Mobility, falls, feeding, incontinence and dementia-related issues often are the driving forces behind older adults moving from their homes to assisted living facilities or nursing homes.
Even when you know your loved one no longer can live at home safely, the decision is difficult. Knowing what to look for in a long-term care facility and what questions to ask can make the transition easier.
Explore in-home services first
Scott Seeger, a Marshfield Clinic social worker, recommends exploring in-home supportive services before making a permanent move to a long-term care facility. Supportive services can be especially helpful for people returning home from short-term post-acute care in a nursing home after illness or injury.
“People who don’t need 24-hour care may be able to secure services to stay in their homes safely,” he said.
Adult day services are another option to give caregivers a break and provide assistance and activities for people who aren’t ready to move to a long-term care facility, said Dr. Scott Erickson, a Marshfield Clinic geriatrician.
Community organizations provide help with personal care, chores, errands, meal preparation and transportation to medical appointments. Marshfield Clinic’s community resources department or your county’s Aging and Disability Resource Center can connect you with supportive service providers in your area.
Choose the right type of facility
“Nursing home placement is driven by the inability of caregivers to keep up with the day-to-day demands of the patient, even with the assistance of in-home services,” said Dr. William Yanke, a Marshfield Clinic geriatrician.
If your loved one can’t live at home safely, you’ll need to decide which type of long-term care facility is best. Social workers and staff at the facility can help you answer this question.
Assisted living facilities offer different levels of help with personal care activities for people who don’t have demanding medical needs. Skilled nursing facilities have nursing staff in the building 24 hours a day and doctors on call.
Ask about how well the facility is equipped to handle specific safety needs. Is there adequate support to reposition and transfer patients who can’t get up and walk? Is there supervision for people who may try to wander from the facility?
Consider the facility’s location. Is it most important for your loved one to stay in his or her community, or to be near family members who can visit often?
Ask questions and look around
“Get out and tour different facilities,” Seeger said. “Ask for a summary of costs and a list of services that involve extra fees. It’s fair to ask for references from people who live there.”
Check out the activities offered. Are they catered to people who function at a higher or lower level than your loved one? Are they appealing? Can residents request transportation to off-site activities?
Look at the menu options and ask residents what the food is like. Is the food prepared on-site or pre-cooked and delivered to the facility? Can residents make meal requests?
Find out what community members say about the facility. Religious leaders sometimes have feedback on what they hear about the facility and what they see when they visit parishioners, Seeger said.
Cope with difficult feelings
Moving to a long-term care facility can trigger difficult emotions for the person making the move. Counseling can help someone who is grieving loss of independence. Encourage your loved one to be upfront about their feelings and concerns.
Talk to health care providers about whether it may be possible for your loved one to return home after a temporary stay.
“Elders sometimes perceive a nursing home placement as a life sentence rather than a potential bridge to functional recovery sufficient to return to a less restrictive place in the community,” Erickson said.
Family members may feel guilty about bringing up long-term care and worry that a relative who chooses to stay at home will get injured or sick. However, a caregiver who becomes physically and emotionally unhealthy from worry won’t be able to help an aging loved one.
If the time comes for your loved one to enter a long-term care facility, look to their health care providers to support the transition. Ask if their current primary care provider can continue seeing your loved one as a patient after the move to long-term care.
“I frequently tell caregivers they shouldn’t be too hard on themselves when it comes to needing to place a loved one in a nursing home,” Yanke said.
One more thing to consider
Talking to your loved ones about what kind of health care they want as they age and who they want to make their health care decisions if they become unable to do so can be helpful before and after they enter long-term care.
A social worker in Marshfield Clinic’s Community Resources department can help your loved ones document their wishes in a health care advance directive.