One of the hardest things a caregiver will ever
have to do is to know when it’s time for their loved one to go into
a long-term care facility. Often, caregivers will go long past the
point of when they should have incorporated help from the outside.
Sometimes, it’s their own fear of failing as a caregiver and the
fear of letting someone down that stands between themselves, their
loved ones, and an improved quality of life for both. Identifying
some of the following may help make the decision process a little
easier, and define certain things a little more clearly for you. A
long-term care facility may be needed if: your relative’s condition
keeps getting worse and is becoming too much for you to handle on
your own; no matter how hard you try to give care to your loved one,
it’s just not enough; you feel as if you are the only one around who
is having to care for someone who is ill or elderly; you’re not
receiving any type of respite, and it doesn’t look like anything can
be arranged for you to get much-needed time away or rest;
relationships with other family members are breaking down because of
the time you must dedicate to caring for one person; your caregiving
responsibilities are beginning to greatly interfere with your work
and personal life; you have feelings of guilt when it comes to
taking care of yourself; your coping skills are beginning to include
self-destructive behavior, such as eating too much or too little,
increased drug use or alcohol use, or losing emotional control too
often; you rarely experience any moments of happiness, but have too
many real moments of exhaustion, anger, and resentment; you hold
your feelings in, never allowing them to be shared with a friend or
with a professional. As a caregiver, you may very well have
experienced many, if not all of these things from time-to-time, or
you may now be starting to experience these things constantly. In
order to conquer your fears of placing a loved one into a long-term
care facility, you need to understand more about some of the
facilities nearest to you.
For example, in Miami-Dade County, there exists
an innovative concept to the traditional nursing home or a long-term
care facility. The Hebrew Homes Health Network provides seven
different state-of-the-art residences located throughout different
neighborhoods in Miami. People are given the individualized care
that they need by a professionally trained staff which concentrates
on the specific medical, social, and dietary needs of the residents.
Also, the cleanliness of a facility is one of the more crucial areas
of importance and concern to the caregiver and to the health and
well-being of a resident, and this is why all seven facilities of
the Hebrew Homes Health Network take cleanliness very seriously.
What makes these residences so innovative is that they strongly
encourage continued involvement of family members and friends of
those residing in one of the homes. Compassionate, caring staff
members work closely with family members, and are always available
to meet with them, even when it’s not “regular” business hours.
There are also “Family Night” activities held monthly, as well as
holiday celebrations that include all family and friends of the
residents. William Zubkoff, PhD., M.P.H. and president of Hebrew
Homes Health Network states, “We are dedicated to our mission to
provide the highest quality and most compassionate long-term and
rehabilitative care and service, meeting the needs of our residents,
our families and our employees with compassion, dignity and love. We
will continuously strive, as a team, to improve our network by
developing the most effective systems to provide cutting-edge elder
As a caregiver, you may wonder how to go about
finding what’s available to your loved one in and around the area in
which they live, and how to decide upon what type of facility will
be best for them. A few people you may want to ask are: your family
physician; hospital discharge planners; social workers; home
healthcare nurses; friends and/or neighbors who have been through
similar experiences; your religious leader; geriatric screening
programs through a local hospital or community center; and finally,
government agencies such as the federal Area Agencies on Aging, or
local social services or family services groups. If there is a
professional familiar with your loved one’s condition, ask them
about what kind of facility would be best in matching and meeting
particular needs. These people may be able to help you base a
decision upon specific medical considerations and information, such
as conditions like Alzheimer’s or Parkinson’s, mental health and
awareness of the person, and their physical and mobility factors.
When deciding on a few places to check out, first call them and ask
if there is a waiting list for the facility, what the cost might be,
and what types of insurance or supplements, if any, are accepted.
The answers you receive from these phone calls should help you
narrow down your list of possible places. When you’ve selected a few
places, make sure you ask even more questions to help you better
assess the quality of each facility. Also, listen to your “gut”
feelings when you begin each tour, and it may be helpful to bring
along a friend or other family member in order to get some other
forms of input regarding each facility. Some general questions to
ask each place can include:
Location - is the facility
conveniently located to where you live? Will it be easy for you to
get to in order to visit? Is public transportation available nearby?
Appearance/Atmosphere - are the
kitchen, day rooms and bedrooms clean? Is there good natural and
artificial lighting? How is the temperature? Are there
any unpleasant odors? Does the facility meet your standards of
cleanliness? Is the facility wheelchair and walker friendly?
Are there handrails to help with walking?
Menus - is the menu varied and
nutritious? Will the facility accommodate special dietary needs? Is
food available throughout the day? Are people allowed to snack? Are
mealtimes flexible and varied? How is the food? Visit facilities at
mealtime. Does the food look appetizing? Do residents appear to be
enjoying their meals? Is there adequate assistance and supervision
for those residents who need it? Ask if you can sample the food.
What do you think of it?
Bathrooms - are they private?
Are they clean? Are they easy to find? Are they close to where your
loved one will be? Do they have grab bars and other safety devices
Alzheimer’s-friendly – if your
loved one has Alzheimer’s, is the staff specially trained to care
for someone with this condition or other forms of dementia? Is there
a separate unit for Alzheimer’s residents? Are Alzheimer residents
able to wander safely indoors and outside?
Resident-to-staff ratio - What
is the resident-to-staff ratio? How many residents have Alzheimer’s
disease? Does the staff provide enough care throughout the disease
process, no matter what the disease and/or condition?
Interaction - do all staff
interact with residents on a regular basis, and in a friendly and
Activities – are there
meaningful activities for groups and individuals? Are there
therapeutic activities, like music, pet, or plant therapy? Are there
opportunities for your loved one to socialize? Are the routines
flexible and offer variety?
Visiting – when are you allowed
to visit? Can you have privacy with the resident when visiting? Can
you take the resident on outings, such as to a park, a restaurant,
or to a family function?
Behavior Management - how are
different types of behaviors handled? Are restraints used? (Physical
restraints like straps, chemical restraints like sedatives, or
restraints to the environment, like a locked door.) Don’t be afraid
to ask what portion of the residents has to be “medicated” or have
to have physical restraints; also, try noticing these things
Safety - are there smoke
detectors? Are there slip-proof mats in the baths, grab rails, bed
Medical Care - can you continue
to use members of your loved one’s healthcare team? Is there a
doctor always available or on call in case of emergencies? How often
does a doctor visit? Can you meet the doctor?
Philosophy of Care - does the
facility focus on the needs of the individual resident? Can
flexibility in routines be accommodated? Are there regular care
planning meetings regarding your loved one? Will these meetings
include you and other family members as well?
Individualized Care - is
consideration given to individual cultural, religious or spiritual
needs? Are other languages spoken? Is the facility “home-like”?
Atmosphere - what is the
atmosphere like? Are residents up and about? Are they socializing
with one another? Is the staff actively engaged with residents?
Does staff treat residents with respect?
Outdoor Areas - is there a nice
spacious outdoor area for residents? Is there a covered
outdoor area in case of rain?
Another great way to obtain information is to
speak directly to the residents. Ask them how they like living
there, and let them know that you are considering the facility for a
family member. Larger facilities may offer an opportunity for you to
speak with residents in a more private setting, enabling you to get
more candid answers and information. You may find residents at
smaller facilities to be a little less comfortable speaking about
their experiences, since they have less privacy; if this is the
case, don’t push the issue. After you’ve had the “official” tour,
you may want to walk around the facility by yourself, unaccompanied.
Just remember not to enter any of the residents’ rooms or areas
without receiving permission first. When making your final decision,
take into consideration not only the services your loved one will
need right now, but what they may need in the way of care further
down the line. Make sure the facility you decide upon has services
that you may also need in the future. Before making your decision,
carefully review the entire admissions packet, especially the
section that covers fees and services with a complete schedule. Will
Medicare be accepted? Will Medicare be willing to cover the chosen
facility? Will Medicaid be accepted if personal funds run out? Even
after doing all your homework and visiting several facilities, you
may not find exactly what you’re looking for; however, keep your
options open and flexible. You can help promote quality-of-care for
your loved one by staying actively connected to them as much as
possible, no matter what type of facility is decided upon.
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