Post by norbert1 on Dec 5, 2007 10:24:12 GMT -5
-- Plan Ahead before you actually need the nursing home. ---
From a post by Alice alzheimers.proboards32.com/index.cgi?board=ADgen&action=display&thread=1196268391
What Susan and Lewie are going through should be a wake up call for everyone who is a care giver. All that happened to Susan was because of being hospitalized unexpectedly. There was no other choice but to place Lewie where there was an opening.
This should be a wake up call for everyone who is a care giver in your home to go ahead today and start your research, visit, go different times of the day to any NHs your thinking of placing your LO in for several months so you can have confidence that your loved one will receive good care and go ahead and place their name on their list as the good ones have long waiting list..please know that. .
Perhaps others who have found a good NH for their LO will share what you should look for on your visits.
On NH comparison you will be able to look back for at least 3 years for any deficiencies, abuse, etc. I would check all in your area. The one I really liked for my husband and felt he would have received very good care, should I have not been able to have given him the best of care at home, didn't call that his name had came to the top until 7 months after I placed his name..2 week after his passing. I did have his name on one other NH..not my first choice...thank God we didn't need them. I feel even if your determined to keep your LO at home you need to do this as you never know something could happen to you or you could break a leg, et. So go ahead and get moving with this please.
I know here they call you when your LO's name comes to the top and if your not ready it will be placed at the bottom again..but they are more willing to work with you in an emergency situation if your LO's name has been on the list for several months. - Alice
--- When to seek Nursing home care ----
There are multiple aspects to this issue…..
From home - The answer to this question depends not on some arbitrary point in the progression of the disease, but on the caregiver. Generally, admission is needed when the care is more than the caregiver can give. For instance, the caregiver is exhausted and cannot get enough sleep to function properly. Another explanation - his or her care needs or behaviors exceed the abilities or resources of their family or friends to care for them at home. This may include the need for skilled nursing care (e.g. treatment of infected ulcers) or behavior that requires physical intervention (e.g. agitation or violent conduct, wandering off, falling).
From assisted living -- Some assisted livings demand the LO to move out when bowel incontinence starts. Others will keep longer. When the person is not eating properly or getting proper nutrition. At this time it is generally time to move to nursing home where they develop and follow a plan of care to make sure that the person is getting proper nutrition and hydration.
Money issue - It is usually better to look for a nursing home when there is still enough money left to pay for a years worth of care. (Make sure the nursing home accepts- keeps Medicaid residents) If you are looking for admission when the person has exhausted funds and is on Medicaid, the selection and desirability of the available NH is not as good.
-- Selecting a nursing home --
www.medicare.gov/NHCompare
Two other very infromative sights: ....please check:
www.elder-abuse-foundation.com/html/choose.html
memberofthefamily.net/reports.htm
-- Nursing home check list. --
I am not a big fan of checklists. They focus too much on all kinds of physical details of the facility instead of the important elements of good enlightened dementia care. But since everyone seems to want a checklist, here is one from medicare dept.
www.medicare.gov/nursing/checklist.pdf
The Alzheimers association is attempting to define what is needed to provide good dementia care in a facility
www.alz.org/professionals_and_researchers_dementia_care_practice_recommendations.asp
--- The difference between assisted living and a Nursing Home -----
Assisted-living facilities usually provide private, apartment-style housing and offer a range of services. These services may include meals, cleaning and laundry services, and help with personal needs, such as bathing, grooming, and dressing. Assisted-living facilities do not provide medical care. An assisted-living facility may be appropriate for people with early mild Alzheimer's disease or another dementia who cannot live alone but who can still function fairly well on their own. ALs have few regulations to follow, so the type of care varies greatly. They are not required to have a nurse in the facility round the clock, so there may only be a few aides overnight. They are generally not allowed to have residents that require a high level of skilled medical care. How much assistance the AL is willing to provide to a resident varies. The cost structure also varies. Some charge according to a care level (from 1 of 3 levels for instance). Others charge a base rate plus charges from a checklist for each activity the person needs help with. Everyone would rather have their LO in an assisted living because they are less institutional and home-like, have atmosphere (and wall paper) and have private rooms. But the person may require a higher level of care that the assisted living cannot provide well.
Nursing homes provide skilled nursing care up to 24 hours a day. All aspects of care are provided, including medical attention, medication, housing, meals, laundry, help with personal needs (such as dressing, bathing, and using the toilet), and other support services. A nursing home is the most expensive type of long-term care facility, but it also may be the most appropriate choice for many people with advanced dementia. NH must comply with Federal requirements and must be able to provide for all the care the residents need. (In some states, there NHs with different class of skill levels.) All nursing homes must provide services per regulations, including activities appropriate for the resident. While federal regulations generally control NH operations, some states have laws requiring higher staffing ratios.
Special care units (SCUs) for people with dementia are a feature of some residential care facilities and nursing homes. These units are designed to meet the needs of people with this disease, and they include staffs experienced in dealing with people suffering from dementia. These are usually secure units, to prevent wandering and elopement. They should be designed to accommodate wandering/pacing behavior. At least one study indicates that people do better when the unit has 23 or fewer residents. It is critical that there is a program of meaningful activities
---- Who provides medical care ----
Most assisted livings do not have a “staff doctor”. Residents are expected to have their own doctor. So if the person is having dementia problems that need the intervention of a doctor, admission to an AL is not likely to solve them. In fact, the environment may make things worse. The AL will expect the caregiver and the resident’s doctor to resolve these problems.
In a nursing home, there is a staff doctor who is legally, the “Medical director.” Residents can still use their personal doctor if they wish, but would likely have to travel to the doctor’s office for appointments. It is easier to use the doctor at the nursing home. Since 50% of people in nursing homes have some degree of dementia, Nursing Home doctors usually have a reasonable knowledge treating dementia. They also have a reasonable ability to treat common chronic ailments of the elderly. The objective is usually to provide as much medical care in the facility without having to transport the resident to doctor’s offices. Physical therapists visit and use therapy rooms in the facility, visiting dentists provide care in the NH, etc Residents will still need to be taken out to see specialists however.
I have seen medical practices that specialize in medical care in Nursing Homes. This meant that a doctor was in the building almost every day, and there was always coverage by a doctor when problems arose.
In Columbus there was a doctor who specialized in dementia care and consulted/visited about 50 nursing homes. I doubt if similar practices many other places. (I would be interested if anyone else has seen anything similar.)
--- Hospice care ---
Most nursing homes have services from a hospice provider available. The hospice provider must have a written agreement with the Nursing home, since the Hospice becomes legally responsible to develop the person’s plan of care. So the hospice available will be the one/s selected by the Nursing home. My experience is that Nursing homes do not recommend contacting Hospice as soon as they should. Some nursing homes do not want hospice in their facility and do not have a hospice agreement in place.
---- Misc-----
Legal strategy makes Nursing homes lawsuit-proof when they deliver poor care
New York Times September 23, 2007
"More Profit and Less Nursing at Many Homes"
www.nytimes.com/2007/09/23/business/23nursing.html?_r=2&th=&emc=th&pagewanted=print&oref=slogin
From a post by Alice alzheimers.proboards32.com/index.cgi?board=ADgen&action=display&thread=1196268391
What Susan and Lewie are going through should be a wake up call for everyone who is a care giver. All that happened to Susan was because of being hospitalized unexpectedly. There was no other choice but to place Lewie where there was an opening.
This should be a wake up call for everyone who is a care giver in your home to go ahead today and start your research, visit, go different times of the day to any NHs your thinking of placing your LO in for several months so you can have confidence that your loved one will receive good care and go ahead and place their name on their list as the good ones have long waiting list..please know that. .
Perhaps others who have found a good NH for their LO will share what you should look for on your visits.
On NH comparison you will be able to look back for at least 3 years for any deficiencies, abuse, etc. I would check all in your area. The one I really liked for my husband and felt he would have received very good care, should I have not been able to have given him the best of care at home, didn't call that his name had came to the top until 7 months after I placed his name..2 week after his passing. I did have his name on one other NH..not my first choice...thank God we didn't need them. I feel even if your determined to keep your LO at home you need to do this as you never know something could happen to you or you could break a leg, et. So go ahead and get moving with this please.
I know here they call you when your LO's name comes to the top and if your not ready it will be placed at the bottom again..but they are more willing to work with you in an emergency situation if your LO's name has been on the list for several months. - Alice
--- When to seek Nursing home care ----
There are multiple aspects to this issue…..
From home - The answer to this question depends not on some arbitrary point in the progression of the disease, but on the caregiver. Generally, admission is needed when the care is more than the caregiver can give. For instance, the caregiver is exhausted and cannot get enough sleep to function properly. Another explanation - his or her care needs or behaviors exceed the abilities or resources of their family or friends to care for them at home. This may include the need for skilled nursing care (e.g. treatment of infected ulcers) or behavior that requires physical intervention (e.g. agitation or violent conduct, wandering off, falling).
From assisted living -- Some assisted livings demand the LO to move out when bowel incontinence starts. Others will keep longer. When the person is not eating properly or getting proper nutrition. At this time it is generally time to move to nursing home where they develop and follow a plan of care to make sure that the person is getting proper nutrition and hydration.
Money issue - It is usually better to look for a nursing home when there is still enough money left to pay for a years worth of care. (Make sure the nursing home accepts- keeps Medicaid residents) If you are looking for admission when the person has exhausted funds and is on Medicaid, the selection and desirability of the available NH is not as good.
-- Selecting a nursing home --
www.medicare.gov/NHCompare
Two other very infromative sights: ....please check:
www.elder-abuse-foundation.com/html/choose.html
memberofthefamily.net/reports.htm
-- Nursing home check list. --
I am not a big fan of checklists. They focus too much on all kinds of physical details of the facility instead of the important elements of good enlightened dementia care. But since everyone seems to want a checklist, here is one from medicare dept.
www.medicare.gov/nursing/checklist.pdf
The Alzheimers association is attempting to define what is needed to provide good dementia care in a facility
www.alz.org/professionals_and_researchers_dementia_care_practice_recommendations.asp
--- The difference between assisted living and a Nursing Home -----
Assisted-living facilities usually provide private, apartment-style housing and offer a range of services. These services may include meals, cleaning and laundry services, and help with personal needs, such as bathing, grooming, and dressing. Assisted-living facilities do not provide medical care. An assisted-living facility may be appropriate for people with early mild Alzheimer's disease or another dementia who cannot live alone but who can still function fairly well on their own. ALs have few regulations to follow, so the type of care varies greatly. They are not required to have a nurse in the facility round the clock, so there may only be a few aides overnight. They are generally not allowed to have residents that require a high level of skilled medical care. How much assistance the AL is willing to provide to a resident varies. The cost structure also varies. Some charge according to a care level (from 1 of 3 levels for instance). Others charge a base rate plus charges from a checklist for each activity the person needs help with. Everyone would rather have their LO in an assisted living because they are less institutional and home-like, have atmosphere (and wall paper) and have private rooms. But the person may require a higher level of care that the assisted living cannot provide well.
Nursing homes provide skilled nursing care up to 24 hours a day. All aspects of care are provided, including medical attention, medication, housing, meals, laundry, help with personal needs (such as dressing, bathing, and using the toilet), and other support services. A nursing home is the most expensive type of long-term care facility, but it also may be the most appropriate choice for many people with advanced dementia. NH must comply with Federal requirements and must be able to provide for all the care the residents need. (In some states, there NHs with different class of skill levels.) All nursing homes must provide services per regulations, including activities appropriate for the resident. While federal regulations generally control NH operations, some states have laws requiring higher staffing ratios.
Special care units (SCUs) for people with dementia are a feature of some residential care facilities and nursing homes. These units are designed to meet the needs of people with this disease, and they include staffs experienced in dealing with people suffering from dementia. These are usually secure units, to prevent wandering and elopement. They should be designed to accommodate wandering/pacing behavior. At least one study indicates that people do better when the unit has 23 or fewer residents. It is critical that there is a program of meaningful activities
---- Who provides medical care ----
Most assisted livings do not have a “staff doctor”. Residents are expected to have their own doctor. So if the person is having dementia problems that need the intervention of a doctor, admission to an AL is not likely to solve them. In fact, the environment may make things worse. The AL will expect the caregiver and the resident’s doctor to resolve these problems.
In a nursing home, there is a staff doctor who is legally, the “Medical director.” Residents can still use their personal doctor if they wish, but would likely have to travel to the doctor’s office for appointments. It is easier to use the doctor at the nursing home. Since 50% of people in nursing homes have some degree of dementia, Nursing Home doctors usually have a reasonable knowledge treating dementia. They also have a reasonable ability to treat common chronic ailments of the elderly. The objective is usually to provide as much medical care in the facility without having to transport the resident to doctor’s offices. Physical therapists visit and use therapy rooms in the facility, visiting dentists provide care in the NH, etc Residents will still need to be taken out to see specialists however.
I have seen medical practices that specialize in medical care in Nursing Homes. This meant that a doctor was in the building almost every day, and there was always coverage by a doctor when problems arose.
In Columbus there was a doctor who specialized in dementia care and consulted/visited about 50 nursing homes. I doubt if similar practices many other places. (I would be interested if anyone else has seen anything similar.)
--- Hospice care ---
Most nursing homes have services from a hospice provider available. The hospice provider must have a written agreement with the Nursing home, since the Hospice becomes legally responsible to develop the person’s plan of care. So the hospice available will be the one/s selected by the Nursing home. My experience is that Nursing homes do not recommend contacting Hospice as soon as they should. Some nursing homes do not want hospice in their facility and do not have a hospice agreement in place.
---- Misc-----
Legal strategy makes Nursing homes lawsuit-proof when they deliver poor care
New York Times September 23, 2007
"More Profit and Less Nursing at Many Homes"
www.nytimes.com/2007/09/23/business/23nursing.html?_r=2&th=&emc=th&pagewanted=print&oref=slogin