Choosing a Nursing Home for your Elderly Loved One in Northeast Florida

Choosing a Nursing Home for Your Elderly Loved One

Contributed by
Dena Howard, J.D.
ElderCare Jax
Serving - Jacksonville ~ St. Augustine ~ Daytona Beach, Florida
www.eldercarejax.com
(904) 536-3890

Most people dread the day they have to deal with the thought of moving their elderly loved ones into a nursing home. Caregivers often feel guilty about the decision, and we are confused, overwhelmed, and a little scared about making the right choices. This article is based on a workshop we offer to help caregivers make the best decisions for their aging loved ones and themselves.

In the State of Florida, a physician must authorize the admission of someone into either an assisted living facility or a nursing home. (There are two different forms the doctor completes for these facilities.) The doctor’s decision may occur after your loved one has been in the hospital, and then is discharged to a nursing home for a short term stay or rehab. But when the rehab is over, how do you know whether your loved one should stay there or can go home again?

Or how about the situation where someone’s health at home deteriorates? He falls, or she begins to wander outside the house. They aren’t taking their medicine when they should, or they stop eating good food or stop doing personal hygiene. When is the right time for a nursing home?

At Senior Care Managers, we help elders stay at home as long as possible before moving them into assisted living or nursing homes. We first consider bringing in help at home -- housekeepers who cook, do laundry, go shopping, provide transportation; or sitters for company; or home health aides and nurses for more hands-on personal care and medical monitoring.

Home care for a few hours a day is one of the best health care purchases you can make. It helps the elder get used to accepting assistance, it provides company and socialization, it enables the elder to continue to “be in charge” at home and it helps relieve caregivers.

But when home care begins to extend to 12-hour, 18-hour or 24-hour days, it is very expensive and Medicare pays for almost none of it. Which means, of course, that you need to have a long term care policy that helps pay for it or you are footing the bill entirely, which is most often the case.

So, when considering someone’s needs, you must consider the cost and your loved one’s ability to pay.

You need to also consider medical needs. You can have a hospital bed at home along with nurses and trained aides to handle even complex medical conditions. Often, people with terminal illnesses or who have been a hospice for a period of time choose to be at home when they die. You don’t need to be terminal to have hospital-like care at home. That choice involves the elder’s home environment, the ability of the spouse or caregiver to cope with and help with their medical needs, and the doctor’s recommendations.

Many times the question of nursing home care comes up with someone who shows signs of dementia or Alzheimer’s Disease. They are incontinent and won’t let anyone help them shower. They wander out of the house and down the street. They have mood swings that are difficult for the spouse or caregiver to handle, or may stay up during the night.

Many assisted living facilities have accommodations for people with dementia. Some places are specially designed for that population. Someone with dementia doesn’t necessarily have to go to a nursing home. However, most ALF’s will not admit elders who are hostile or combative due to dementia or other conditions. And some ALF’s do not have secured wings or sections in their facility that protect wanderers.

Assisted Living or Nursing Home?

4 Main Issues:

1. Mobility

How can you tell whether your loved one would be fine in an ALF or needs nursing home care? The first criteria that most assisted living facilities (ALF’s) use to determine if someone is appropriate for their care is whether the elder can transfer himself. hat means that he or she must be able to sit up in bed and move into a wheelchair or another chair, or move from a wheelchair to the toilet. Some ALF’s have other restrictions, such as, using a walker is acceptable, but not a wheelchair.

2. Medical Needs

Next, ALF’s consider other medical needs, such as the number of medications and times of days they must be administered. If someone needs IV therapy (medications through an IV), they generally need skilled care at a nursing home. Then consideration is given to your loved one’s abilities for personal care, such as dressing, bathing and toileting. The more help he or she needs, the less likely they will be able to function well in an ALF and will need nursing home care.

What many ALF’s tell me is that the words “assisted living” means that they are there to help someone who is still independent in many ways but needs only some help. The degree of assistance varies with each facility, and some ALF’s charge for the level of help they provide to each resident as needed. The more dependent the elder is for their activities of daily living, the more they will need nursing home care.

3. Demands on Caregivers

Another important consideration that spouses or caregivers must have is how long they can continue to provide care for their loved one at home. A survey conducted by the National Family Caregivers Association shows that a majority of caregivers are female spouses who are elderly and need help themselves. An increasing number of caregivers become ill from the stress and daily exhaustion of caregiving, and many die before their loved ones.

One of the most loving acts that a caregiver can do for their loved one is to make decisions based on everyone’s needs, not just their loved one’s needs. Often, that means that a decision to move the elder into an ALF or nursing home is the toughest -- and most loving -- decision to make. Caregivers need to take care of themselves so they can go the distance for their loved ones.

4. Money

Finally, how are you going to pay for an ALF or nursing home? Most ALF’s are private pay. That means that there are very few ALF’s that will accept Medicaid payments to supplement the cost of care. ALF’s in northern Florida vary from $1800 to over $3000 per month. Added on top of the monthly cost will be medications, clothing, incontinence supplies, etc. You need to plan how long your loved one’s savings will last based on expenses in an ALF.

Elders receive only a little help from Medicare when they go to a nursing home. Medicare can help pay for up to the first 100 days in a nursing home, after the elder has had skilled care in a hospital for at least 3 days. After that, nursing homes are providing “custodial care” and Medicare will not cover that. When your loved one moves into a nursing home directly from home, or needs “custodial care”, the nursing home will charge you a private pay rate. Nursing homes in northern Florida average $135 per day, ranging from $115 to $175 a day, or $3,500 to $5,800 per month. Unless you have a long term care insurance policy that will supplement this cost, again, you must determine how long your loved one can afford to pay privately.

Once elders spend down their assets to $2,000, and have less than about $1,800 per month income (for one person, figures vary for couples), they are eligible for financial assistance for nursing home care from Medicaid. There are complicated rules about Medicaid eligibility, and you should consult a geriatric care manager or elder law attorney for financial planning for Medicaid.

The decision, then, to move to a nursing home is one that involves the doctor’s recommendations based on your loved one’s medical needs, the level of care needed for activities of daily living, the cost of care, and the caregiver’s needs.

When you have determined that your loved one needs a nursing home, the next step is to find a good facility that is close to family and friends. Your loved one needs to have frequent visitors and family and friends may not drive across town often enough to visit. The Options directory lists facilities in five northeast Florida counties and I use it all the time to find a phone numbers and addresses.

You should also find out how the State of Florida rates the nursing homes you might consider. The Agency for Health Care Administration publishes quarterly reports on facilities that have been cited for poor care. The agency will send the latest report, or you can read it on the Internet at www.ahca.gov/nurhome/survey.

After you have found 3 facilities in a good location, you should call the admissions staff and schedule a tour. We all our tours a “Sniff and Snoop Tour.” We want you to be very observant when you go in the nursing homes. How does it smell? Do residents look alive, active and happy? Do you have time to look around

During your visit, the admissions staff should give you a written list of services and fees. Some places charge extra for laundry, hairstyling, transportation, or other necessary services.

Generally, most physicians in the community stop seeing patients who move into nursing homes unless the patients continue to go to their offices for appointments. Nursing homes have one or more physicians who serve as medical director of the facility. The medical director then becomes the elder’s primary care physician, unless you want to continue care with the physician in the community, in which case the medical director supervises the outside physician’s prescribed care with the nursing home staff.

Currently, Medicare pays for many routine annual exams, such as ob/gyn exams for women, and prostate exams for men. Medicare also pays for podiatry care and dental screenings. If the nursing home you are considering does not provide those services in-house, you will need to take your loved one outside to physicians in the community.

Most nursing homes have moved away from an institutional model of care to a home environment model of care. Residents are dressed and moved from their rooms to congregate dining halls for meals and engaged in activities throughout the day, including off site field trips. Good people to meet during your tours are the nurse manager, social worker and activities director. Try to talk to nurse assistants or aides on the floor if you can, and family members of residents.

After you leave, try to take a few minutes to write down your observations and feelings before you drive home. You will be surprised how much you remember at that moment, but the longer you take to make notes, the less you will recall.

I have found that elders are susceptible like everyone else to hearsay stories. You know, “they say” that so-and-so nursing home is an awful place, or that another one is a great place. It’s hard to tune out that kind of talk, especially when it comes from close friends or family.

If you use the information I’ve given you here, you will have a lot more to go on than someone’s opinion or rumors. But if you still feel that you could use someone to advise you about this important step to take, call us! We are really good at this. Let us help you prioritize your loved one's needs and consider the best options so you can make an informed choice.