Most people who make the decision
to move to a nursing home do so during a time of great stress. Some have
been hospitalized after a stroke, some have fallen and broken a hip, still
others have progressive dementia, like Alzheimer's disease, and can no
longer be cared for in their own homes.
Whatever the reason, the spouse
or relative who helps a person transition into a nursing home during a
time of stress faces the immediate dilemma of how to find the right
nursing home. This task is no small one, and a huge sigh of relief can be
heard when the right home is found and the loved one is moved into the
nursing home. For many, the most difficult task is just beginning: How
to make sure you get good care in a nursing home?
Getting Good
Care!!
There will always be
problems with how care is delivered in a nursing home. No one is going to
take care of you or your loved one exactly the way you think it should be
done. The question is how to deal with these inevitable problems. Nine
times out of ten, a solution can be found if one is polite and persistent.
Solutions come from people, not paperwork. Don't assume a hostile
attitude, it just makes matters worse. A worker who is treated with
respect and kindness is more apt to treat you or your loved one the same
way.
The Transition
The best way to get
good care for your loved one in a nursing home is to make a transition
yourself. It is time for you to move from the role of caregiver to the
role of care advocate. In this role, while you may continue to do a
variety of things for your spouse or relative, your main job is to ensure
that the nursing home staff provides good care. You cannot be at the
nursing home 24 hours a day, so you want to know that the staff is caring
for your loved one as it should.
The single best
method to ensure that your loved one receives good care is to understand
the care-planning process and to become consistently involved in it. The
care plan is a blueprint that outlines such things as physical and speech
therapy, range-of-motion exercises, nutrition requirements and other
appropriate activities required for optimum functioning. This plan, which
must be reviewed every three months, or more often if there is a major
change in condition, works like this:
1. Baseline Assessment.
During the first few days after admission to the nursing home, each
resident undergoes a thorough assessment by the facility's
multi-disciplinary staff, a team that includes physicians, nurses,
dietitians, physical or occupational therapists, recreation therapists and
social workers. (The nursing home calls this assessment the MDS, which
stands for Minimum Data Set.)
Together this team gathers
information from both the resident and the family about the medical and
psycho-social (i.e. emotional/lifestyle) needs of the resident. The team
has two weeks to complete this assessment. At that time, a formal care
plan must be put in place.
Your role: As care
advocate, you should contribute the information you possess about your
loved one's medical, psychological, spiritual and social needs, as well as
information the staff should know about your loved one's preferences. For
example, "Dad likes to watch the news and then read for a while each
night. He also likes to have a snack of graham crackers and milk. This has
been his routine for years and helps him relax before going to
sleep." This helps the staff get to know your Dad and allows him to
maintain routines that are familiar and comforting.
2.The Care Plan. The care
plan is also written by the team. The purpose of the care plan is to spell
out the areas in which care is needed by the resident and to spell out the
manner in which the staff plans to address and meet these needs.
For example, your Mother has
suffered a stroke with resulting paralysis on one side of her body. She
needs to learn to accomplish the independent activities of daily living,
including hygiene needs and dressing herself, with the use of only one
side of her body. The plan might be to work with physical and occupational
therapy five times each week to recover independent functioning in these
activities.
Your role: As care
advocate, you will want to make a list of all problems and needs you know
affect your loved one. This is important because you may be aware of a
need that the staff does not uncover during its assessment. Give this list
to a nurse or social worker in the early days when the assessment is being
done, then bring your list to the care planning meeting.
3.The Care Planning Meeting. No
later than three weeks after admission, the facility is required to have
the first care planning meeting. You should receive written notice of the
date and time. The staff who attends these meetings usually includes the
Director of Nursing or the Assistant Director, often another staff nurse,
a social worker, a dietitian, a physical or occupational therapist if
appropriate, and a recreation or activities therapist. The staff will
discuss the needs of the resident and the team's specific plan to meet
those needs. It is the job of the nursing home staff to maintain or
improve functioning by your loved one, when improvement is possible, and
to slow the loss of functioning, when improvement is not possible. For
example, if your Father is able to walk independently when he goes to a
nursing home, the staff must work hard to assure his continued ability to
walk, barring some medical event that changes this ability.
Your role: As care
advocate, attend the care planning meeting and bring the list of needs you
drew up and gave to the staff during the assessment period. Also be sure
your loved one attends the meeting if he or she is able to participate.
Your role at this meeting is critical, because you are in a position to
monitor whether all problems and needs have been addressed. If something
has been missed, you or your loved one can add that information now so
that a comprehensive care plan is put in place.
4. Care Plan Updates. The
nursing home is required to evaluate each resident's care plan on a
quarterly basis, or at any time there is a significant change in the
resident's status. For example, your Mother has been in the nursing home
four months when she has a stroke that leaves her barely able to speak.
This represents a significant change in her status and requires the staff
to develop a new care plan to address her current needs. There should also
be a care planning meeting to review the new plan.
Your role: As care
advocate, you should attend all care planning meetings to be sure your
loved one's needs are being addressed. Throughout this on-going process,
you should provide input that contributes to good care for your spouse or
loved one. It is widely recognized that the residents who receive the best
care in nursing homes are those whose spouse and/or families consistently
attend care planning meetings and communicate with staff on a regular
basis.
Remember that there is an
obligation between the nursing home and your loved one. In exchange for a
monthly fee, the nursing home has agreed to provide individualized care to
maintain the highest level of well-being for your spouse or loved one. In
your new role of care advocate, use the care planning forum to bring your
questions to the table, to identify your loved one's needs, and to
formulate solutions to any problems that may arise.
-Return
to How to Find the Right Nursing Home Page-
© 2000-2005
Marshall & Associates www.paelderlaw.com
