Nursing Homes

Nursing homes are able to provide almost constant care to residents. They are most appropriate for people needing medical care and close observation due to mental or physical illness, but are no longer ill enough to remain in the hospital.

While we typically think of nursing homes as places for the elderly, they are also commonly used to rehabilitate people after surgery, strokes, or other medical issues after they have been discharged from the hospital.

In a nursing home, nurses and other caretakers are always available to you. There is also a lot of staff that provide rehabilitation services. Physicians are available when needed.

Nursing homes can be rather expensive, ranging from $4,410 to $11,710 a month for a private room. Mostost offer more affordable shared rooms. Although usually covered by federal Medicare and some other insurances, it is important to check how much of the cost your insurance will cover and how long of a stay they permit. There may be other restrictions imposed by insurance companies. For example, Medicare will only cover nursing home stays if they begin within 100 days after being discharged from the hospital; although you may choose a nursing home as the setting for your death, being admitted from home is an expensive option if you have not been in the hospital within the last 100 days.

If chosen as a setting for the end of your life, your personal and medical needs will be met, taking the responsibility off you and your family. Family members will not need to be responsible for your day-to-day care or medical treatments or be responsible for arrangements to remove your body. Staff are available to relieve pain, respiratory distress, and other physical responses that can happen before death. Your family may need to request extended visiting hours to  ensure they have access at the time of your death.

Depending on how long you have been there, you may develop a relationship with the staff that may help personalize your death, though they may not have training in palliative care. If you are involved in hospice, they will also guide your care while you are in a nursing home.

Nursing homes can be very busy places that may not be able to provide a peaceful setting to die or allow you to have everything you want around you when you die.

When choosing a nursing home, it is most important to consider the level of comfort and the amount of care provided. Other considerations include the facility, staff, meals, and services.

 All areas in the facility should be easy to navigate and get around in, as well as:

  • appear clean and orderly with an easy-to-understand and remember layout;
  • have doorways and walkways that easily accommodate walkers and wheelchairs with elevators as an alternative to stairs;
  • smell pleasant, without strong and unpleasant odors (urine, feces, or sanitizer/deodorizer);
  • have rooms with features you desire, such as comfortable chairs and beds, windows, bathroom handrails, television, etc.; and/or
  • have clean and well-maintained common rooms and outdoor areas.

Ask about any desired services, including:

  • the ability to manage a schedule (when to wake up, eat, and go to bed);
  • interesting social or other activities;
  • a volunteer program or other persons that assure adequate social stimulation to all residents;
  • transportation as needed for medical visits;
  • housekeeping and laundry services;
  • hairdresser, barber, or other personal grooming services; and/or 
  • religious services.

Important medical care considerations include:

  • handling of medications, medical emergencies, non-emergency medical situations (e.g. falls or infectious illness), and problems like wandering, disorientation, and agitation;
  • how visits from physical therapists, occupational therapists, medical specialists, and physicians are scheduled and maintained;
  • the degree of medical care provided by the facility, including nursing coverage, the number of nurses’ stations and aides; and/or
  • trained staff or special programming for residents with dementia or Alzheimer’s.

Important staff qualities include being:

  • warm and welcoming to residents and families;
  • kind, patient, and respectful with residents, including referring to them by their names;
  • helpful and attentive, but not overworked; and/or
  • able to communicate clearly with residents, families, and other caregivers, without language or communication barriers.

Other important considerations regarding staff include:

  • if they wear nametags;
  • if they knock before entering a resident’s room;
  • if there is adequate personnel during weekdays, weekends and holidays, evenings, and overnight;
  • if they have consistent caregivers on a daily basis, as possible; and/or
  • if they’ve been vetted via background checks to ensure they haven’t been found guilty of abuse or neglect.

You should be comfortable with the residents and the facility culture by determining if:

  • the current residents seem happy and comfortable;
  • the residents socialize with each other;
  • you are able to talk with residents about their experience at the facility;
  • you think that you and your roommate will get along when you are considering sharing a room; and/or
  • there are other options if you don’t.

In order to be sure meals are enjoyable you should:

  • be sure the menu appeals to you and the kitchen can accommodate religious or medical dietary needs;
  • observe or participate in a meal at the facility; and/or
  • ask about the option of eating in your room rather than in the dining room or a packaged meal, bringing non-resident guests to dinner, holiday dining schedules, and if alcohol is served or available at meals.

Checklist: Questions To Consider When Choosing A Nursing Home. everplans website.

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