Yena accepted that verdict last fall, but four different institutions have failed to meet her father’s needs. He wandered away from one assisted-living facility, and the next one was unable to provide adequate care. Nor could either of his first two nursing homes. “The salespeople tell you how great their facilities are,” Yena says. “But they’re short staffed, they don’t follow through on things and they resent it when you try to get involved.” Last week her father was in Chicago’s Rush-Presbyterian-St. Luke’s Medical Center, resting up for yet another transfer.
Countless families now face similar dilemmas. More than 22 million U.S. households are involved in an aged relative’s care, and 40 percent of them are simultaneously raising children. The problem is growing as the elderly population explodes, yet few of us are prepared to deal with it. Among adults who say their elderly parent has a regular physician, 45 percent don’t know the doctor’s name, according to a recent study by the Kaiser Family Foundation. And 43 percent know little about their parents’ health insurance. The obstacles to finding good care are daunting, but with careful planning you can overcome them. Here are some tips:
Plan ahead. Start weighing options before you face an emergency. By sitting down early with a doctor, a lawyer and a social worker, you can calmly assess an aging person’s likely needs. For help finding information and experts, contact the National Association of Area Agencies on Aging (800-677-1116) or the National Association of Professional Geriatric Care Managers (caremanager.org).
Count your money. The facility you choose will depend partly on fees, payment procedures and insurance coverage. Does your relative have long-term-care insurance? Will you need a place that accepts Medicaid and Medicare? These government programs cover only nursing care, not assisted-living arrangements, and not all nursing homes accept Medicaid or Medicare payments. If you choose a retirement community with graduated levels of care, “make sure you understand how changing needs will affect the costs you pay,” says Karen Wayne, president of the Assisted Living Federation of America. “It can come as a shock to your pocketbook.”
Check the record. Once you identify the type of care you need, use the Internet to identify the best facilities in your area. Medicare.gov posts inspection reports under “Nursing Home Compare.” CareScout.com rates the quality of different nursing homes, and the Consumer Consortium on Assisted Living (ccal.org) offers a good checklist for evaluating those facilities yourself. Other useful sites include careguide.com, seniorhousing.net, alfa.org, naela.org and aahsa.org.
Look for yourself. When you visit a home, make sure a physician is always available for emergencies. Look for safety features such as well-lit stairs and handrails in bathrooms. And don’t mistake fancy decor for quality of life. Are residents free to bring their own furniture and personal items? What happens if someone misses or refuses a meal? Who decides when a person is no longer able to stay there? Will residents get to see young people, or just their peers? The Pleasant Bay Nursing and Rehabilitation Center in Brewster, Mass., maintains an onsite preschool for its employees, enabling toddlers and oldsters to spend time together.
Check staffing. The 1987 Nursing Home Reform Act leaves staffing requirements largely to the states. Only seven of them mandate 24-hour care by a registered nurse, and more than half of all nursing homes are now short on nurses’ aides. Inadequate staffing has been linked to such problems as malnutrition, dehydration and pressure sores. A bill before the Senate would provide $1 billion over two years to address the problem. The nursing-home industry says it can’t afford more staff–partly because it spends so much insuring itself against legal actions by residents.
The sad truth is that aging parents sometimes require more care than any family can provide. Adults with Parkinson’s or Alzheimer’s can require 80 hours a week from their caregivers, and any disabled adult may be too heavy for a spouse or daughter to lift. Institutional care is no one’s first choice. But a high-quality facility may help you spend less time feeling stressed and inadequate, and more time planting kisses on well-worn cheeks.
