|
The 2010 U.S. Census determined that 13.0% of Americans were over the age of 65. It also determined that Pennsylvania’s population included 15.4% people over the age of 65. Pennsylvania ranks 4th in the nation for percentage of population aged 65 or over. This creates unique opportunities and challenges in promoting the ongoing health of our residents.
As a whole we remain healthier longer and most of us will never need to reside in a nursing home. However, for more than 81,000 Pennsylvanians (March 2009) nursing home  placement was essential to attaining or maintaining their highest physical, social, and emotional well-being. We are fortunate in Pennsylvania because there are many nursing homes from which to choose. For additional information visit the Centers for Medicare and Medicaid Nursing Home Compare website.
Choosing a nursing home can be an emotionally challenging time in an individual's or family member's life. For most of us, as we grow older, we recognize the need to plan for the future. We may put our affairs in order so our children will not be burdened unnecessarily. While we may have the foresight to prepare a will, we often neglect to prepare for the possible need for nursing home placement. The Department of Health would like to encourage you to spend a little time thinking about your wishes and preferences. Even if you were not ready to choose a nursing home right now, we would like to provide you with some resources and tips you can consider in the future.
Do I need a nursing home? Are there other options?
 Nursing homes provide both short and long term nursing and rehabilitative care. Individuals who require nursing home care usually have great difficulty completing many daily activities independently. These individuals require supervision or assistance to complete activities such as taking medications, walking, completing grooming tasks like brushing their hair and teeth, taking a bath or shower, and using the toilet. This may have resulted from an acute illness (such as a fractured bone, stroke, etc…) or from long term chronic illnesses (such as arthritis, pulmonary diseases, dementia, etc…).
Nursing homes can be a place for someone who needs brief rehabilitation; it is no longer true that a nursing home placement is “forever.” Hospitals tend to discharge people sooner than they have in the past. Often a brief nursing home stay allows an individual to recuperate prior to returning to her/his previous lifestyle. Whether choosing a nursing home for a short-term or long-term stay, the first step is to have a physician evaluate your needs. The physician will determine the services you will need and make a recommendation for the length of your stay. Your physician may provide you with opinions as to the appropriate nursing homes to meet your needs. If you are in a hospital, the hospital social worker can also help you choose a nursing home and plan your discharge.
The Area Agency on Aging will also complete a need assessment to determine the level of care and length of stay appropriate to your situation. This is called an Options Determination. To learn more about this program go to the Department of Aging website.
Under certain circumstance you may even be able to rehabilitate at home with assistance from home health services. This option is considered when there is adequate support available from family, professional caregivers, and the communities in which you reside.
It is important to remember that nursing homes provide a high level of supervision and resident interaction. Some medical conditions require this intense type of monitoring, however, not all medical conditions require this skilled level of care. Some individuals can benefit from less stringent monitoring and assistance. Options for this type of care can vary widely including personal care homes, assisted living, boarding homes, and continuous care retirement communities (commonly referred to as CCRC’s). There is a wealth of information on these placement options available on the Internet. Simply enter key words and complete a search. The Pennsylvania Department of Public Welfare monitors many of these types of facilities.
Locating Nursing Homes in your area.
As we discussed earlier, in Pennsylvania we are fortunate to have over 700 nursing homes from which to choose. This said, it could also prove to be a bewildering experience when trying to select the nursing home that best suits your needs. A good beginning point is to talk with your Area Agency on Aging representative or Ombudsman. Because they typically deal with the nursing homes when assessing an individual's need for nursing home placement, they will be able to offer some insight as to the quality of care rendered at the facility.
Selecting a Nursing Home
It is often best to research as many nursing homes as possible prior to making your selection. By going to our web site you can print an alphabetical list of all nursing homes in the county that you select. Once you have the list, cross off those nursing homes that are outside of the area you feel comfortable traveling.
It will be important to determine whether the nursing home accepts insurance coverage, Medicare (for more information on Medicare coverage), Medical Assistance, or is private pay. It is important to consider whether a nursing home will be able to continue providing service if you run out of financial resources necessary for private pay placements. You may wish to discuss this with a financial advisor familiar with long-term care issues.
After you have determined the distance and financial status of the nursing homes on your list, it is time to review the types of services that each provides. Consider whether the nursing home offers services in-house such as physical and occupational therapies, counseling, activities and recreation, pharmacy, podiatry, specialized medicine, etc… Research which acute care facilities (hospitals) are nearby and with whom the nursing home has transfer agreements. Again, it is important to ask what services will be covered by insurance and what is paid for privately. For instance, television cable services, hairdressing, and telephone service charges often vary widely. Once you have completed these preliminary steps, your list should be down to a more manageable level.
Reviewing Survey Results
 With your list in hand, return to our web site to review the latest survey results on these nursing homes. Surveys record only the deficient practices that have been identified within the nursing home. All surveys will show the reader how serious the deficient practices are based on the frequency (how many residents are affected) and the severity (potential for harm vs. actual harm); this is called Scope and Severity. Please keep in mind that surveys do not identify the strengths of the nursing homes, only the deficient practices. Examine what has been identified as a problem in the nursing home, determine whether this issue is important or relevant to you and your own care needs. Remember that deficiencies are only one indicator of the care rendered at a nursing home and that many other factors should be taken into consideration. Each nursing home responds to the statement of deficiencies by writing and carrying out a plan of correction. These are also on the web site for your review. Beware of facilities that are continuously unable to correct deficiencies and have repeatedly received severe penalties for their non-compliance. Penalties for deficient practices are generally progressive unless the practice placed residents in extreme danger, which is considered immediate jeopardy.
Using a Checklist when Selecting a Nursing Home.
After reviewing the survey results, it is time to visit the nursing homes that remain on your list. Most nursing homes have admissions workers who will be happy to schedule a tour for you. Be sure that you are also welcome to drop in after your tour to review your first impressions. It is often helpful to visit in early evening so that you have observed the caregiving activities on both daylight and evening shifts. Checklists are a recommended way of recording your observations when you visit a nursing home. You can design your own or use one of the many checklists available on the Internet. Any checklist you choose to use should include some basic information. The following are suggestions for items that you may wish to include on your checklist. These are not all-inclusive but should rather be viewed as a starting point. Remember to put the date and time of your visit on each checklist as you visit nursing homes. A photograph of the outside of the facility can also be a good reminder. If the facility offers you a brochure be sure to attach this to your checklist.
-
Will you have to move to a different part of the facility based on your financial resources?
-
Is there a waiting list?
-
Does the facility have a license?
-
Is there a licensed nursing home administrator?
-
When you enter the nursing home, what is your first impression?
-
Is it a warm and inviting environment?
-
Is it odor free?
-
Is the temperature comfortable?
-
Is it clean?
-
Is it quiet?
-
Do staff and residents appear to interact with ease?
-
Are there regular staff or does the facility depend on Agency or contracted employees?
-
Are there special care units designed to meet specific resident needs such as Alzheimer’s/Dementia Units, Ventilator Units, etc
-
Is there sufficient staff on evenings and weekends?
-
Are requests for assistance by residents/families responded to in a timely manner? For example, how long does it take staff to answer a call bell or light?
-
Are care planning meetings held at times that are convenient for residents and family members? Are the meeting times flexible?
-
Are meals attractive, nutritious, and varied?
-
Does the facility have a dietary/nutrition specialist who monitors the menus?
-
Is the facility able to provide specialized or therapeutic diets when necessary?
-
Do residents routinely have input into the menu selections?
-
Is cold food cold and hot food hot?
-
Are dining rooms attractive and conducive to eating?
-
Is assistance offered to residents as needed?
-
Are fluids readily available to residents in the dining areas, common areas, and in their rooms?
-
Are resident’s weights monitored regularly?
-
Are snacks available at all times even when the kitchen is not open?
-
Does the facility appear to be safe and hazard free?
-
Are carts routinely stored in hallways/corridors where residents must walk?
-
Is carpet or tile in good repair to prevent tripping hazards?
-
Are walking areas well lit without shine or glare?
-
Are there wander protection devices in areas where confused residents reside or visit?
-
Are exits clearly marked and visible to residents and visitors?
-
Are spills cleaned up quickly and thoroughly?
-
Are handrails stable, clean and hazard free?
-
Are handrails available everywhere that residents go without interruption?
-
Do you notice any residents in physical restraints (devices that prevent the resident from moving freely) that seem inappropriate?
-
Are there smoke detectors and fire escape plans?
-
Are there regular fire drills? |
