternative is to find a different home. Physicians and researchers tell us that the elderly can be more adaptable than we realize.
What is every family’s goal?

Dr. James M. Ellison, a professor of psychiatry at Harvard Medical School, says, “Families need to know that their loved ones are being cared for by a kind staff in an atmosphere that stimulates them emotionally, socially and cognitively. It’s important to remember that even with a diagnosis of dementia people can find joy in the appropriate surroundings.”

‍Rita ‍Watson, MPH, a regular Thrive contributor, is a 2013 MetLife Foundation Journalist in Aging Fellow, a program collaboration of New America Media and the Gerontological Society of America.
Copyright 2013 Rita Watson/ All Rights Reserved