Care Arrangement: Nursing Homes

When looking at care arrangements for a loved one who is suffering from dementia, family members often have to make difficult decisions with regards to it. For example, should their loved one stay at home or move to a specialized facility? Which arrangement would be more beneficial for them? Will they get all the appropriate care facilities they require? There are several different options available, but coming to a decision can be tough and stressful for the family and/or caregiver. Among the various options available, you can consider shifting your loved one into a nursing home.


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WHAT IS A NURSING HOME?

A nursing home is a facility with the highest level of care for adults, second only to hospital care. There is always a nurse on-duty and each patient’s case is followed by a doctor. In addition, it includes other professionals including physical and occupational therapists. It is usually a place for people who do not require hospitalization but at the same need company and cannot live unassisted. There are three different types of nursing homes:

  • Hospital – the facility has a hospital set up with medical, physical, occupational and speech care available. It usually has shared rooms and stationed nurses. It may be possible to accommodate couples. Family photos and room decorating can be encouraged.
  • Household – With the purpose of creating a more relaxed feeling, they are made to appear more like a home for the patients. The staff is encouraged to bond with the patients.
  • Combination – Different units with different decoration and appear Doctors that visit on-site. Sometimes they have separate areas for people with serious memory problems such as dementia.

In addition to this, there are some nursing homes that specialize in the care for individuals with dementia. These are nursing homes with memory care.

Regular Nursing Home vs. Nursing Home with Memory Care

A nursing home with memory care is a facility that provides everything that a nursing home provides but specializes in caring for people with dementia. These facilities, despite the extra cost, offer high-end care for people with dementia, including:
  • Secured units
  • Alarm devices
  • Enclosed outdoor areas to prevent wandering
  • Staff trained specifically for dementia (verbal cues, sensory stimulation)
  • Space to be active, promotion of physical and emotional wellbeing
  • Care focusing on non-pharmacological treatment instead of relying heavily on medication
  • Bracelet tracking (to prevent wandering)
  • Care is focused on the patient (arts and crafts, personalized “good morning” tapes)
  • Encourage communication

Nursing Home vs. Other Care Arrangements

Other than nursing homes, there are other possible care arrangements. This includes home care or assisted living facilities.
Care Arrangement for Dementia and Alzheimers
Before choosing a nursing home, it is important to have an idea of what it can offer in terms of services, activities, and payment and whether it is a good fit for your loved one where his/her condition is concerned. Below is a chart elaborating on the similarities and differences of each form of care arrangement:
Dementia and Alzheimers Care Arrangements Compared
 

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THE NUMBERS BEHIND NURSING HOMES

As of 2014, there are a little over 15,600 active nursing home providers in the United States. Of this, over 90% are Medicare or Medicaid certified. There are about 1.4 million nursing home residents across the country, where the total number of licensed beds is about 1.7 million. Another aspect of nursing homes is that there are both for-profit and non-profit facilities available. The proportion of nursing homes with for-profit ownership is nearly 70%. However, the difference in level of service between for- and non-profit nursing homes is minimal.

As mentioned, some nursing homes have memory care available to properly serve dementia patients, while others are regular nursing homes. Of the total number of nursing homes in the United States, about 15% of the facilities have a designated wing for dementia care, while only 0.4% of all nursing homes are completely dedicated it.

Patient-Caregiver Ratio

The patient to caregiver ratio will vary depending on each nursing home facility. However, the average is around 1:6 or 1:8 in terms of caregivers and nurses during daytime and 1:15 or 1:18 during nighttime.

HOW TO FIND A NURSING HOME FACILITY

Websites

These days one of the easiest ways to search for nursing homes is through the web. Browsing online allows you to go through a lot more information that would be traditionally available. Below are some websites that can be very useful to you in the process of finding the right nursing home for your loved one:
  • The Joint Commission Service - this site is a good resource to help you choose the best place to care for your loved one
  • medicaid.gov – provides information about the different types of care available
  • medicare.gov/nursinghomecompare - allows you to compare nursing homes near you
  • medicare.gov/Nursing/Payment.asp - a tool to help you choose the best health insurance for you and your family
  • ltcombudsman.org – a reference regarding legal concerns, action, and advice
  • va.gov – for veterans
  • aplaceformom.com is a website to help you choose a place and provides other types of advice. NOTE: The company will assist you in finding a new place for your loved one in exchange for the value of 2 months of what you pay in the location your loved one is placed in. We do not recommend this tactic as it does not keep the patients interest a priority. 

Resources

There are also various organizations relating to dementia that are available to provide information as well as assist you in the process of finding the right nursing home for your loved one. Here are some of those resources to get you started:
AARP
601 E Street, NW
Washington, DC 20049
1-888-687-2277 (toll-free)
1-877-434-7598 (TTY/toll-free)
1-877-342-2277 (Spanish/toll-free)
aarp.org
    American Health Care Association
    1201 L Street, NW
    Washington, DC 20005
    1-800-321-0343
    ahca.org
      Centers for Medicare & Medicaid Services
      7500 Security Boulevard
      Baltimore MD 21244-1850
      1-800-633-4227 (toll-free)
      cms.gov
        Department of Veterans Affairs
        VA Benefits: 1-800-827-1000 (toll-free)
        1-800-829-4833 (TTY/toll-free)
        va.gov 
          Leading Age
          2519 Connecticut Avenue, NW
          Washington, DC 20008-1520
          1-202-783-2242
          leadingage.org
            National Clearinghouse for Long Term Care Information
            Administration on Aging
            Washington, DC 20201
            1-202-619-0724
            longtermcare.gov
              National Consumer Voice for Quality Long-Term Care
              1001 Connecticut Avenue, NW
              Suite 425
              Washington, DC 20036
              1-202-332-2275
              theconsumervoice.org
              National Long-Term Care Ombudsman Resource Center
              1001 Connecticut Avenue, NW
              Suite 425
              Washington, DC 20036
              1-202-332-2275
              ltcombudsman.org
              Gov
              For more information on health and aging, contact:
              National Institute on Aging Information Center
              O. Box 8057
              Gaithersburg, MD 20898-8057
              1-800-222-2225 (toll-free)
              1-800-222-4225 (TTY/toll-free)
              www.nia.nih.gov/health
              www.nia.nih.gov/espanol
                For information on Alzheimer’s disease, contact:
                Alzheimer’s Disease Education and Referral (ADEAR) Center
                O. Box 8250
                Silver Spring, MD 20907-8250
                1-800-438-4380 (toll-free)

                HOW TO GET PLACED IN A NURSING HOME?

                A nursing home works within clearly set boundaries of law and standards of medical practice, where a patient may be required to have an order from a doctor and cannot be admitted by the personal choices of the patient or their family members. The admission process is more complex than that of an Assisted Living facility or other places. It is also more difficult to get admission. Nursing homes can select which patients to accept for admission and are not required to approve every applicant even if they have empty beds. The reasons for disapproving admission vary and the facility is not required to justify to the applicant or their representative why someone is not accepted for care.

                These facilities are medical institutions are primarily providing skilled nursing care, rehabilitation therapies, and related services for residential clients who require such care and/or treatments for their illness, disability, or injury on a scheduled basis and are available only through such a facility. Therefore, usually a medically acceptable applicant is referred to the nursing home through clearly established medical diagnosis and a physician’s orders. They require specific information on the patient, such as their medical condition, care regimen, ability to pay for services, and the psychosocial background in order to consider the person for admission.

                Residents of long term care most often come directly from a hospital stay with discharge planners making the referral and providing the necessary information and medical orders.  Referrals are also made by personal physicians, assisted living facility staff, home health services, hospice, social service agencies, or someone with an interest in the well-being of the person needing care.  Although the referral or initial contact with the nursing home may come from another source and admission may be approved before a formal application is made, an application process is necessary.

                A nursing home is required to meet, at the facility’s acuity level, all the medical care needs of a resident without exception.  Admitting a resident and then failing to meet their medical or psychosocial needs due to factors limiting the facility’s ability to provide adequate care and protection is not acceptable. Even if beds are available, a nursing home is not required to admit a person if they judge themselves unable to fully meet the applicant’s care needs.  The facility must assess the potential resident with what information is provided and decide if they are the appropriate placement to satisfy the needs of that person.

                There may be a variety of reasons for a nursing home to refuse admission to a patient. For example:

                  • The nursing home does not have an open bed or a bed appropriate for the needs of the applicant. 
                  • The applicant may not meet the level of care criteria required for admission or may be judged to have a primary need for the treatment of mental disease. 
                  • The facility may not have a contract with their insurance carrier or the applicant may not have clearly identified sources of payment.
                  • The facility may feel they cannot provide adequate care in areas other than medical for a prospective resident
                  • The prospective resident may not fit into the population already being served
                  • Necessary equipment or building design may not be available to adequately serve the patient
                  • The applicant and/or their family may have a history of disruptive behavior
                  • An applicant does not provide sufficient medical and/or financial information
                  • There are no payment sources to cover the full cost of care and services.
                  • The patient has a history of wandering if the facility design would make it difficult to prevent elopement
                  • The facility may not have the adequate care arrangement for patients with a history of drug or alcohol abuse and have a need to go through withdrawal

                Financial Factors of Admission

                The certified facility must have and respect a policy where residents or potential residents are not required to waive their rights to Medicare or Medicaid nor will they be required to make oral or written assurance that they are not eligible for or will not apply for Medicare or Medicaid benefits. In the case of a person eligible for Medicaid, a nursing facility must not charge, solicit, accept, or receive, any gift, money, donation, or other consideration as a precondition of admission, expedited admission, or continued stay in the facility beyond any amount otherwise required to be paid under the State plan.
                It should be noted that a nursing home is not required to accept an admission without a clearly identified source of payment for services. They have the right to decline admission when they are unlikely to be paid for the resident’s care. Nursing homes may require both a primary and a secondary payment source before approving admission. The most common combination of a primary and secondary source would be a person qualifying for Medicare and as the secondary source, Medicaid, private insurance, or payment out of pocket by the individual.
                A licensed nursing home may choose not to certify beds for Medicare or Medicaid and can decline an admission when either of these would be the only source of payment for services.  A facility with certified beds must accept payment by Medicare and/or Medicaid when the resident’s cost are covered by either of these two sources.

                WHAT TO LOOK FOR WHEN SELECTING A NURSING HOME WITH MEMORY CARE

                Since admission into a nursing home requires a referral from a medical professional, one of the first places where you seek help to select a nursing home is at the hospital or clinic itself. The staff can help you to find one that will provide the kind of care that’s best for your loved one. Additionally, most hospitals have social workers who can help you with these decisions. If you are looking for a nursing home, ask your doctor’s office for some recommendations. Once you know what choices you have, it’s a good idea to define your priorities:

                What Is Important To You

                Nursing care, meals, physical therapy, a religious connection, hospice care, or Special Care Units for dementia patients? Do you want a place close to family and friends so they can easily visit? Speak to friends, relatives, social workers, and religious groups to find out what places they suggest. Check with healthcare providers about which nursing homes they feel provide good care. Use their suggestions to make a list of homes that offer the types of services you want.
                Get in touch with each place on your list. Ask questions about how many people live there and what it costs. Find out about waiting lists. Make plans to meet with the nursing home director. Remember to look for:
                • Medicare and Medicaid certification
                • Handicap access
                • Residents who look well cared for
                • Warm interaction between staff and residents
                Don’t be afraid to ask questions. For example, you can ask the staff to explain any strong odors. Bad smells might indicate a problem; good ones might hide a problem. You might want to find out how long the director and heads of nursing, food, and social services departments have worked at the nursing home. If key members of the staff change often, that could mean there’s something wrong.
                Make a second visit without calling ahead. Try another day of the week or time of day so you will meet other staff members and see different activities. Stop by at mealtime. Is the dining room attractive and clean? Does the food look tempting? 
                Once you select a nursing home, carefully read the contract. Question the director or assistant director about anything you don’t understand. You can also ask a good friend or family member to read over the contract before you sign it.

                COSTS OF A NURSING HOME FACILITY WITH MEMORY CARE

                Of the different types of care arrangements available, nursing homes can be the most expensive among them. Therefore, many states and organizations provide services to individuals who require nursing home level care but choose to remain living outside of nursing homes. It is important to check with Medicare, Medicaid, and any private insurance provider you have about their latest policy regarding the coverage of long-term care costs.

                There are several ways to pay for nursing home care.

                Medicare

                For someone who needs special care, Medicare, a Federal program, will cover part of the cost in a skilled nursing home approved by Medicare. However, the benefits that Medicare offers toward the cost of nursing home care are limited.  Medicare is not intended to provide a long-term care solution. It is designed for those who need skilled nursing care for a limited time.  
                As such, Medicare will pay for twenty days of care at 100% of the cost. For the eighty days following, Medicare will pay 80% of the cost.  For those who subscribe to a Medicare Supplemental Insurance plan, the secondary insurance will pay the remaining 20% of the cost for the last eighty days of coverage. It should be noted that neither Medicare nor Medicare Supplemental Insurance will pay for nursing home care after the 100-day maximum is reached.  
                A minor exception to this rule exists when the nursing home doubles as a psychiatric hospital and the individual has a psychiatric condition.  In this situation, Medicare increases assistance for up to 190 days.
                Further limiting Medicare's coverage is the policy that skilled nursing is only for those recovering from an illness or injury, not for those with an irreversible long-term or chronic condition. As with many things Medicare related, there is a partial exception to this rule for individuals who live in states that offer Medicare PACE Programs. You can find out more about this at:

                Medicaid

                Medicaid is a State/Federal program that provides health benefits to some people with low incomes. Contact your county family services department to see if you qualify.
                Some people pay for long-term care with their own savings for as long as possible. When that is no longer possible, they may apply for help from Medicaid. If you think you may need to apply for Medicaid, ensure the nursing home you’re interested in accepts Medicaid payments.
                There a few things to note regarding this method of financing, such as:
                • Medicaid is the largest single payer for nursing home care.
                • Medicaid pays at least 40% of the total nursing home costs in the United States.
                • The applicant's income and financial assets are closely analyzed prior to acceptance into the program.
                • Should the patient qualify, Medicaid will pay for 100% of their nursing home costs at an approved skilled nursing facility.
                • Medicaid's eligibility requirements vary depending on the age, marital status and state of residence of the applicant.

                Veterans Affairs (VA)

                A veteran in need of long-term care may be able to get help through the Department of Veterans Affairs (VA). A starting point to get more information in this area is through www.va.gov. 
                With regards to financing options, there are two that work specifically for veterans:
                • The Aid and Attendance Benefit is intended to help those with limited financial means—though not as limited as Medicaid. A veteran's income and financial assets are both considered during the application process. 
                • State VA nursing homes for veterans or spouses that are designated at least 70% disabled.

                Private Insurance

                With regards to private insurance, each company has its own policies and benefits. When considering this option, it is important that you look carefully at several companies and the different politicies they offer before making a choice. Keep in mind that in some cases, the insurance coverage may not be 100% or it may exclude certain things such as personal care supplies or services. In order to cover the items that are excluded, you may have to pay a higher premium for your policy or take on the cost personally.

                Reverse Mortgages

                A reverse mortgage is a loan that a borrower takes from a bank against the value of their home. It can be used to help with the costs of care. If you are considering this option, it is important to keep in mind that you must also be able to pay off the mortgage over the time set in the mortgage contract to avoid unintended consequences such as losing the home or other assets or even face lawsuits.

                Relocation

                Another option that can reduce the cost of nursing home care is to relocate the individual in need of care to an area of the country where the cost of care is lower. While this can lead to thousands of dollars in possible savings, for a variety of reasons, it is not always possible or easy to do.

                POTENTIAL ISSUES WITH NURSING HOMES

                Errors in Medication Management

                Medication errors in nursing homes and other inpatient medical facilities are recognized as a common problem in the medical field. When investigating medication errors within nursing facilities, state inspectors must identify each facility’s medication error rate. All facilities must maintain a nursing home medication error rate below 5 percent.
                While minor medicine errors are inevitable, nursing home residents must remain free of any severe medication errors. By definition, medication errors are mistakes that occur while preparing or administering medicine. The medication error occurs in a manner that contradicts the doctor’s orders, the manufacturer’s instructions, or the accepted professional standards regarding that medicine.
                In most nursing homes, medication is administered when a nurse or nursing staff member completes a “med pass.” A “med pass” is the common term used to describe the process of dispensing medicine to nursing home patients as ordered. During a med pass, the nurse typically uses a cart while transitioning from resident to resident on a clearly-defined schedule. In most cases, a licensed nurse conducts the med pass. However, some states allow for an unlicensed nursing staff member to administer the medication under the general supervision of a nurse. The med pass typically requires 4 to 5 hours of the nurse’s time during medication administration. In addition, it can take several more hours to organize the medications and complete any necessary documentation.
                Some types of errors include:
                • Wrong time administration (71.3%)
                • Omitted dose (12.2%)
                • Wrong dose (11.3%)
                • Extra dose (3.7%)
                • Unauthorized drug (1.4%)
                • Wrong drug (0.2%) 
                The possible causes of these errors can be:
                • Miscommunication
                • Wrong ordering
                • Mis-dispensing
                • Faulty admin Process
                • Other staff factors

                Incident Reports – The Process

                There are different types of errors and issues that can arise in nursing homes. Errors can be committed by either staff or management.
                Staff errors could occur due to inadequate screening or qualification during the hiring process, inadequate training, or negligence. In some cases, there may be issue of abuse, such as:
                • Physical abuse – includes unwarranted physical harm such as slapping, hitting, pushing, or kicking. Improper use of restraints and excessive restraints are also included. Physical abuse occurs when the resident is denied food or drinks, or forced to consume certain foods or drinks.
                • Sexual abuse – occurs when an individual engages in non-consensual sexual acts with a resident.
                • Psychological abuse – may occur as verbal assault, harassment, bullying, and degradation. Psychological abuse may also occur as “babying” a resident or giving the “silent treatment” as a result of undesired actions.
                • Financial exploitation – occurs when a resident is taken advantage of financially. This may include the unpermitted use of the resident’s money or property for the benefit of another.
                Issues with the nursing home management on the other hand, can occur due to poor maintenance of the facility, bad management, or dissatisfaction in way the management handles issues and other concerns. The following is a list of some medical malpractice concerns that nursing home residents may experience, which are they are grounds for a nursing home lawsuit regarding elderly medication error:
                • Ignoring medication orders
                • Poor elderly medication management
                • Medication borrowing
                • Diversion of elder medications

                Filing Complaint to Nursing Home Management

                In the case of negligence, abuse, or mismanagement, your first line of action should be the nursing home management. Ensure that they take necessary action and make appropriate changes to ensure that similar issues do not occur again. At the same time, you should report the problem to the state licensing agencies that oversee nursing homes. You can contact Adult Protective Services (APS) or the state's licensing agency for assisted living in addition to the Long-Term Care Ombudsman in your area immediately. In some states, APS staff are responsible for investigating complaints.
                It is important to record all the details of the complaint. The more information that you can record, the more effectively the complaint can be handled. Some details that you will need to record include:
                • What happened?
                • To whom did it happen?
                • When did it happen?
                • Where did it happen?
                • Who did the abuse?
                • Who was responsible for the neglect?
                Individuals are encouraged to raise their concerns through the nursing home management’s internal complaint resolution process. If you do not get a satisfactory resolution using the operator’s internal complaint resolution process, you can escalate by filing a complaint against the nursing home itself.

                Filing a Complaint against a Nursing Home

                When filing a complaint against the nursing home itself, you may contact the Office of the Ombudsperson who may investigate complaints about unfair administrative decisions or actions of a public agency. Long-term care ombudsman programs in the complainant's state may be able to assist with filing a complaint against the nursing home to the regulatory agency. A local ombudsman can assist with filling out complaint forms, following up on complaints and advocating for the rights of resident in the nursing homes through local law enforcement agencies and government organizations.

                Discharges and Evictions from Nursing Homes

                Nursing homes are generally prohibited from moving residents. They can transfer or discharge residents from the home only for certain reasons and, even then, only when they follow specified procedures. In order to lawfully transfer or discharge a resident, the home must be able to prove that it complied with all the procedural requirements and that the transfer or discharge is for one of the few allowable reasons. In the absence of such proof, the transfer or discharge must be disallowed or, if the resident already moved, the resident must be allowed to return to the bed, room and facility from which the resident was transferred. Make sure to ask of the procedures and special circumstances under which they can transfer them before moving your loved one in. 
                For a nursing home resident, few events are as traumatic as an involuntary transfer or discharge. At best, such occurrences are stressful and disruptive. At worst, "transfer trauma" will leave a frail elderly person frightened, disoriented, and isolated from friends and families, causing irreparable psychological and physical harm.
                The transfers and discharges discussed here include any time the home moves a resident outside of that facility, including transfers to a hospital. There are separate rules and procedures for transfers from one room to another room within the same nursing home.

                Subsidized Rates

                From a nursing home’s perspective, the ideal resident does not require expensive care, places few demands on staff, and pays the home at the "private pay" rate. Since Medicaid and Medicare typically pay much lower rates than homes receive from their private paying clients, facilities may try to limit the size of their Medicaid-covered populations. 
                At times, the nursing home may claim that, regardless of the patient’s medical needs or desire to stay in the facility, Medicare-covered or "respite" admissions are time-limited (cutoff points of 20 or 90 days are often cited).

                Applicable Discharge or Transfer

                A resident can never be discharged or transferred if moving the resident is "medically contraindicated," i.e., if the transfer would be more harmful than letting the resident stay. But if the transfer or discharge will not be harmful, a nursing home can only require a resident to leave in five situations:
                • Medical care the resident requires cannot be provided in a nursing home setting
                • The resident no longer needs nursing home care because the resident’s condition has improved
                • The health or safety of other individuals in the home is endangered
                • In the case of a self-pay patient, the resident has not paid for care at least fifteen days
                • The home plans to cease operations

                Cessation of Medicaid Program

                A nursing home cannot evict residents covered by Medicaid if the home decides to drop out of the Medicaid program. In this situation, the home must continue to provide care and accept payment from Medicaid for all those in residence when the home decided to withdraw from the Medicaid program.

                Discharge/Transfer Procedure

                Usually, a nursing facility must give you, your guardian, conservator or legally liable relative a written notice, at least 30 days, and no more than 60 days, before a transfer or discharge from one facility to another. A shorter notice is allowed in emergency situations or for residents recently admitted. The nursing home must comply with all of the following notice requirements even if the home claims that the resident "consented" to the transfer or discharge. This is necessary to ensure that residents are made aware of their rights and their opportunity to appeal.
                If the written notice is missing any of the following information, the discharge or transfer would be unlawful. The notice must include:
                • The reason for transfer or discharge.
                • The date of the proposed transfer or discharge.
                • The location to which the nursing facility proposes to transfer or discharge you.
                • Your right to a hearing to contest the transfer or discharge.
                • The procedures you must follow to request a hearing.
                • The date by which you must request a hearing in order to prevent the transfer or discharge from occurring before the hearing is held. The date given must be at least twenty days from your receipt of the notice from the facility.
                • Your right to represent yourself or have legal counsel, a relative, friend or other person represent you at the hearing.
                • If you are being transferred to a hospital, information regarding holding your bed and readmission to the facility.
                • The name, mailing address and telephone number of Long-term Care Ombudsman.
                • If a resident is mentally ill or developmentally disabled, the notice must give the contact information for the Office of Protection and Advocacy. 
                A resident cannot be discharged unless the nursing home develops a written discharge plan. The discharge plan must:
                • Be developed by your doctor or, the nursing facility's medical director together with other medical staff.
                • Consider the possibility of placement near your relatives, spouse, guardian or conservator.
                • Include a written evaluation of the effects of the transfer or discharge on you and a statement of how the nursing facility will make the transfer or discharge less disturbing. Outline the care and kinds of services which you will receive upon transfer or discharge.
                • Except in an emergency, the nursing facility must give you, your doctor, guardian, the conservator or legally liable relative, a copy of the discharge plan at least 30 days prior to the transfer or discharge. 

                Resident’s Right to Appeal

                If you receive notice of a proposed transfer or discharge, it is important to start the appeal within 20 days of your receipt of a transfer or discharge notice. If you file an appeal during this 20-day period, you cannot be moved until a hearing is held and a written decision is issued.
                Legal services organizations and the long-term care ombudsman can provide assistance with transfers and discharges. Facilities that attempt to transfer residents in violation of the law or without providing them with the required advance written notice can be sued. The courts are authorized to issue injunctions to prevent transfers, to order facilities to reverse transfer and to make nursing homes pay residents compensatory and punitive damages.

                TRANSITIONING INTO A NURSING HOME

                How To Get Loved One to Go If They Are Resistant

                Convincing dementia patients, especially those who are elderly, to move from the comfort of the home they've known for many years or other assisted living facility that they’ve settled in to a nursing home can be tough. Change can be difficult for your loved one, especially if it is seen as being another step closer to death.
                Therefore it is important to let your loved one know and explain to them of the advantage of moving to a nursing home and the disadvantages that can arise in their existing living arrangement. Especially with dementia patients, these things should be clearly communicated to them, in order to make them more agreeable to the arrangement.
                Regardless of the reason or situation, moving is an emotional decision. So you should have this conversation before the disease deteriorates to the point where there can be no reasoning. It won’t be an easy discussion, and usually and resistance should be expected. Below are some tips to convince your loved one:
                • Visit Personally: Help them feel the environment of the facility and talk to as many professionals and people as possible.
                • Look into Multi-Level Care Facilities: Be sure to consider the benefits of a multi-level facility or a CCRC (additional services provided, which can be good as only one change will be needed). Seniors progress through different levels of the facility as their dementia worsens.
                • Taste Test: Test the meals
                • See the Accommodations: Don’t believe everything you are told and visit the space so you will know how well your loved one will be accommodated.
                • Activities: This will help your loved one try new things and get new hobbies. This is a major factor for breaking the initial resistance.
                • Build Relationships: People that work in these places are used to resistance, ask for help and learn from their experience as they are confronted with these types of situations daily.
                • Safety: Don’t wait for something terrible to happen before you make this decision. Analyze the situation rationally. If there are safety risks involved and your loved one can’t stay at home alone, act.

                What to Bring When Moving Into Assisted Living

                Try to create a familiar space but keep in mind that it is a smaller place and that there are regulations and restrictions for safety. It is best to collaborate with your loved one and get their insight on what they would like to take with them as well. Make it a team effort. Some basic items that you can bring along for your loved one includes:
                • Bed Sheets (Atleast 2 sets)
                • Comforter
                • Blankets
                • Pillows
                • Pajamas
                • Sweaters
                • Jackets/Coats
                • Towels (Atleast 2)
                • Personal Hygiene Products (Razors, Deodorant, Soap)
                • Formal clothing (for special occasions) 
                • End tables (If not provided by facility)
                • Nightstand
                • Lamps
                • Picture Frames
                • Artwork
                • Clock
                • Vase of flowers
                • Music player
                • Other items that contain emotional value and can help to make the living space more homely

                Make sure you label EVERYTHING with your loved ones name so the staff can distinguish their items from another persons and leave valuables at home. It is very common for wanders to grab things from each others rooms. Avoid having lost items by labeling them and by leaving valuable items such as jewelry at home.

                Tips for Transitioning Into a Nursing Home

                Adjusting to a new care and living arrangement can be hard, but you should try to ensure that your loved one keeps an open mind and start preparing for the transition as early as possible. Any change to a person with dementia takes an adjustment period that may include exacerbated symptoms, new symptoms and behaviors, and disrupted routines.  Give them and yourself atleast 2 weeks to transition into the facility before feeling panicked that there is something seriously wrong with the decision. 
                Another thing they should do is to socialize. For as long as possible, physically and mentally, the dementia patient should socialize with others instead of isolating themselves as it can be crucial for adaptation to the environment. Try to explain how important it is to make new friends and ask for the staff’s help if you are dealing with a person that usually keeps to him/herself. And lastly, as a primary caregiver or family member, you shouldn’t be afraid to ask the staff for help or clarification. The same goes for the dementia patient. If you or your loved one has any doubt, it is best to get is sorted as soon as possible.
                To some, sending your loved one to an assisted living facility may make them feel guilty for ‘abandoning’ their responsibility toward the dementia patient. However natural the feeling may be, there is nothing to be guilty about as you should always strive to provide your loved one with the best possible care for their needs. And of course, once your loved one has been settled into the facility, you and other close family and friends should keep in touch. Visiting your loved one regularly is a very good way to also ensure they don’t feel abandoned at the facility. And lastly, when moving into an assisted living facility, the patient should bring in personal items with them to make it feel more homely. You can also request other family members and close friends to ocassionally sent presents, postcards, and other items to make the patient feel remembered and valued.

                The Transitioning Period

                The transition process during the first few weeks will be complicated, There may be anger, guilt, rage and many other negative emotions. Regardless, you should prepare for the worse. Keep in mind that as each day goes by, your loved one will be feeling better and more at home with your decision. To facilitate the transition process it is important that you do not, or at least try to not express any negative feelings or attitudes, such as crying, towards the new change. This emotional rollercoaster will start from the moment you start the conversation about moving until you leave the assisted living facility on moving day. Don’t bottle up, ask for help from friends, family or even the staff and most importantly, take the time to plan all these changes as you will probably feel sad, angry, and exhausted during this period. Everyone has a different way of handling these situations. Most importantly, remember that it is a stressful time but it is all for the best. 

                TIME TO FIND A NEW CARE ARRANGEMENT

                As mentioned, nursing homes allow residents to stay for as long as they are deemed to need the care and services provided. Once the resident’s needs and care level is considered to be beyond that provided by the nursing home, they can decide to discharge the person. In such cases, you will have to find a new care arrangement that is more suitable to your loved one’s needs.

                With dementia patients, the progress of their disease at this point will likely require hospice care or other similar arrangement where they can receive proper care. However, before coming to a decision about this, it is best to speak to the nursing home management and staff as well as the patient’s doctor in order to make an informed decision.

                Medication Rebalancing – Geriatric Psychiatric Unit

                In order to properly evaluate and decide the next care arrangement for your loved one, you can consult a geriatric psychiatric unit. Not only do they provide dianosis and treatment for elderly patients experiencing emotional, cognitive, and behavioral symptoms, they also have specialized programs for dementia. The professionals there can advice on the next appropriate care arrangement. If needed, the patient can also be admitted to their unit to receive the necessary treatment over the short term.

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