Preparing a loved one for a nursing home or residential care living – Part II

In part one of this two-part series, we discussed some of the important steps toward placing a loved one or friend in the care of a nursing home or residential care facility.  As we previously discovered, this is a very challenging topic for nearly everyone and requires bravery, patience, teamwork, and sometimes the help of an attorney, financial consultant, or others.  Afterall, that loved one who may have once cared for you and gave you unconditional love and attention, now needs your unconditional love and attention in return.

So the decision to place a loved one in a nursing home or residential care facility has been made.  Now what?  Hopefully, the decision is not rushed because of an unexpected illness or concern being experienced by the loved one or friend.  If you are rushed to make a decision, please consider observing as many of the following steps as possible.  If you aren’t rushed, your careful observance of the following steps in their totality should help provide welcomed comfort.

First, compare and contrast assisted living care with nursing home care.  Many people continue to confuse the two options even though they have become distinctly different in the last few decades.  To that end, it is important that you perform some research and have a solid understanding of how they differ. Assisted living care provides long-term housing for older adults who are generally active but need support with activities of daily living. These daily living activities could include bathing, dressing, using the toilet, and managing medications.  In contrast, nursing homes serve seniors and others who require full-time monitoring and medical assistance.  These facilities offer the highest level of care for individuals who do not require hospitalization.  People who need nursing home care often have severe physical or cognitive health conditions that require twenty-four-hour nursing. They may be bedridden or require the use of a wheelchair.  Most of these people would be helpless if left alone.

According to a survey by A Place for Mom, a privately held, for-profit senior care referral service headquartered in New York, New York, of 100 families surveyed, 89 of those families determined that nursing home care was not the right choice for their loved one after consulting with a senior living advisor.  For some of those surveyed, the factors that helped them make their decision were that assisted living care and nursing home care can be very different when it comes to cost, and the types of residents they serve, and the level of caregiving they offer.

Next, enlist the input of your parents, friends, and other family members.  Family harmony makes this very important process much easier if the senior loved one is a parent. But in many families, conflicts between siblings undermine good planning. So if you have siblings, it is best to reach out to them early in the process and invite them to work with you for the benefit of your loved one. You and your siblings may need time to overcome disagreements or long-held resentments.  All of you should be transparent and then decide what each of you can contribute to the process going forward. When discussing the topic with siblings, each of you should discuss your expectations for inheritance and how you will reconcile those expectations with the immediate need to care for your aging parent.  Let’s face it, in many family settings, some siblings worry more about spending away their inheritance than taking care of their loved one.  In other families, one sibling may assume more responsibility than the others.  But if this occurs, continue to seek everyone’s involvement and contribution so that a team atmosphere abounds.  If necessary, seek family counseling if necessary.

When a senior loved one refuses assisted living or nursing home care, it could be because he or she feels pressured.  To avoid this, stay sensitive to their feelings, continue to involve others, and provide each of them with the result of your research so they feel there is consensus on the decisions being made.  Perhaps involve the loved one to such an extent that he or she feels like a leader in this process. These sensitive discussions will include all options for future caregiving arrangements and all available resources.  At all times, avoid misleading your loved one and do not make promises you cannot keep.  If you lose the trust of your friend or loved one at this late stage in his or her life, you may lack sufficient time and resources to mend those fences.

Finally, visit and evaluate various nursing homes and residential care facilities in your area.  Take the senior adult along for as many facility tours as he or she is willing to attend. Try to make these visits as fun as possible.  In one scenario, a client of my firm made these trips like a scavenger hunt with a list of 20 things to look for.  In the event you don’t have time to make your own scavenger hunt list, perhaps incorporate the following variables when making your decision:

1. • What is the overall condition of the facilities?
   • How many staff members are present and how did they interact with residents?
   • How are cognitively impaired residents treated?  Were they left alone or were they in the company of others?  How many residents were seated in wheelchairs?
   • Ask questions of other residents and participate in a few activities with them if possible.
   • Participate in a facility meal and ask how the kitchen handles special dietary needs.
   • Ask about security and whether the facility has a special section for dementia residents.
   • Ask about theft instances at the facility or other crimes.
   • What is the age, gender, and race of the employees?
   • Ask them how many past or present claims of elder abuse they have experienced.
   • Look at an actual room to see how your loved one’s room might appear.
   • Discuss amenities such as salons, religious activities, television, internet, shuttle vans, etc.
   • Ask if the facility is pet friendly.
   • See if your loved one recognizes any friends or acquaintances at the facility.
   • Ask how the facility responds to medical emergencies.
   • Ask who the primary care provider is for the facility and how often they make rounds.
   • Ask the facility administrator about cost, funding options, availability, and what steps are required in order to admit your loved one.
   • Record how long it takes for you to travel to the facility.  How long will it take other relatives?
   • Is the facility close to hospitals and other specialty care facilities.

Upon conclusion of your facility tours, meet with everyone on your decision-making team to review all findings. Work together to decide how responsibilities will be divided before, during, and after the loved one’s transition to a care facility. Even if some can’t provide equal support, try to make sure that everyone on your team is still contributing something meaningful to the effort.  This collaboration should be ongoing.  Change is inevitable, so your plans may change one or more times.  Stay flexible by continuing to review facilities and the treatment of your loved one.  They gave you their best when you needed them.  Now it is time for you to give them yours.

Todd Miller is a regular contributor.  He writes and speaks on various legal topics including bankruptcy, estate planning, probate, and elder law.  In 2006, he formed the Law Office of Todd Miller, LLC, 1305 Southwest Blvd., Ste. A, Jefferson City, Missouri.  He has been awarded the Substantial Contributor Attorney Award by the Missouri Bar and ranked as one of the “Top Attorneys in Missouri” by The Legal Network.  Mr. Miller earned his juris doctorate degree from the University of Missouri School of Law in 1999 and graduated with honors from Lincoln University in 1991.  You may find him at www.toddmillerlaw.com (573) 634-2838 or on Facebook, Instagram, and Twitter.