At some point many of us will be faced with the decision of having to decide on placing a family member into a group facility like a Nursing Home or an ACLF (Adult Congregate Living Facility). Below is some information to aid in this decision.
Before we begin, if your family member has been diagnosed with a terminal illness and has six months or less to live you may want to consider Hospice Care.
They will come in to aid patients and family members regardless of ability to pay
They give medical equipment, medication, and treatment of patients, as well as daily living needs (grooming, feeding, cleaning)
No extraordinary measures will be taken to prolong life.
For the Family they offer counseling, respite care, and when death is imminent they do have someone with you 24 hours a day.
Determining which facility is best for your loved one
Why would you have to do this? Answering this question can help decide which facility is best.
Is the person able to take care of daily living skills but is unable to stay by themselves and you are not able to have them live with you (for whatever reason that may be)?
Do they need daily medical care or supervision?
Have they lost all touch with reality due to advanced Alzheimer's or Senility?
All though these are only 3 questions they can answer a great deal and below explains how these answers effect which facility is best for your loved one..
If the person is functional, can take care of most of their needs but requires help with meals, has poor health and no one around to check up on them regularly then an ACLF might be the best choice for them.
If the person falls somewhere between the above statement and the one below then an ECF might be best.
If the person is unable to take care of their basic needs, needs daily medical care or supervision then a Nursing Home might be the best choice for them.
If they are suffering from advanced Alzheimer's or Senility then a Nursing Home with specialized care for such patients is best.
What is the difference between ACLF's, ECF and Nursing Homes?
An ACLF is like a group home. Many vary in what they offer. Most however take care of cleaning the rooms, cooking meals, checking on patients, and some will even make sure that they take their medication as needed (they do not administer but observer taking of medication).
ECF (Extended Care Facility) this is a facility that offers more care then an ACLF but not as much as a Nursing Home.
Nursing Homes offer more care. They will aid in Daily Living Skills (grooming, dressing), meals, cleaning of rooms, they will administer medications, confer with doctors, etc
Well we've made the decisions but how do I pick the right place for my family member? This is always the hard part but below are some things to check on when visiting a facility. Remember also to check a facility more then once and on different shifts.
1. Is the place clean?
Remember to look above and below eye level. Check for dust on the top of door frames, picture frames, look behind doors.
What do you smell when you walk through the place? If you smell urine or feces and you aren't right near the dirty linen room then something is wrong.
Are the phones for public/patient use clean?
Is the place well lit or does it appear dingy?
Do all garbage bins have trash bags (including bathrooms)
Are items such as diapers, pads for beds, or other items stored on the floor in the patient's closet?
2. How well does the staff act?
Is the staff appropriately dressed and have name tags?
Watch when a light goes off and time it to see how long it takes to be answered. Observe this a few times to compare.
Are residents still in bed and in night clothing at 11am or later?
The residents that are up and about do they appeared to be groomed? Do they have body odor, long finger nails (on men) , are they shaved (for women as well for many get long facial hairs as they get older). If women are wearing makeup is it applied correctly or do they appear painted? Is perfume, cologne or powder over done to help mask odors?
Listen to how staff respond to the residents. Is it respectful, friendly and polite? Do they say their name IE: Mrs. Smith
When food is delivered how long after it is does staff check on them to see if they are eating, how long does the tray stay there? If they eat in the community dining room how long are they given to eat, how long afterwards does it take to clean the dining room? Are there people there to help some eat if they can't feed themselves?
Find out how often showers are given and at what times. If you or the family member has a preferred time then inform them of it and find out if they will honor it.
Listen to how staff talk with each other and treat one another. Listen for vulgarity, condescending attitudes, or in foreign languages while working.
Are curtains and/or doors closed to ensure privacy?
3. Activities
Do they have posted activities for the Residents to attend? If they do are they actually being held? Do they escort them?
If they offer transportation to appointments or outside activities, then verify that the person driving is qualified and who pays for it?
4. Some Final Considerations
Does your family member's doctor have privileges there? If not find out which ones they do have privileges at or which doctors are at the facility you like.
Check to see which hospitals the facility is closest to or sends patients to, make sure this is acceptable for you.
Will they honor a DNR (Do Not Resuscitate)
State survey should be posted and if not ask to see it.
What are the visiting hours? If they don't allow you to visit at any time find out why? This is going to be your loved ones home and they should be allowed to have visitors at any time.
What religious services are provided?
With Nursing Homes verify what extent of medical care they will allow: IE: IV's, Ventilator.
Do they provide laundry services or is it an extra charge?