Housing & Hospice
It may become necessary to make adjustments to the home to keep your loved one safe. Or, it may become necessary to arrange other housing accomodations. If a move becomes necessary, it is important to establish which type of environment the senior is interested in. Whether the senior makes the choice to move or they must move because they can no longer maintain their home, locating and reveiwing housing options can be a time consuming and frustrating task. The purpose of this section is to provide information about home safety, housing options and tips for selecting the best housing option for the senior..
Staying in Your Home
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Staying in Your Home
Seniors who become home health care recepients are mainly those who prefer to stay in their own homes. Often caregivers will try to honor this request until the stress and strain becomes too great. There are many services that help seniors remain in their home.
Services to help seniors remain in their home1
- Home Health Care: skilled care that may include nursing, speech, occupational, physical or respiratory therapy, home health aides, social workers and psychiatric care.
- Adult Day Care: daily, facility based programs in a community setting for seniors who need monitoring or companionship during the day.
- Activity Groups: games, trips, shopping outtings and other group activities. Many local Senior Centers offer group activities.
- Respite Care: a trained volunteer or para-professional stays with your loved one and takes over the caregiving role, whether for several hours or several days. Provides help when vacationing or for out of town travel..
- Live-in Help: for seniors who need around-the-clock support. Often room, board, and in many cases, a salary is provided in exchange for meal preparation, light housekeeping, and other non-medical services.
- Hospice Care: medical, social and emotional services for the terminally ill and their families.
Housing Options <green>
There are many different housing options for the elderly once they decide to leave their home. All of these options may make it difficult to decide which option in best for your loved one. This section provides information about the different housing options.
Independent Living Senior Living Communities2
Provides healthy, self-sufficient seniors a housing option that allows for freedom and privacy combined with the benefits of a senior living establishment inlcuding security, comforat and social activities.
- Independent living is for those who wish to reside in a compact, easy-to-maintain private apartment or house within a community of seniors.
- These communities are usually designated for people of a certain age. Each senior community has its own regulations, typically residents must at least be over the age of 50.
- All activites associate with daily living and health care are the residence's responsibility but social activities are a part of the community benefits.
- Ideal for seniors who:
- Are healthy and able to care for themselves.
- Want to live independently.
- Desire security that may be found in such a community.
- No longer want to maintain a home.
- Prefer to live among their peers.
- Amenities often associated with independent living communities
include:
- Recreational, educational and social activies.
- Group meals.
- Housekeeping.
- Transportation services.
- Exercise facilities; weight rooms, cardiovascular equipement, tennis courts, swimming pools, golf courses and activity rooms.
- Banking services, gardening areas and beauty shops.
Assisted Living3
Assisted living provides numerous types of services for residents who do not have severe medical problems, but who need help with daily living tasks such as bathing, dressing, grooming, meal prepartion and medicine dispension.
Other services that may be provided include
- Social activities.
- Laundary and cleaning services.
- Help with medication and minor nursing care.
- Group meals; typically three meals a day.
- Security and emergency call systems.
- 24 hour supervision.
- Libraries, beauty shops, banking services, exercise rooms, recreation rooms and transportation.
Some assisted living facilities can handle special needs such as
- Cognitive disabilities.
- Short-term care.
- Respite care.
- Community services such as adult day care, shopping and social workers .
- Interim Medical care (after a hospital stay).
- Alzheimer's or Parkinson's disease.
- Hospice (end-of-life) care.
Continuing Care Retirement Communities (CCRC)4
CCRCs are a complex of residences that include independent living, assisted living and nursing home care so that seniors can stay in the same community even as their housing and care needs change over time.
- Allows seniors to age in one place with flexible accomodations that are designed to meet their health and housing needs.
- Typically residents sign a long-term contract that provides for housing, services and nursing care; housing packages allow access to independent, assisted living and nursing homes at one location.
- Advantages include:
- When greater care is necessary, no moving is required.
- If senior becomes better and requires less care, they are able to resume their initial living arrangements.
- Housing options for independent livng include:
- Studio and 1, 2, or 3 bedroom apartments.
- Cottages, townhomes or duplexes.
- Cluster homes or single family homes.
- Typically, apartments with scaled down kitchens are available for residents in assisted living areas.
- Services include
- Meals, including those with special diets.
- Housekeeping and laundary facilities.
- Transportation.
- 24 emergency help.
- Personal assistance; assistance with daily living tasks.
- Recreational, social and educational activities.
- Some CCRCs will provide care for Alzheimer's and / or Parkinson's disease.
Board & Care Homes5
Board & Care homes are a housing facility for seniors or individuals with disabilites who want or need to be in a group living situation and who need assistance with personal care and activities of daily living.
- Used when 24-hour, non-medical supervision is needed.
- These facilities can be a converted single family homes with up to six resdients OR they may be an apartment complex with up to 100 residents.
- Board & Care homes can be goverment ran or "mom and pop" facilities. It is very important to be sure that the home is licensed, by the county or state, and that the license is up-to-date.
- These homes typically have little or no medical care available.
- Those who would benefit from a board and care service include:
- Seniors who are becoming frail.
- Seniors with chronic illness who need help with cooking, cleaning and monitoring of medications.
- Seniors with limited income and assets.
- Living arrangements include
:
- May have private or shared rooms; private or shared bathrooms.
- Generally have common areas for socializing and dining.
- May have fitness and outdoor activities.
- Services
- A b asic room for sleeping (private or shared).
- Meals.
- Help with services; money management, setting up health care and other appointments.
- Assistance with daily living; laundry, transportation, housekeeping.
- Help with medication.
Skilled Nursing Facilities6
A skilled nursing home is a facility that provides medical and daily care 24 hours a day due to physical, emotional or mental conditions. Care is supervised by physicians and nurses.
- Skilled nursing care includes:
- Care after a major surgery.
- Monitoring and administration of injections, I.V.'s and ventilation.
- Physical, speech and occupational therapy.
- Care may be short-term; until they can care for themselves or long-term.
- Daily living care includes:
- Bathing.
- Dressing.
- Eating.
- Grooming.
- Toileting.
- Getting in and out of bed or walking around.
Private insurance and Medicare pay for nursing home care only for limited time periods following a hospitalization:
- Must be hospitalized for at least 3 days
- Must enter skilled nursing care with 30 days of hospitalizaiton
- Only the first 20 day are 100% covered; then there is a daily deductible
- You must be making regular progress as document by medical staff. If progress towards independence is no longer occurring, insurance coverage ends.
- For more information regarding Medicare coverage go to: http://www.medicare.gov/snc
Seniors that would benefit from skilled nursing care include:
- Those who can no longer take perform daily living tasks and also need medical care that can longer be performed by a caregiver or an assisted living facility.
- Those with chronic illness such as Alzheimer's or Parkinson's disease.
- Those who need daily supervision from a physician and nurses.
- Those who are going to be discharged from the hospital and need temporary care.
- Those who have been recommended to a skilled nusing center by a physician.
Services provide by Skilled Nursing Care include
- A furnished room (private or shared).
- Dietary services.
- Housekeeping and linen service.
- Dailiy living care.
- Therapeutic recreation and activities.
- Transportation.
- 24 hour on-site supervision.
- Resident evalution and care planning.
- For an additional fee, many skilled nursing centers provide:
- Rehabilitation services; occupational, physical, respiratory or speech therapy.
- Pharmacy, laboratory and radiology services.
- Dental services.
- Special care units.
- Personal care items and laundry service.
- Some skilled nursing homes provide special care units including:
- Kidney dialysis treatment.
- Alzheimer's and demental care.
- Respiratory care.
- Parkinson's care.
- Terminal illness (hospice or end-of-life care).
- Chronic psychiatric care.
Hospice or End-of-Life Care7
The concept of hospice is palliative care (pain and symptom relief) rather than curative care. Hospice is an option for persons with a life expectancy of less than six months. Hospice focuses on helping the person to live their last days to the fullest, with purpose, dignity, grace and support.
Hospice care
- Hospice or end-of-life care can be provided in some hospitals, nursing homes and other health care facilities or in a home.
- Hospice services include:
- Nursing care.
- Social services.
- Physician services.
- Spiritual support and counseling.
- Home health aides and homemaker services.
- Trained volunteer support.
- Physical, occupational and speech therapies.
- Respite care.
- Inpatient care.
- Bereavement support.
- Eligibility requirements include:
- A physician's referral.
- Patients are permitted to go on and off hospice care as needed.
- Tips for selecting hospice care providers include:
- Ask about the hospice's patient to caregiver ratios for each discipline.
- What is the average frequency of home hospice visits.
- Response time and procedures followed for after-hours questions and concerns.
- Contiunity of care (having same care provider over time).
- Whether a written treatment plan will be developmed for smooth coordination of care.
Choosing A Long Term Health Care Facility
Choosing a nursing home or long-term health care facility is a decision that if often made by the primary caregiver and other family members. The decision to move a loved one into a nursing home may be made during times of illness and stress. This can be an emotional and difficult decision for the family members, particularly the caregiver. Because a nursing home may be “home” for a long time, it is important o check out the facility to make sure it offers the quality of care and lifestyle that will enhance the resident’s life.
Tips for Choosing an Assisted Living Facility
- Is the community well-designed for resident's needs?
- Does the community provide safety features (emergency call system, handrails in the bathroom and staircases, etc.)?
- Does the stafff greet you warmly, do they call residents by name, do residents socialize with each othe and appear happy.
- Do the resident's appear like people you would like to get to know
- Is the food nutritiuos, appetizing, and prepared according to dietary restrictions
- If the senior has a pet, are they welcome in the facility?
- What professionals are on staff; what are their qualifications and availability?
- Are the daily living services offered what you need or desire?
- What social and recereational activites does the facility offer?
- Does the facility meet local and state licensing requirements?
- Is government, private or corporate assistance available?
- Which insurance plans are welcomed, if any?
- What are the costs, including any additional fees for extra services?
- Do residents receive a written service plan?
Tips for Selecting a CCRC Facility
- Find out whether or not the Continuing Care Retriement Community is accredited by CARF. If it is not, you should conduct a thorought review of its services, operations and finances.
- Determine if the CCCRC contract is appropriate for your loved one's lifestyle and financial situation. You and the care recipient may want to consult an attorney or accountant prior to signing any contract.
- What is the community's mission?
- See whether it is possible to spend at least one night at the facility and for your loved one to fully participant in the social activities for at least two days.
- After visiting the community
determine if:
- The living accomodations what the care receiver desires and expects.
- if your loved one has pets, are they allowed in the residence?
- What kinds of social, recreational and cultural activities are offered? Are fitness facilities provided?
- Is the food to your loved one's liking?
- Is the staff warm, friendly, knowledgeable and responsive?
- What types of healthcare and personal care services are available? Does the facility have both short and long-term services, such as routine physical and dental examinations, pharmacy services, skilled nursing and therapy services?
- What are the procedures for handling medical emergencies?
Nursing Home and Staff Credentials8
- Determine what the nursing home requirements are in your state. This information may be found through your state or county health department.
- Research the licensing requirement for your state for various types of facilities. Make sure the facilities on your list are licensed and that their license is prominently displayed in the facility. Again, this information may be found through your state or county health department.
- Ask about staff credentials (Number of CNA’s, LPN’s and RN’s on staff, how long have they have worked there, etc…)
- Are there staff dedicated to different types of dementia?
- How many RNs are on staff at all times?
Nursing Home Care and Services
- Ask to see the Resident’s bill of Rights, ask for a copy and keep it on file.
- Are patients with dementia grouped together in one facility or on one wing or are they spread out?
- Is there a social service worker on staff in the facility?
- What do the meals consist of? Can a special diet be implemented? What steps are taken to ensure the proper foods are given to the right residents?
- Look at the activity noise level and cleanliness of the facility. Is it clean? Is there a healthy amount of background noise?
Nursing Home Safety and Accessibility
- Are safety and accessibility top priorities for the facility?
- What precautionary steps are in place for emergencies?
- Are there smoke detectors, how many and are they working?
- How often do they have fire extinguishers check and if they know where they are located?
- Are safety procedures adequate? Are stairways and exits clearly marked?
- Is it easy to move from one place to another?
- Are halls and toilets wide enough for wheelchairs?
- Are there any floor hazards like being too slippery or having a thick carpet?
- Is there an emphasis on allowing residents to be independent as they can be?
- Are bathing devices available? Are handle rails provided in bathing areas?
- Are dining rooms and amenities well-spaced to keep walking distances short?
- What Types of amenities and comfort does the nursing home provide?
- Does the facility have a community feel?
- Are the residents happy, alert, groomed, clean, well-fed and healthy?
- Are the interactions between co-workers, and between workers and residents caring, friendly, and supportive?
- Does the staff know the residents by name?
- What services does the facility provide?
- A facility dedicated to resident comfort and services should provide laundry facilities on each floor, flat linen service, monthly housekeeping, maintenance and scheduled transportation.
- Other amentities may include a hair salon, bank, and gift shop.
- Each room should have individually controlled heat and air conditioning with an emergency response system.
A Good Nursing Home Provides Recreation
- What types of activities are provided?
- How are nursing activities supervised? How often are they held?
- Does the nursing home provide social, recreational, spiritual, fitness and wellness programs?
- What kinds of exercise regimes are included?
- Does the nursing home provide exercise equipment that is appropriate for residents and easy to use?
- Does the nursing home have a fitness instructor on staff?
- What types of social and individual activities are offered?
- Are religious services available, including visitation and worship?
- Does the nursing home property include nature areas, gardens and footpaths?
What Health Services Does the Nursing Home Provide?
- Are different levels of nursing home care, from assisted living to health care to short term rehabilitation programs, available?
- Is there a focus on needs assessment to determine the appropriate level of care for each nursing home resident?
- Is there sufficient nursing and personal care, including medication management?
- Are in-home health services available?
- Are nurses always close at hand?
- If the facility offers short-term rehabilitation programs, is there a private wing with private rooms and dining area?
- Does the nursing home facility offer care for residents with dementia? What kinds of programs are available for these residents?
- Does the nursing home provide personal care plans? Are these plans developed by an inter-disciplinary team?
Financial Issues to Consider When Choosing a Nursing Home
- Is there a guarantee that the entrance fee is refundable?
- Do the assisted living and health care services come at no additional monthly fee?
- To what degree does the nursing home manage resident’s finances?
- Are independent insurance, Medicare and Medicaid plans accepted?
A Good Nursing Home is Dedicated to Quality Improvements
- Does the nursing home have programs in place to study processes, re-evaluate services and ask residents and families what might be done better?
- How often are the findings from these programs implemented into change for the staff, residents, and administration?
- Is the center dedicated to the continuous training of its staff? How is training implemented? How often?
- Does the dedication to improvements carry over to every facet of the facility?
Choosing and Evaluating Nursing Home9
Typically the search for a nursing home takes place under the gun, when a person can no longer stay in the hospital or rehabilitation center and are not able to return to their home. There are a few rules of thumb that can be followed to assist this process:
- Location is important. Visitation can improve quality of care and quality of life for your loved one. Therefore, it is important to choose a nursing home that makes it as easy as possible for family members to visit.
- Get references. Ask the facility to provide names of family members of residents so you can ask them about the care provided in the facility and the staff’s responsiveness when the resident or relatives have concerns.
- Check certifying agency reports
- Talk to the nursing home administrator or nursing home about how are plans are developed for residents and how they respond to concerns expressed by family members. Make sure you are comfortable with the response. It is better that you meet with and ask questions of the people responsible for the care and not just the person marketing the facility
- Tour the nursing home. Try not to be impressed by a fancy lobby or depressed by an older, more rundown facility. What matters most is the quality of care and the interactions between the staff and residents. Focus on how well the residents are attended to and whether or not they are treated with respect. Also, inspect the quality of the food service
Tips for Talking With Family About Placement9
- Include all family members in the decision. Let them know what is happening to the person who needs care and what providing that care involves. Talk to family members either in person or via the phone or email.
- Research other options. Find out what care can be provided at home, what kind of day care options are available outside the home and whether local agencies provide respite care. Also, look at other residential care options, such as assisted living and congregate care facilities.
Resident Rights9
In 1987 Congress enacted the Nursing Home Reform Law that has since been incorporated into the Medicare and Medicaid regulations.
For a summary of these laws go to: www.elderlawanswers.com/elder_info/elder_article.asp?id699
Resolving Disputes9
- Talk to the staff. Let them know what you expect, what you care about and what your family members care about in regard to your loved one's care. This may help prevent problems or solve the problem.
- Talk to a supervisor, such as the nursing chief or an administrator. Explain the problem as you see it. Do it with the expectation that the issue will be favorably resolved.
- Hold a meeting with the appropriate nursing home facility. This can be a regularly schedule care planning meeting or you can ask for a special to resolve a problem that wasn’t resolved more informally.
- Contact the ombudsperson assigned to the nursing home. He or she should be able to intervene and get an appropriate result. Contact information for the Omsbudsman Program in your state can be found at: www.ltcombudsman.org/static_pages/ombudsmen.cfm
- Hire a geriatric care manger to intervene. This is an advocate for you who is not as personally involved as you and who understands how nursing homes function.
- Hire a lawyer, while a lawyer may be necessary to assert the resident’s rights, the involvement of a lawyer may escalate the dispute to a point that it may be difficult to resolve the problem.
- Move your relative. If nothing else works you have the option of moving your family member to another location. This may be difficult, but in some circumstances it may be your only solution. It does not prevent you from pursuing legal compensation for any harm inflicted on the redisent at the original facility.
Sources
8. How to Find the Right Nursing Home; Sharon O’Brien, About.com
9. Nursing Home Issues January 15, 2006, ElderLawAnswers http://www.elderlawanswers.com/elder_info/elder_article.asp?id=699
