Note: In the acronym language of Medicare and Medicaid, nursing homes are “SNFs” (pronounced “sniffs”) for “Skilled Nursing Facilities.” I prefer the older, simpler and better known term.
When you need care beyond what an assisted living facility can offer, you become a candidate for a nursing home. Nursing homes are for people who don’t need to be in a hospital but can’t care for themselves.
Some nursing homes are set up like hospitals, with a nurses’ station on each floor. Others are more home-like. In these, residents’ rooms generally surround a common kitchen and living area. Residents usually have more choices about when they wake up, when they eat, and what they do during the day than they would in the more hospital-like set-ups.
The quality of care in nursing homes varies enormously. In an ideal world, residents would be treated with dignity. They would be kept clean and dry and their medical condition would monitored regularly. They would be encouraged to develop relationships with nurses and staff, who would be attentive to their medical and emotional needs.
The reality is often far from the ideal. At the bottom are places where residents have lost most of their rights. They have little or no privacy when they sleep, bathe or dress. They have little freedom about what they eat or the clothing they wear. They may have no effective control over their money, their doctor or their medical treatments. They may receive poor quality food and treatment. They are often over-medicated. Some suffer physical and verbal abuse including rough treatment and demeaning words during care.
Nursing homes have received very poor press in recent years. Report after report has highlighted instances of neglect and abuse including malnutrition, dehydration, cracked or dry lips, overlong fingernails or toenails, dirty garments, poor grooming, soiled or wet bed linen or clothing, unattended bedsores or pressure sores, and drugs and physical restraints used to control behavior.
In response, there have been efforts for nursing homes to adopt more “resident-oriented” care approaches where staff and nurses are assigned to individuals. “Care planning meetings” are supposed to involve the resident and their “care team.” They are often described as offering residents’ friends and family a place to bring up issues and complaints, ask questions, give information, make suggestions and learn about strategies used in the nursing home. How they work for people without family goes undiscussed.
Sadly, those who do the grunt work in nursing homes are often the poorest and least skilled in our society. Some have social or mental problems preventing them from getting better jobs. In some nursing homes, residents may be preyed on by staff interested in stealing drugs or gaining access to finances. Those without family are likely to be the most vulnerable.
Nursing homes often emphasize that the well-being of residents is greatly helped by concerned friends and family. Advice about what to do if problems arise generally assumes competent, energetic people (adult children) prepared to take action. Without such advocates, you’re on your own.
Your first recourse is to bring the problem up with the charge nurse, the director of nursing, a social worker or one of the administrators. You can also go outside the nursing home. Your local Area Agency on Aging is likely to have an ombudsman program that will respond. You can also seek help from citizen advocacy groups and the state’s licensing agency – assuming you have the energy to identify these resources and pursue the issue. Advice for adult children includes keeping a written record of each time the problem occurs and who is involved. What if you can’t do this? Who knows?
Medicare covers short-term nursing home expenses (up to 90 days) for people who require skilled nursing care or rehab after a hospitalization of at least three consecutive days. A doctor must certify that these services are necessary, related to the hospitalization, and only possible on an inpatient basis.
Long-term residence in a nursing home cost a minimum of $5,000 a month in 2009. Medicare covers only the medical services residents receive. You must cover room and board until you’ve depleted your resources and become eligible for Medicaid.
FYI: Nursing Homes for the Rest of Us
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