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Evaluate Facilities Before Choosing Long-Term Care

By Susan Albert, Examiner-Enterprise

November 21, 2004

Becky Burch/Examiner-Enterprise Sharon Taylor, CMA-CNA, helps
Silverlake Care Center resident Pat Clair with her shoes.

As the population of senior citizens in America increases, so too does the number of men and women who will need long-term care. According to the Medicare web site, about 7 million men and women over the age of 65 will need long-term care this year. By next year, that number is expected to increase to 9 million. By 2020, the number of older Americans projected to need long-term care is 12 million.

While many don't want to think about it, experts say it's best to make plans "before" the need arises.

One of the biggest concerns is paying for long-term health care, which can cost from $2,000 to $3,000 a month. Generally, Medicare doesn't pay for it. Medicaid, a state and federal government program, can help when all other financial resources are exhausted, but eligibility and services vary from state to state.

Many options are available for long-term care depending on the amount of care needed by the individual and whether he or she needs skilled nursing care or just help with daily activities, such as dressing, bathing, or using the bathroom. Some of these options include community services, home care, subsidized senior housing, board and care homes, assisted living and nursing homes. 

The thought of needing nursing home care brings a sense of foreboding to many. And why not. News reports regularly cite instances of abuse, neglect and unthinkable horrors in nursing homes.

Trisha Dodd, long-term care ombudsman with the Grand Gateway Area Agency on Aging, says there are a number of factors that can result in allegations of abuse or neglect at a nursing home.

"Every case is different and there are a number of reasons that abuse can occur, but the environment and the facility itself play a big part," says Dodd. "Training can be a problem."

Dodd says when an incident does occur, the nursing home is supposed to send a report to the state detailing the cause and staffing level at the time of the incident.

The best way to protect oneself or a loved one from abuse or neglect, according to Dodd, is to carefully screen a nursing home before admission.
"Talk with the staff and the residents at the facility you're interested in," says Dodd. "Ask the administrator or director of nursing how abuse and neglect is reported, what they do to prevent it, if they offer staff training and inservices on abuse and neglect prevention."

When considering long-term care, Dodd says one of the smartest things a person can do is start looking as early as possible.

"Get to know the facility you're considering," she says. "Unfortunately, many times these decisions have to be made quickly, so it's helpful if some of the legwork has already been done."

Nursing homes are routinely surveyed by the Oklahoma State Department of Health and the number of health deficiencies cited can be found on the Medicare web site (http://www.medicare.gov). The report also compares quality measures for that home to a state and national average, and the average number of hours per day the nursing staff spends with each resident.

Resources for someone interested in evaluating nursing homes include the Medicare web site; the State Department of Health, which can provide actual copies of inspection reports; ombudsman, who can also send copies of inspection results and will mail information packets detailing consumer information, resident rights and care plans. To contact an ombudsman for northeastern Oklahoma call 1-800-211-2116.

"We want people to know what should be happening in a facility," says Dodd.

A Perfect Cause, a non-profit group whose Oklahoma chapter is located in Oklahoma City, focuses on issues related to the elderly and long-term care. Their web site, www.aperfectcause.org, offers a number of resources including "Long-Term Care Investigations Findings 2000-2003" and articles published in state and national newspapers concerning nursing homes and elderly care.

According to an article published in "The Oklahoman" in September, one in ten nursing homes in Oklahoma is on the Consumer Report's watch list of homes whose quality of care is questioned. Information was based on federal and Oklahoma Health Department surveys. There are 400 nursing homes in Oklahoma, according to the article.

None of the nursing homes in the Bartlesville area were included on the watch list. A search on the Medicare web site for nursing homes in the Bartlesville area include Bartlesville Care Center, Heritage Villa Nursing Center, Silver Lake Care Center, all in Bartlesville, and Forrest Manor Nursing Center and Medicalodge of Dewey, both in Dewey.

Megan Friend, marketing director of Medicalodge of Dewey, says the transition to a nursing home can be difficult for the elderly and it helps to find a place where the potential resident will feel comfortable.
"Many people find it hard to change their regimen to fit the nursing home's schedule," said Friend.

They are trying to accommodate that notion with "person-centered care," a national pilot study spearheaded by the Oklahoma Foundation for Medical Quality.

"We take their habits into consideration," said Friend. "For example, if someone is used to sleeping late and eating breakfast at 10 a.m., we're getting their breakfast ready at 10 a.m. instead of 7:30 a.m."

She also suggests using the nose to rate a nursing home.

"If the nursing home is clean and smells nice, you know the staff is taking care of soiled clothing and briefs quickly."

She also recommends selecting a nursing home that offers activities for the residents.

"Some residents are more mobile than others," says Friend. "Some like to watch. But the activities keep them motivated, independent, and socialized."

Friend says the physical environment and staff are what make a good nursing home.

"The staff needs to be respectful, call the residents by name, for example," says Friend. "They shouldn't rush up behind a wheelchair and start 
pushing someone. The person might have their hand on the wheel and get hurt. They should talk to them first."

She also suggests, during a tour of the facility, watching how the staff interacts with the residents.

"Notice if their demeanor changes when you get there," says Friend. "The staff should treat residents the same whether or not family or visitors are present."

According to the Nursing Home Checklist provided on the Medicare web site, additional points to consider when touring a facility include:

Whether residents are clean, appropriately dressed for the season and well groomed.

Noise levels are comfortable in common areas.

Staff wear name tags.

Nursing home does a background check on all staff.

There is a licensed doctor on staff who is there daily and can be reached at all times.

The same team of nurses and Certified Nursing Assistants work with the same resident four to five days per week.

Residents have a choice of roommates.

Nursing home has smoke detectors and sprinklers.

Each resident has storage space, closet and drawers, in his or her room.

Residents, including those unable to leave their rooms, may choose to take part in a variety of activities.

The nursing home has outdoor areas for resident use.

Care plan meetings are held with residents and family members.

Nursing home has corrected all deficiencies on its last state inspection report.

Choosing long-term care is an important decision and the sooner one can explore options for the future, the better, says Dodd.

For more information go to "Nursing Home Compare" on www.medicare.gov

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