Nursing Home Care

The term “nursing home” has become generic over the years, and it is used to define all facilities from a rest home to an acute care hospital.  The truth is that this muddled meaning can be confusing to those caregivers trying to decide on a facility for their loved one.  

Nursing homes can be broken down into three categories.  They are intermediate care facilities, skilled nursing facilities, and skilled nursing facilities for special disabilities.  An intermediate care facility(ICF) must provide at least eight hours of nursing supervision per day.  It generally caters to patients who are mobile and need less care.  At the least, an ICF provides medical, pharmacy and dietary services.

The skilled nursing facility (SNF) must provide 24-hour nursing supervision.  This is most likely what people mean when they say “nursing home.”  Normally those who are incapacitated, and need long- or short-term care, stay in one of these facilities.  In addition to the services that would be provided by an ICF, the SNF will also assist in daily living activities such as eating, bathing, dressing, and walking.

All nursing home facilities are required to be licensed by their state.  If you come across one that isn’t, avoid it.  A state inspector visits each home at least once a year to make sure that it is complying with state standards for care and services.  This passing grade is a requirement in order for these places to be reimbursed by Medicare and Medicaid.

Many nursing homes are run as businesses for a profit by individuals or corporations, and may even be a part of a chain of nursing homes.  Others are run as non-profit companies and are sponsored by religious or charitable groups or by government agencies. 

One requirement for all patients in a nursing home is that they be under the care of a physician.  The reason is that only a doctor can evaluate and prescribe a program of medical care for a patient’s well being.  That is beyond the scope of a nurse’s responsibility.  In fact, a nursing home cannot authorize any restraints, medication, medical treatment , change in diet or therapy without a physician’s okay.  A complete physical exam before entering a nursing home may help in evaluating what treatments are needed, the duration of a loved one’s stay, and the potential for rehabilitation.

When choosing a nursing home for your loved one, you should compile a list of several that would be appropriate.  It is essential that you visit each one in person.

Things to look for are:

Location

• Close to a hospital for emergencies
• Convenient for you, friends, relatives, and your loved one’s doctor

Visiting Hours

• Are the hours convenient?
• Can you visit at any time?

Size of Facility

• Small home=more personal
• Large home=more activities
• Consider the quality of activities and service

Room Selection

• Is attention paid to room and/or roommate selection?
• If loved one dislikes roommate, can he or she change?
• Can we bring some of our own furniture?

Holding a Bed

• If transferred to hospital, is a bed reserved?

Valuables

• How are these protected?

Volunteers

• Are community volunteers used—the more volunteers a home has, the greater the amount of patient services provided

Morale

• How do the patients seem?
• Is there respect and privacy?
• Is there access to TV and radio?

Food

• Does it taste good?
• Ask other patients about it
• Dining room—is it clean, attractive, nice atmosphere?
• Is the food the right temperature
• Can special diet needs be met?
• Is food available at any other time than at regular meal times?       

Grievance procedure

• Is there a procedure in place?
• If there is one, ask other patients if it works.
• Is there a patient’s council?
• Are patient’s involved in the decision-making process? 

Financing

• Check what services Medicaid or Medicare covers.
• Are there extra costs above the room rate?

The transition to one of these homes may be difficult at first so be there on moving day, and furnish the new room with items that are familiar.  Family photos are ideal to make it seem you’re your family is “there” even when you’re not.  Always remember to visit often after the move.  The bottom line is, do whatever is best for your loved one.