When Mom & Dad can no longer live at home

Since I work with ElderCare daily, I forget that most ordinary folk are unfamiliar with its challenges.  Most of us ignore articles about subjects that have no interest for us, like nursing home care or the cost of long term care. Once YOUR parent has a crisis, you develop a definite interest but don’t know where to go for information.  I’m starting a series of blogs about what you need to know when looking for Long Term Care (LTC). You can find plenty more information on my website, www.kaypaggi.com.

All too often the first sign of the impending need for LTC  is a medical crisis. A parent gets a poor diagnosis from a doctor, or falls and has surgery, or suffers a stroke. Until then, you and your parent happily ignore their accumulating years and continue with your lives as you have in the past. With this first crisis, your family is forced to realize some grim realities.  You need some information, fast!

Older adults who have been hospitalized due to a stroke or surgery can regain strength and mobility by short stays in rehab. I highly recommend that everyone age 75 and older go for a short stay in rehab before returning home after a hospitalization of more than 3 or 4 days. If they were sick enough to need to be hospitalized, they will have lost body strength during the days in the hospital. The therapists in rehab will help them regain function so they can return home safely.

Many older patients refuse this extra assistance because they want to go home.  They are frightened by the thought of going to a ‘nursing home.’ The percentage of older adults that are re-hospitalized after going home directly is appallingly high. Avoid this unnecessary second trip to the hospital by spending a few days in your friendly local rehab. You may have to request a rehab stay from your hospital physician; their job may be to keep costs down rather than to keep the patients safe following discharge.

Medicare does not pay for long term care. It is medical insurance, and good insurance at that. If your care receiver doesn’t have it, switch! But that’s going to be a future blog. Medicare does pay for some short term care in a rehabilitation facility. There are two types of rehab. One is a rehab-only facility, where treatment is fast paced and the stays are short, numbered in days, not weeks. The other is done in nursing communities.

Usually the hospital discharge worker gives the family a booklet and tells them to choose a facility. The family sometimes chooses the closest place to home, or the place that was used by a friend or relative in the past. A better solution is to use the Medicare.gov website.

From the main page, go to Facilities and Doctors, click on Compare Nursing Homes, and enter your area of the country. Here you can check on facilities by name, zip code, city or county. medicare uses a 5-star rating system, like the one used to rate hotels.

I warn you that Medicare is not always accurate. First, the ratings are done by people, who have differing opinions. 2nd, the criteria are not necessarily the same as the ones you might use. Last, Medicare is not updated often, so the staffing or ownership can change without the changes being reflected online. Use the Medicare site as a guideline, a starting point, not a decision maker. You still need to actually visit 2 or 3 facilities., and you must do this quickly while your care receiver is still in the hospital, so you can make arrangements for transfer when the elder is discharged.

One of the most important areas in determining quality of care is Staffing. It is also an area that is broken out in the ratings, so you can see the number of stars for Staffing. Possibly the most frequent complaint from patients in a facility is the length of wait time from the time they press the call button until someone comes to help. This is reflected in the Staffing rating. In order to go into a facility that has a higher staff-to-patient ratio, you may have to opt for a facility that is further from home. The average annual turnover rate in this industry is 300%. When you visit, ask how long the aides and CNA’s have worked there, or what their turnover rate is. The best facilities have staff members that have been there the longest.


About kaypaggi

I am an Aging Life Care Professional/ geriatric care manager in private practice. I have been active in eldercare consulting since 1994. I am a Licensed Professional Counselor, a National Certified Gerontological Counselor (the only one in north Texas), and a Care Manager, Certified. I have been a certified Mediator since 1993, and recently achieved certification as an ElderCare Mediator.
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