Dr. Cheryl Woodson

Straight Talk With Dr. Cheryl: The Nursing Home Decision-Make the Best of Bad Options

When I was in practice, I tried to help families avoid too-late nursing home decisions. Well before the need became obvious (often as soon as I presented the Level of Care Prescription [LOCRx],) I would ask caregivers, “What changes (in the senior, yourself, or the overall situation) would make you decide that you could no longer care for him at home?”

My goal was to draw a line. As our relationship continued and the illness progressed, I could remind the family of the boundary they had set. Then, I would raise the nursing home issue, so they didn’t have to.

Many families realized that their loved one’s illness was already so advanced and the caregiver already so overwhelmed that they had crossed that line months or even years before I asked the question.

Other caregivers used those boundaries to make proactive plans. Each time changes brought them closer to the “impossible point,” families recruited more resources and moved the line. They knew that the nursing home would be the only alternative when they could not provide more resources. When that point came, they didn’t feel guilty because they also knew they’d done all they could.

Families could have more  good time with their loved ones if they did not wait until the last minute to use the nursing home. Allowing the staff to handle the day-to-day care frees caregivers to do things with and for and with their loved ones, not to them. It also allows families to concentrate on advocating for their senior.

Stay in Control of the Care Plan
Your senior is in the nursing home, but you are still the caregiver. You do not give up the rights or the responsibility for your seniors’ care, but you can serve their best interests only when you are a strong advocate. It is important to understand how to get the information you need and voice your concerns effectively.

It Takes a Village to Raise a Child AND to Support a Senior: Make Other Families Your Allies
Families of residents in long-term care facilities can join forces to watch out for loved ones.
Changes in behavior can be early signs of illness. Roommates often see changes before the professionals do, alerting the staff before conditions deteriorate. Get to know your loved one’s roommate’s family. Good relations make the environment more pleasant for the seniors, but they also offer mutually supportive relationships for caregivers, as well as an early warning system.

Get to Know the Nursing Home Staff, Too
This is not just a ploy; it is a way to develop relationships that contribute to a cooperative, healthful, and pleasant situation for everyone. Security guards, receptionists, dietary, and housekeeping staff can offer useful information about the facility. Do not expect these workers to be spies or informants, but informal, casual conversations can give you impressions about the quality of life in the facility. This information can either ease your mind, let you know it is time to voice a concern, or guide your decision about making a change.

Follow the Chain of Command
Families can become frustrated when they don’t get the answers they need. Sometimes, this happens because they asked the wrong person.
The registered nurse (RN) on your senior’s care unit should be your first point of contact about any concerns or complaints and for information about medicines, specific treatments, and changes in health status. Certified nursing assistants (CNA) and the nursing aides who provide direct care are the best source of information about the residents’ daily lives: eating, continence, participating in care and programs. If the nursing staff cannot resolve your concerns, or if there are serious or repeated problems, contact the director of nursing and then the nursing home administrator. If the question involves a health issue or a medication, contact the doctor’s office. Leaving messages at the nursing home is not an effective way to communicate with the doctor, because they don’t know the doctor’s most current schedule. The office is command central even if the doc has seen your relative only in the nursing home.

Next Week: How to Avoid or Manage Serious Problems

Dr. Cheryl Woodson is a geriatrician who navigated her mothers ten-year journey with Alzheimer’s disease. This is an excerpt from the second edition of her caregiver resource “TO SURVIVE CAREGIVING: A Daughter’s Experience, A Doctor’s Advice.” which is due out in 2016. Contact Dr. Woodson at www.drcherylwoodson.com for media interviews, to schedule a presentation, or a professional or family consultation.

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