About Nursing Homes?

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About Nursing Homes?

Understanding the different types of nursing home care, how to manage your nursing home experience, and how to solve problems are all important factors in getting good care.

Types of Nursing Home Care

There are generally two types of care available in a nursing home:  short-term, rehabilitative care and long-term care for chronic conditions.  Patients receiving rehabilitative care, most often due to an acute illness or surgery, may continue staying at the facility as a long-term care patient if they do not recover the ability to live in their previous environment.  Usually the long-term care units are in a separate area of the facility and the patient will have to change rooms.

Long-term care, often called custodial care, includes help with activities such as getting in and out of bed, feeding, bathing and dressing, and continual supervision for patients with dementia. Long-term care in a nursing home can also include skilled nursing care that is medically related.  A licensed physician supervises each patient's care and a nurse or other medical professional is almost always on the premises. 

Most nursing homes have a mixture of residents who have a variety of health problems.  Nursing homes may have separate areas for residents with more intense care needs, or those that require advanced dementia care.

Generally a nursing home is made up of individual rooms that have one or two beds.  A bathroom is usually accessible from the room but may be shared with the room next door.  The facility may maintain a larger room for assisted showers and baths that is shared by several residents.  Nursing homes have congregate dining areas that provide for special diets, and can also deliver meals to a resident's room if necessary. 

There is generally an activity director employed by the nursing home who oversees an activity plan for each resident.  For residents who are able to travel outside the facility some nursing homes have transportation available to medical, dental and other health maintenance appointments.  Some nursing homes have on-site amenities such as a hair salon, exercise room and outdoor activity areas.  Most nursing homes have living areas with televisions and other activities that encourage socialization.

Managing Your Nursing Home Experience

Transitions at any age can be stressful, including a move to a nursing home following a hospitalization.    Here are some areas to focus on that will make the experience go more smoothly for everyone.

Residency Agreement.  Confirm the following items during the enrollment process:

  • Date for completing admission paperwork and move-in date
  • Designated room and personalization of the room
  • Billing/payment arrangements
  • Patient rights and responsibilities
  • Grievance procedures
  • Refund policy
  • Move in / move out policies

Admissions.  Be ready to provide the following during the admissions process:

  • Emergency contact names and telephone numbers
  • Health insurance information, Medicare card
  • Names of all physicians and their phone numbers
  • Health Care Proxy paperwork
  • Medical release form with physician approval to participate in facility programs
  • Medical record if you transition your health care to a facility physician
  • Medication information
  • The admissions process may include a health assessment by a nurse or physician

Plan of Care.  The nursing home will work with you to prepare a care plan.  They will:

  • Evaluate the amount and type of personal care assistance needed
  • Identify the resident's preferences
  • Specify how often and when the care plan will be reevaluated

Settling In.  Once you choose a nursing home, be prepared for an active social life.  There might be a welcome party, a new resident announcement, and opportunities for a meet-and-greet at mealtime. The facility might also ask for personal life details to share with other residents.  Other events you might find at a nursing home include:

  • Social gatherings, parties, planned excursions
  • A health club or recreational facilities
  • Community meetings

Care Service Delivery.  Most facilities offer personal care services.  Details about these services should be noted on the residency agreement.  The resident should be encouraged to do as much as possible to support a sense of independence and belonging.

Privacy.  Nursing homes usually make a special effort to maintain a resident's privacy and dignity.  For residents who require assistance with personal care, the following points should be included on the resident's care plan:

  • Personal preferences about when and how frequently assistance is provided
  • Details on medication administration or reminders
  • When disposable supplies will be replenished

How to Solve Problems

Nursing homes are generally committed to providing residents with the best possible care.  But there may be times when your expectations won't be met.  When a resident is unhappy about a situation, the facility should be willing to hear and resolve the concern.  Be sure to refer to your Patient Rights and Responsibilities forms to justify your arguments, or use the nursing home grievance policies to solve a problem. 

Generally, most issues involve some type of miscommunication between individuals.  Be sure that the issues are understood, expectations are clarified, and the solution meets everyone's needs.  Some nursing homes have resident councils to address issues related to the nursing home overall.  If you feel you need to take your concern to a higher level, contact your state long-term care ombudsman.

See the Care Library Article titled "Nursing Home Touring Tips" for help with questions to ask and what to look for when visiting nursing homes.

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