The decision to place an elderly relative in a nursing home is always difficult for a family.

For the patient, a nursing home represents a frightening loss of independence and abandonment by family and friends. For the family, the decision creates guilt feelings, even when they can no longer care for the elderly relative. To lessen feelings of fear and guilt, it helps to involve the patient, if possible, in choosing the nursing home. Adjusting to nursing home life will be easier if your relative understands the alternatives, and feels his or her wishes are being considered.

Types of Nursing Homes

Patients and their families can choose from three types of facilities, depending on the level of care needed:

• Skilled Nursing Facility: This institution provides the most intense care, including round-the-clock attention from registered nurses; physical, occupational and nutritional therapy; and social services.
• Health-related Facility: This organization provides care for those who do not require skilled nursing, but need a protected environment and assistance with daily activities.
• Combined Facility: This type of facility provides both levels of care. If a patient’s condition changes, he or she may simply be moved to another area.

What to Consider

Your primary concerns should be the quality of the nursing home’s care and its location. Frequent visits by family and friends can lessen feelings of loneliness and make the transition to a nursing home smoother. Before choosing a facility, speak to people with relatives in the homes you are considering. In other words, get some references. You should consult the local Department of Aging for further information about the homes. If there have been complaints, they might be able to advise you.

Most importantly, visit the facility, and do so unannounced at least once. On your visit, pay attention to how well the home is kept. If the staff is sloppy about cleanliness, chances are they are slipshod in other important areas. Is the atmosphere homey or institutional? Is there an outdoor seating area for residents? People confined to an institution develop a strong need to occasionally get out of doors. Note the residents’ appearance and behavior and whether they are involved in activities. Ask them how they like the home.

Observe the staff. How do they interact with residents? Do they seem friendly toward the residents? Do they respond promptly to calls? Are they personally well groomed? Also, check the quality of the food. Most organizations will invite you to dine with them. If so, take them up on the offer. Do those residents who need help eating get the proper assistance? Is food served at the right temperature? Visit the activity room. Is it well equipped and staffed? Do residents participate? Are efforts made to engage residents in activities? Does there seem to be enthusiasm for activities?

The nursing home must have on view a Consumer Information System poster summarizing findings of the most recent Health Department inspection. Look for that poster and read it very carefully. If you do not see one displayed, ask about it.

Meeting the Staff

After visiting the facilities, consult with the admissions staff about their policies. What is the make-up of their present enrollment? Does the home have a waiting list? How long are applications kept on file? What application forms are required?

Discuss financial matters. Does the home accept Medicaid? It is very important to be certain the extent of Medicare coverage applicable to their charges. What portion does Medicaid cover? What services are included in the basic rate? There are bound to be items that are not covered. Get a complete list of extra charge items and carefully weigh each item. A nursing home with a moderate basic rate may be planning to get substantial revenue from such add-ons.

Inquire about medical services. Are physicians on staff? Can residents select a doctor from among the staff physicians or use their private physician? What arrangements are made for emergency care? What hospital would a resident be taken to? How close is it, and is it well equipped and well-staffed? It is ideal to have the patient visit the home, too. If that is impossible, describe the facility to the patient and give them an opportunity to review literature without feeling pressured.

Most nursing home placements are made from acute care hospitals where the person is recovering after an illness or accident. Long waiting lists may preclude placement at some of the most desired facilities, so it is best to plan early. If a patient is admitted to a hospital and it seems likely he or she may need to be placed in a nursing home, the family should contact the hospital’s Social Service Department. Although the final choice may be limited by factors beyond the patient’s or family’s control, remember placement does not have to be permanent. Transfers can be made to other nursing homes that are more satisfactory or convenient.