A Short and Happy Guide to Elder Law by Kenney Hegland

Author:Kenney Hegland
Language: eng
Format: epub
ISBN: 9781634593649
Publisher: West Academic
Published: 2015-04-15T00:00:00+00:00

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CHAPTER 18

Nursing Homes and Geriatric Care

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Managers

In many ways a good nursing home care is better than home care. While residents lose privacy and sense of home, nursing homes provide better medical treatment with nurses, certified nursing assistants and, sometimes, physicians on staff. Most provide exercise programs, craft classes, and field trips. And there’s a lot to be said for hanging out with folks your own age talking Ed Sullivan, the Great Depression, and Andrews Sisters. Many fear dying in a nursing home. It’s always possible to return home at the time of one’s last illness and receive hospice care.

The major mistake is waiting too long before considering this option; too many are rushed into a nursing home when they are released from the hospital, after a fall, a major accident, a heart attack, or when the family just can’t take it anymore. One task is to decide what level of care is needed.

Hospice care: This is end-of-life care, often at home, usually (but not always) paid by Medicare.

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Skilled-nursing home care: This usually follows hospitalization for the short term; it is expected that the patient will return home. Some of the costs are picked up by Medicare—if the patient is deemed to have rehabilitative potential but under a new policy it will pay even if this is not so as in the cases of Alzheimer’s, MS and Parkinson’s.

Custodial care: It is expected that the patient will not return home unless it is to die at home. The costs of custodial care are not covered by Medicare.

There are a host of alternatives to nursing homes, depending on the level of disability, including subsidized senior housing, independent living and assisted living facilities, and Continuing Care Retirement Communities (CCRCs). Good advice is crucial.

Geriatric Care Managers, trained in gerontology, social work, nursing, or counseling, provide a bundle of services, from financial and physical assessments to recommendations of living arrangements. They can also help with long-distance arrangements, and be surrogate eyes and ears to monitor future care. The field is unregulated but there is a National Association of Professional Geriatric Care Managers. Ask about training, scope of services, and letters of recommendation. Call the Association at 520-881-8008 or look online at www.findacaremanager.org.

Selecting a Nursing Home

Some nursing homes are great; others, both figuratively and literally, stink. Remember, “It’s the location, location, location!”

Who to talk to? Hospital discharge planners, social workers, doctors, clergy and volunteers who help the elderly. Every community has a Long-Term Care Ombudsman who visits nursing homes and takes complaints. They cannot recommend homes but can answer 83

questions about complaints and survey results. Other resources:

* National Citizen’s Coalition for Nursing Home Reform which publishes “Nursing Homes: Getting Good Care There”

* Medicare maintains a database of nursing homes and their past performances. www.medicare.gov/NHCompare/. It has an excellent checklist.

Visit at least two (we can’t see without contrasts) and visit each several times, at different times of day. Don’t make appointments; just show up.

Staff. Adequate to give individual attention or overworked? How does the staff treat the residents? Turnover: 30% per year is okay; 50% spells trouble.

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