Take Charge of Your Health - Important Considerations When Looking to Find the Best Long Term Care
Approximately 70% of seniors will require some form of long term care…
When someone has a progressive medical condition or is at the age they can no longer care for themselves at home, two of the options to consider are assisted living and skilled nursing. Many people are hesitant to transition themselves or their loved ones to residential care outside their home feeling that they are abandoning the person or their caregiving responsibilities. However, in many cases the senior experiences a higher quality of life with less isolation and greater community involvement while minimizing responsibilities for ongoing home maintenance.
The time may be right for assisted living if you or a loved one need: supervision, help with personal care and ADLs (Activities of Daily Living), assistance with medication, support to help them feel less stressed, anxious or depressed, or help doing household chores. According to the Department of Health and Human Services, nearly 70% of adults turning age 65 now will develop the need for long-term care services and support and about 35% will receive in-facility care.
Generally speaking, assisted living is best suited to those who need help with daily living activities such as bathing/showering, dressing, eating, and medications whereas skilled nursing centers are designed for those who require more comprehensive services and medical care (such as IVs, ventilators, or respiratory therapy), the use of medical equipment, and treatment from a registered nurse. Whether it be assisted living or skilled nursing, the goal is to provide residents with safety, quality support services, compassionate care, and the appropriate level of independence.
OVERVIEW OF ASSISTED LIVING:
Assisted living provides a healthy social environment in a residential setting. Residents commonly live in an apartment that has a bedroom, bathroom, living/dining area and sometimes a small kitchen where they can prepare their own meals or snacks. Unlike skilled nursing, assisted living residents often create a home-like setting in their room by decorating the walls and bringing in their own furniture. In terms of socialization, assisted living facilities offer large, comfortable dining rooms and common areas, and there are often many activities on site for residents to choose from including exercise programs, enrichment classes, and book clubs. Transportation is also provided so residents who can no longer drive can enjoy activities in their community.
In assisted living, care is available 24/7 and most assisted living centers have full time registered nurses on staff to help coordinate the resident’s personal care plan with the resident, their family, and their health care providers as well as provide ongoing reassessments. Assisted living facilities also partner with local health care organizations who visit the facility to provide residents with specialized services such as physical, occupational or speech therapy or hospice care.
OVERVIEW OF SKILLED NURSING:
Sometimes people have short term stays in a skilled nursing facility following hospitalization, surgery, an injury, a heart attack or stroke. In this case the patient focuses on rehabilitation services so they can return to independent or assisted living.
In terms of long term care, residents in a skilled nursing center require help with their daily living activities as well as typically needing access to around the clock medical care provided by licensed health care providers and supervised by a physician. In the US, a 100-person skilled nursing facility will have approximately 7 RNs, 13 LPNs, and 40 nursing assistants on staff.
Medical conditions that require skilled nursing include: lack of mobility, feeding tubes, IV medication, regular injections, wound care, respiratory therapy, radiology services, and end of life care. In addition to medical services, residents are offered an assortment of social activities to help improve their comfort and quality of life.
Both assisted living and skilled nursing facilities may offer specialized memory care for those with cognitive difficulties.
BE PREPARED WHEN VISITING
Before visiting care facilities, it is helpful to develop a list of questions and be able to clearly describe what is most important to you or your loved one in terms of the care and the services needed.
When visiting assisted living or skilled nursing facilities, some things to consider are:
The location. Can family members easily travel to the facility making it convenient to visit regularly?
Your first impression of the facility when you walk in the front door and how the staff greets you.
Be sure to chat with residents and/or their family members to get their feedback on the care offered, their level of overall satisfaction, the quality of the food, their relationships with the nursing staff, their favorite activities, and what they feel the facility should improve upon. It is also helpful to ask the staff about their levels of satisfaction working at the facility and how they would describe the culture. What are the facility's core care values and philosophies?
What makes the facility different and better than others in the region?
Does the staff seem happy and tightly-knit?
What is the level of staff turnover?
What will the daily schedule of the resident look like?
Be sure to get a comprehensive tour and ask to see: residents’ rooms, dining areas, the kitchen, common areas, therapy rooms, activity rooms, library, outdoor patios/pool, and the fitness room. Take note of any strong odors and the cleanliness of these spaces.
Inquire about the number of beds in the facility, the number of staff (RNs, assistants, physicians…), the staff to resident ratio, and consistency/schedule of the team that cares for the resident.
Inquire about the use of mood altering medications.
Inquire about the care services, amenities, and programs offered in assisted living and those offered in skilled nursing.
Emergency call system
Schedules and assistance with bathing, dressing, meals
Monitoring of vital signs
The administration of medications by an RN or LPN
How often staff members check on residents
Dining/meal services and menus in the resident’s room and in the dining room
Coordination of medical appointments
Transportation (ease, responsiveness, reliability…)
Services and safety for those with dementia
Social and educational activities to reduce isolation, depression, and anxiety
Exercise activities to help with strength, balance, and flexibility
Safety features and security in the residents’ rooms and in the facility
TV and Internet services
Outdoor activities including how often residents can spend time outside
Family visitation
Housekeeping services
Laundry services
Pet visitation
Infection control programs (Covid, Flu, MRSA…)
Emergency preparedness
Adherence to advance directives
Accreditation (Ex: CARF - Commission on Accreditation of Rehabilitation Facilities
Any cases of elder abuse
The financial model of the facility and fees for all care and services, including Medicare, Medicaid and long term insurance coverage
Also, be sure to investigate nursing home ratings, including deficiencies, by using the Nursing Home Compare tool on Medicare.gov.
Decisions about long term care are best made through discussions that include the resident, their family and/or loved ones, and their primary care physician (with input from medical specialists who are providing treatment, as appropriate). Ultimately the services needed and the “comfortable, at home atmosphere” the resident feels when visiting facilities will determine which community is best for them. Be sure to ask as many questions as you can and visit the facility as many times as you wish to feel at peace with the long term care decision.