Having to move older family members to a nursing home owing to a variety of factors like their debilitating health conditions, need for rehabilitation services, special nutritional requirements etc. is not uncommon. Regardless of the reason, the admission of a loved one to a care facility can be overwhelming. However, familiarizing oneself with the working of such establishments can ease these fears and build confidence for the next steps.
What is a nursing home?
Residential care facilities that provide a variety of health and personal care services for the elderly are called nursing homes. They are often referred to as care homes or long-term care facilities. These facilities are for those who don’t need hospitalization but need more caregiving assistance than what they get at home.
It provides custodial care that involves assistance with daily living activities such as meals, laundry, medication management, and even moving around. Also, it is different from most other senior housing facilities as it focuses more on providing better medical care.
Common reasons to find a nursing home
Here are a few common reasons why people usually start searching for one for their senior family member.
As a family member who is the primary caregiver
- Your own health has started deteriorating.
- You are the only caregiver.
- You have started to worry about your senior family member’s health and well-being all the time.
- You are unable to care for yourself, your children, or your partner as the caregiving responsibilities take up all your time.
As the senior
- You are experiencing fast declining health.
- Frequent accidents, falls, or injuries at home.
- You feel isolated.
- You need rehabilitation services.
- You wish to age among your peers.
Other reasons
- A care home will cost far less than at-home care services.
- If you are wondering “Can a doctor put someone in a nursing home?, then it is true that you need to move into one when a doctor or a care team recommends it.
Types of nursing homes
While all the long-term care facilities offer a few common services such as 24/7 monitoring, personal care assistance, and on-site medical care, some types of long-term care facilities will give extra levels of care services. Here are a few common types:
Intermediate nursing care
These facilities offer basic level care. The residents here do not require help with daily activities. They are only given health-related care, such as medication management and meal services.
Skilled nursing facilities
These facilities are designed to offer a higher level of medical assistance and care. Residents here are mostly bound to the bed or are in need of dialysis. This is why a skilled nursing facility is staffed by a nurse and a physician round-the-clock. Moreover, you can also expect a skilled nursing facility to have in-house rehabilitation services such as occupational, physical, and speech therapy.
Memory care nursing facilities
They offer specialized facilities such as 24/7 monitoring and care for those with Alzheimer’s or any other type of dementia. These facilities are designed to meet the unique needs of residents with memory impairments. They offer a wide range of services and amenities to provide the best possible care. The staff members at these facilities are trained to provide therapy and activities to dementia patients. Some facilities may also have separate units for memory care or Alzheimer’s. The atmosphere at these memory care facilities is generally designed to be more home-like for the patients.
Subacute nursing units
These units are meant to provide services that involve highly intense monitoring or therapy. These can include intense rehabilitation services and 24-hour availability of licensed registered nurses trained in administering complex IV therapy or the use of ventilators.
Services to consider
All nursing homes are built differently. Most of them look more like a hospital, with one or two nurse stations on every floor. A few facilities may add certain features to make the place feel more like home or a small community.
It is important that the care home you pick is able to take care of seniors in all aspects, including medical, nutrition, fitness, and social. It should be equipped with the essential medical equipment and facilities. While the precise services will be different, here are a few commonly provided services.
- 24/7 monitoring
- On-site medical services
- Assistance with daily activities
- Availability of shared as well as private rooms
- Basic services such as meals, housekeeping, and laundry
- Social activities such as game nights, book or cooking clubs, crafting, and movie nights
- Opportunities for outdoor as well as indoor physical activities that are senior-friendly
- Assistance to keep in touch with family and friends through video or phone calls and visits
How to go about admissions
There are certain steps to be followed for admitting someone in a nursing home.
- The first step is choosing a care home.
- The second step is learning about the various criterias required to be met for admission.
- The third step is querying for a medical assessment that is required prior to the admission.
- The fourth is gathering all the documentation and doing the paperwork.
Choosing a nursing home
Despite being well-acquainted with the different types of assisted living facilities and their services, it may still be difficult to choose the right one. So you need to have as much information as possible, which will increase your chances of selecting the right one. Here are a few tips that will help you pick a suitable facility for your loved one.
Ask for referrals
Talk to a person with first-hand experience with long-term care facilities. It is beneficial to gain knowledge from someone who is familiar with the various nursing homes in your area. You can also consult your family doctor. They might have some suggestions that could help you decide.
Research facilities
Make sure you thoroughly research the available care homes in your area. You will find several online resources such as blogs, forums, and even official websites of some facilities to check and verify information.
Take into account the medical requirements of the senior
Since there are different types of nursing homes that specialize in different areas, consider the various medical requirements of the senior. For example, if you’re looking for a care home for a senior with Alzheimer’s, memory care centers would be the best option for them.
Consider the distance of the nursing center from home
It will be easier for everyone if the care home is located closer to where the family members of the senior stay. It will be convenient for friends and family to visit regularly.
Visit the places you’ve shortlisted
Once you’ve shortlisted a few nursing homes that you like, make appointments with them for a visit. Most of them let family members look around the facilities before making a decision for admission. A visit is crucial to understand if the place would be safe and comfortable for your loved one.
Meet the staff
When you visit different care homes, ensure that you meet the staff as well. After all, they are the people who will be taking care of your loved one. A few things you can look out for include checking the frequency of staff turnover and the staffing level on weekdays, weekends, and evenings. Also, note whether they take out time to interact with you or if everything feels rushed.
Look around and observe the current residents and their families
During your visit, try to observe the residents currently staying there. Note whether they seem engaged or overmedicated. Check if they are well-groomed. Observe the interaction with the family members.
Check the hygiene and cleanliness
Don’t forget to examine how clean the facility is. Check if you see any house cleaning staff on duty. Ask them questions regarding the cleaning routines and schedules.
Ask about the meals served
Some long-term care facilities will let you have a meal with the residents in their cafeteria. This is a good opportunity to examine the meals that are normally served. If there is no such facility, ask the staff about the meal services. Check whether they provide special meal services based on the health conditions of the residents. Also, ask what kind of help is available with meals.
Enquire about the various activities they have for their residents
You will want your loved one to be engaged and able to socialize with other residents as much as their health allows. So make sure you ask whether the facility plans events and activities for their residents.
Once you have selected the nursing home that is close to the family, has adequate medical facilities, and is the right choice for you, you need to understand its criteria for admission.
Criteria for nursing home admission for seniors
There are several criteria that must be met and most of these rules have been mandated by the state. Therefore, it is essential that all medical conditions of the elderly are documented and confirmed by a medical practitioner. This will make it easier to exhibit all the proofs necessary to meet the state’s criteria.
What are a state’s requirements for nursing home admission?
The requirements will be different across states. However, the Centers for Medicare & Medicaid Services (CMS) have mandated a set of general guidelines for all states to follow. But, all the states have been given the flexibility to have their own set of assessments in addition to the CMS’s regulations.
Therefore, a senior may meet the criteria for admission in one state but may not be eligible in another. So, ensure you contact the local government agency or the local Medicaid representative to understand the state’s standards and regulations.
In addition, you will need an assessment of the medical requirements of your loved one to ensure they meet all the state’s regulations for admission to a long-term care facility. Here’s how you can get official assessments.
Medical assessment
Through a physician or primary care doctor
You can consult a physician or a primary care doctor to help you with the assessment. They will examine the medical history of the senior and ascertain the various health-related requirements to verify whether your loved one meets the state’s requirements for nursing home admission.
Through attending staff of a hospital
In case your senior parent or family member is hospitalized, the attending staff will do the medical assessment during their stay at the hospital. This can also help to ascertain whether they meet the state’s admission criteria.
Through the state
In some states, free healthcare assessments for seniors are provided. For instance, Maryland has the Adult Evaluation and Review Service (AERS) program. Through this program, an assessment is done by a social worker or qualified nurse to verify if a senior meets the nursing home admission criteria set by the state.
Once the medical assessment is done, you will have to gather all the required documentation for the further procedure. Here’s a list of documents that you will need.
Documents required for admission
Before getting admitted, it is mandatory to provide them with all the necessary documents. Here are a few common documents required by most nursing homes.
Written proof that the elderly have consented to stay in the nursing home
Since nursing homes are regulated by federal as well as state laws, they require all residents to provide written proof that they are staying at a facility of their own free will. The document needs to state that they have consented to receive treatment in the long-term care facility.
A physician’s order for admission
This is similar to a prescription given by a doctor. It states and confirms that a person needs care at a nursing home.
A physician’s order for treatment and medication
At the residential care facility, a new physician and caregivers will be responsible for the health and well-being of your loved one. So to enable a seamless transition, the care home will require written recommendation of treatments and medications from a primary care physician or a physician at a hospital.
Documentation citing medical history and physical examination
Before admission to the nursing home, a person must undergo a physical examination. In addition, the primary care doctor must make a report of the medical history. This needs to be documented and provided to the facility.
State-mandated forms
All the states have a set of mandatory forms that must be filled for nursing home admission by a physician or the hospital. These forms certify that a senior is eligible for long-term care facilities and that they meet all the criteria. You can get these forms at the care home you have chosen for your loved one.
Healthcare tests
All nursing homes provide tests for tuberculosis and shots for flu and pneumonia. But if a newly admitted resident has already taken these tests and shots, they should provide proof.
In some cases, additional documents may also be required. These include the following:
- Social Security card of the senior
- Documentation related to Medicare or Medicaid
- Insurance cards
- Nutritional requirements
- Medical orders for life-sustaining treatment (MOLST)
- Living will
- Power of attorney documents (POA)
- Do not resuscitate (DNR) documents
- End-of-life care wishes
Based on the paperwork and documentation you will need to provide, it may take a few hours or a day for the process of admission to be completed. In most cases, all the paperwork is usually done one day before or on the day of the admission at the facility itself. However, this varies from one nursing home to another as well as the state of residence of the senior.
Transitioning to an assisted living facility from one’s own house is a difficult process for a senior as well as their family member. To make things easier, it helps to include the senior in the decision-making process. Moreover, asking for their opinion and considering their wishes regarding admission to a nursing home will help them cope with the new changes.
