Several weeks ago, we received a call from a frantic woman who had recently been caring for her demented mother. The mother had been living independently since the death of her spouse and was now experiencing increasing physical and cognitive problems. It was clear to the daughter that her mother was no longer able to live independently and needed nursing home care. The solution seemed simple enough; however, the mother had articulated to her daughter prior to her illnesses, “please do not put me in a nursing home.” The daughter was now exhibiting extreme feelings of guilt at what appeared to be the only solution. Her time was being taxed by her mother’s care needs, as well as the needs of her own family. Does this sound familiar? Many adult children of elderly parents face this same dilemma. Sometimes consultations with clergy can help an adult child work through the guilt associated with a commitment having been made to a parent in good health versus one who is now experiencing severe illnesses.

The Ohio Health Care Association states that “placing a loved one in a long-term care (LTC) facility can become an emotional decision, one which is confronted by hundreds of people every day.” It is not an easy decision and typically is laden with feelings of inadequacy, guilt and stress. As Geriatric Care Managers, our goal is always to keep elderly people in their own environment as long as possible, providing the necessary in-home care. While some long-term care policies will reimburse for in-home care, the costs associated with such care can be overwhelming, and can approach $175,000 annually should 24/7 care be warranted. Typical nursing home care is $75,000-90,000 annually, depending upon the region of the country.

Once a decision has been made that a long-term care facility is appropriate, the following steps should be followed:

1) Consult with the patient’s doctor to determine the type of services required. Will the doctor continue to care for the patient or will the patient be seen by staff physicians?

2) Compile a list of LTC facilities in your area that are most appropriate for the patients needs.

3) Is the facility licensed by the state? Is the administrator licensed?

4) Is the facility approved to receive benefits from Medicare, Medicaid and the U.S. Department of Veterans Affairs?

5) Does the facility have accreditation from the Joint Commission on Accreditation of Hospitals?

6) What is the resident-staff ratio? What are the charges? Is there a patient bill of rights?

7) Visit the LTC facility on your “short list” unannounced. Make observations. Speak with the administrator or the director of nursing. Make evaluations and decisions based in part on these visits. The right facility for your loved one might not be the one closest to your home or work.

Additionally, as Geriatric Care Managers, we examine individual accommodations by evaluating the number of residents per room, private bathroom, window(s) and ADA compliancy. Do rooms have drapes for privacy, reading lights over beds, comfortable chair(s), etc.? Are communal areas well-lit? Do they have hand rails? Is there a lounge with scheduled recreational activities? How is the ambiance? Is the facility clean, sans institutional smell? Does it have adequate heating, ventilating and air conditioning? Additionally, we determine if exits are clearly marked and unobstructed. Does the facility have a posted emergency evacuation plan? Practice drills for residents and staff? Do nurses and aides have necessary credentials and are they adequately trained? What is the turnover of staff? Does the facility accommodate special dietary needs? These are but a few of the areas of importance to be examined, and they are by no means inclusive. Other important areas of concern should be medical care, both on and off site, meals and meal preparation, in-house therapy, religion, and staff morale.

One of the most important aspects of helping to select an LTC facility is involving the person (resident) in the process. Make the move and transition into the facility as emotionally painless as possible. Be with them on admission day and be prepared to stay for several hours. The American Health Care Association states “nursing facilities should try to be like a community — where residents can feel comfortable, find familiar faces and build relationships just like they enjoyed in their own homes. By planning ahead, you can ensure that your loved one will be provided with the highest quality of care and quality of life.”

Finally, assuming you are an Ohio resident, check with your county ombudsman, the Ohio Department of Aging (www.aging.ohio.gov), the Ohio Health Care Association (www.ohca.org), the Ohio Department of Health (www.odh.gov) and the Ohio Long-term Care Consumer Guide (www.ltcohio.org). Their Web sites provide valuable information; however, keep in mind that there is no substitute for your personal visit and interviews with administrative personnel. Should any not make themselves available to you, the facility is probably not the right one for you.