Tuesday, December 25, 2007

Thinking about a nursing home? A consumer's guide to long possession care

Whether you're thinking about a nursing home for a relative, a friend, or yourself, this guide will help out you make a astute selection. The type of facility you select depends on the wants of the individual. Your personal physician or social worker is best qualified to discuss those needs next to you.


Types of Services


Four basic types of services are offered by nursing homes.


Nursing care--Nursing procedures require the professional skills of a registered or a licensed practical nurse. These include administering medication, injections, catheterizations, and similar procedures ordered by the attending physician. Post-hospital stroke, heart, or orthopedic care is available near related services such as physical therapy, professional therapy, dental services, dietary consultation, laboratory and X-ray services, and a pharmaceutical dispensary.


Personal care--These services include aid in walking, getting in and out of bed, bathing, dressing, intake, out preparing special diets as prescribed by a physician.


Residential services--These include general supervision and protective environment, such as room and board and a planned program for the social and spiritual desires of the resident.


Medical care--Each patient contained by a nursing home is under the comfort of a physician, who visits periodically and is responsible for the long-suffering's overall plan of care. In most cases, the long-suffering's personal physician refers the patient to the facility and certify the need for access. Once the patient is admit, the physician writes orders for medication and develops the lenient care plan, including restorative and rehabilitative procedures, special diets, and other treatments. Every nursing home usually have at least one physician on staff or on ring up to handle emergency.


Types of Facilities


Nursing homes provide different categories of nursing caution. The individual's needs will dictate the type of facility you select.


Skilled Nursing Facilities (SNFs) provide 24-hour nursing service for convalescent patients. Registered nurses, licensed practical nurses, and nurse aides provide services prescribed by the patient's physician. Emphasis is on medical nursing precision with restorative, physical, professional, and other therapies also provided. SNFs are eligible to play a part in both Medicare and Medicaid.


Intermediate Care Facilities (ICFs) provide regular medical, nursing, social, and rehabilitative services added to to room and board for people incapable of independent living. ICFs care for residents requiring smaller number intensive nursing care than that provided by SNFs. ICFs may play a part in the Medicaid program.


Facilities which share in any Medicare or Medicaid must meet the National Fire Protection Association Life Safety Code and federal regulations for long possession care services. All facilities must assemble state licensure requirements.


Residential Care Facilities provide safe, verbs, sheltered living to individuals capable of "functional nouns." The residential care facility stresses the social desires of the "resident," rather than the medical requirements of the "patient." Residents are provided dietary and housekeeping services, medical monitoring, and social, recreational and spiritual opportunity. These relieve the "functionally independent" person of the anxieties of dated age or disability and allow enjoyment of a full productive life span.


Adult Day Care Facilities provide nursing and nutritional services and medical monitoring in a clean and comfortable non-residential environment. Adult sunshine care give seniors an opportunity to make their own decision, while extending the long term carefulness facility's participation contained by the community.


Mental Health Care in long permanent status care services is designed to provide comprehensive psycho-social services--with therapeutic intervention and remedial education--in a home-like setting.


Child Care Facilities come across the long-term needs of chronically sick children. A close staff/parent/child relationship must be formed to guide the ill or impede child toward normal nouns. Specialized nursing, social, and educational services are provided beneath medical supervision in concert near all member of the family.


Boarding Houses, undesirably for the reputation of licensed nursing homes, share a common ancestry. The expressions boarding house and nursing home should not be confused or considered interchangeable. Boarding houses generally are not licensed, regulated, or inspected, as are nursing homes. Boarding houses do not provide nursing attention. Boarding houses do not have to comply beside the same stringent fire safekeeping rules to which nursing homes are subject. One of the only things nursing homes and boarding houses hold in adjectives is a high proportion of elderly residents.


Finding A Nursing Home


After you and your personal physician discuss the type of services needed, come by a list of nursing homes in your nouns offering those services.


Your doctor or social worker will be familiar with nouns facilities. Also, contact your state affiliate of the American Health Care Association, your local medical society, community welfare agency, or condition or welfare department. Friends and neighbors may offer information if they are acquainted near someone in a neighbouring home. Your church or temple also will be able to make available you names of nouns homes.


By telephoning the homes on your initial detail, you will be able to dictatorial the field to two or three offering the specific services and location you desire. Plan to pop in each of these homes at smallest once. Talk with the administrator and tour the facility. Take along this brochure and use the checklist provided. Don't be afraid to ask question.


Many qualified nursing homes participate within two voluntary quality assurance programs. One is a program of accreditation by the Long Term Care Program of the Joint Commission on Accreditation of Hospitals, base on surveys in which the facility's operation are evaluated in expressions of substantial compliance with JCAH standards.


Many nursing homes also monitor internal feature assurance standards. Each department is evaluated; patients, family member, and staff are asked to evaluate the care provided. These types of self-appraisal actions may be part of the American Health Care Association's "Quest for Quality" program or they may be one and only to a facility.


Paying For Nursing Home Care


Be selective in choosing a nursing home. As your physician will confirm, the services offered by a facility should reflect the requests of the patient. Basing your choice on the requests of the individual also will help maintain down costs and allow others in greater entail of higher level of services to obtain them. Remember, various nursing homes have waiting list.


Not all residents earnings for their own nursing home care. within fact, almost 70 percent of SNF and ICF consumers rely on public support.


When council with nursing home administrator, discuss financial conditions in detail. All payment agreements should be within writing, and you should have a copy of the final arrangements. You may will to cover the following areas before signing the papers:


* What are the forms of available public support?


* Will the merciful or resident receive a refund of finance payments if he leaves the facility?


* How are cash and assets entrusted to the home protected? Is a tally given to the resident? Are withdrawals noted by signed acceptance so that the resident can keep track of his information?


* Are the agreed-to date of admission and the amount of care to be furnished set forth contained by the written agreement?


There are many ways to nouns nursing home care. These might include Social Security payments, your own funds, assets in escrow or as an endowment, or assistance from the local welfare department, or from private organization such as veterans' groups, trade unions, fraternal organization, or health insurance plans. Some insurers provide fixed nursing home coverage. Be sure to check with your agent and/or group insurer to see if you hold nursing home benefits. The administrators of the homes you call round can help within your financial planning under these methods or underneath Medicare/Medicaid.


Medicare/Medicaid


Medicare, administered by the U.S. Department of Health and Human Services (HHS), is a federal insurance program for (1) people 65 and over; (2) population disabled for at least two years; or (3) folks suffering from chronic kidney disease.


Medicare will pay for nursing home carefulness under the following conditions:


* If the nursing home is certified by Medicare as a SNE (If you intend to use Medicare financing, receive sure the nursing home you choose is a certified SNE Medicare benefits are limited to 100 days of safekeeping.


* If the patient have spent at least three consecutive days within a hospital and if the admission to the SNF occur within 30 days after discharge from the hospital.


* If the physician certify that extended care services are needed for impossible to tell apart or related illness for which the individual was hospitalized.


* If continuous skilled nursing fastidiousness or skilled rehabilitation services, as defined by HHS, are required on a daily spring by the patient.


* If the above requirements are met, the bill (for covered services only) can be rewarded by Medicare (experts on Medicare determine the amount to be paid, which the nursing home can adopt as full payment) for the first 20 days in respectively benefit period. For the 21st through the 100th light of day, the patient must share the cost of attention to detail by paying a nationally set day by day rate of $74.00.


The Medicare patient's overnight case is, however, under constant review by a committee of physicians as resourcefully as by HHS. When reviewers determine that the patient no longer requires professional nursing services, Medicare payments are done. In many instances some or adjectives of a patient's stay within a nursing home may not be covered by Medicare. Only about two percent of nursing home patients are supported by Medicare.


The American Society of Internal Medicine have published "Medicare: What it Will and Will Not Pay For," a clearly written explanation of a person's benefits and exclusions beneath the Medicare program. Single copies are available by sending a self-addressed envelope to ASIM, 1101 Vermont Avenue, N.W., Suite 500, Washington, DC 20005.


Medicaid, on the other hand, is a federal-state financed assistance program for unquestionable needy and low-income individuals of adjectives ages. States design their own programs within broad federal guidelines. Thus, Medicaid programs oscillate from state to state. Under certain conditions, Medicaid pays for fastidiousness in nursing homes certified as skilled nursing services or as intermediate care services. About 65 percent of all nursing home residents are supported by Medicaid.


Personnel


Nursing homes provide the services of a choice of full-time and consultant staff specialists. The numbers and types of personnel reflect the desires of the residents.


Nursing staff are available around the clock. In skilled facilities this 24-hour coverage is provided by licensed nurses. When you tour a facility, look to see if the nursing staff is interacting next to patients, answering call signals rapidly and talking next to the patients. If special treatments or nursing measures are needed, ask if they will be available.


Activities are provided in all services. Ask to speak with the amusement coordinator and find out what types of individual and group activities are sponsored. Ask whether social services are provided by the facility staff or through an outside agency.


The dietary department is underneath the direction of a food service supervisor. A consultant dietician also may be available.


Other specialists may be on staff or available on a consultant basis: physical therapist, occupational therapist, therapeutic recreators, psychiatric personnel, medical director and consultant pharmacist (both surrounded by skilled nursing homes), podiatrists and dentists. It is important to determine the specialists you will call for and to make sure the facility have them or is able to provide their services.


The overall paperwork of the facility is the responsibility of a licensed nursing home administrator. Other administrative personnel include medical records staff, personnel director and financial staff. Building upkeep and housekeeping personnel are also on staff.


Most importantly, be sure that the people who attention to detail for the residents are kind. People providing services to society is what nursing home care is adjectives about.


A Guide To The Right Choice


The following checklist is intended as a convenient mention for use when visiting several homes. Remember, the most defining consideration in any choice is the individual's specific situation. The elderly forgiving often have different needs than the young-looking patient. The ambulatory tolerant has different requests than does the bedridden. While the emphasis you place on any query is up to you, keep within mind that you can't change the lenient to fit the home. You must select the home that meets the desires of the patient.


A Checklist


Licensure


* Does the home enjoy a current license from the state?


* Does the administrator have a current license from the state?


If the answer to any of these questions is "no," do not use the home.


Certification and Quality Review


* If Medicare and/or Medicaid coverage is needed, is the home certified to provide it?


* Does the home enjoy a formal quality assurance program? Location


* Is the facility pleasing to the merciful?


* Is the facility convenient for the patient's personal physician?


* Is the facility convenient for frequent visit of family and friends?


* Is the facility close at hand a cooperating hospital?


* Is the facility near a hospital where on earth your personal physician practices?


Accident Prevention


* Is the facility well lighted inside?


* Is the facility free of hazard underfoot?


* Are chairs sturdy and not easily tipped?


* Are alert signs posted on freshly waxed floors?


* Are handrail in hallway and grab bar in bathrooms?


Fire Safety


* Does the facility touch federal and/or state codes?


* Are exits clearly marked and unobstructed?


* Are written emergency evacuation plans posted near floor plans throughout the facility?


* Are fire drills conducted?


* Are exit doors unlocked on the inside?


* Are doors to stairways kept closed.


Bedrooms


* Do bedrooms open onto the meeting room?


* Does each lenient room have a windowpane?


* Are rooms limited to four bed?


* Is there a drapery for respectively bed?


* Is there a nurse telephone bell by each bed?


* Is fresh drinking marine beside each bed?


* Is near at least one comfortable bench per patient?


* Is near a clothes closet or separate set of drawers for each forgiving?


* Is there room for a wheelchair to maneuver?


* Is aid used in select roommates?


* Is there unproblematic access to each bed?


Cleanliness


* Is the facility as verbs as you set your personal standards?


* Is the facility free of unpleasant odors?


Lobby


* Is the atmosphere welcoming?


* Is the furniture attractive and comfortable?


* Is within a bulletin board with the endeavours schedule?


* Are certificate and licenses on display?


Hallways


* Are hall large ample for two wheelchairs to pass smoothly.


* Do halls enjoy hand grip railing?


* Are halls economically lighted?


Dining Room


* Is the dining area attractive and inviting?


* Are table convenient for those in wheelchairs?


* Is food luscious and attractively served?


* Is time adequate to guzzle meals?


* Do meal match posted menu?


* Are those need help delivery it?


Kitchen


* Is the food preparation area separate from the dishwashing and litter areas?


* Is food needing refrigeration not standing on counters?


* Does kitchen comfort observe sanitation rules?


Activity Rooms


* Are rooms available for lenient activities?


* Is equipment (such as games, easels, cotton, kiln, etc.) available?


* Are residents using equipment?


Special Rooms


* Are rooms set aside for physical examinations or psychiatric help?


* Are rooms available for private visits beside family and friends?


Isolation Room


* Does the home hold at least one bed and bathroom for patients next to contagious illness?


Toilet Facilities


* Are toilets convenient to bedrooms.


* Are they glib for a wheelchair patient to use?


* Is nearby a sink in each bathroom?


* Are nurse phone bells near respectively toilet?


* Are hand grips on or close to toilets?


* Do bathtubs and showers have nonslip surfaces and mitt grips?


Grounds


* Is there assured access for the handicapped?


* Is outdoor furniture available for residents and visitors?


* Are hazardous objects contained by patient walkway?


Medical


* Is a physician available in an emergency?


* Are personal physicians allowed?


* Is regular medical attention assured?


* Are medical store and plans of care kept?


* Are patients involved in plans for treatment?


* Is confidentiality of medical archives assured?


* Are other medical services (dentists, podiatrists, optometrists) available?


* Will the patient's personal physician be notify in an emergency?


* Does the facility report periodically to the long-suffering's personal physician?


Care Planning


* Does the home provide services for terminally ill patients and their family?


* Does the home have an Alzheimer's disease program?


* Does the home fastidiousness for mentally ill patients?


Hospitalization


* Does the home hold an arrangement with a near hospital?


* Is emergency transportation readily available?


Nursing Services


* Is a registered nurse responsible for nursing staff in a SNF?


* Are licensed nurses on duty around the clock in a SNF?


* Are trained nurse aides and orderlies on duty in homes providing nursing vigilance?


Pharmacy


* Are routine and emergency drugs available?


* Does a pharmacist review patient drug regimens within a SNF?


* Is a pharmacist available for staff and patient consultation?


Religious Observances


* Are arrangements made for patients to worship as they please?


Therapy Program


* Is within a physical therapy program available underneath the direction of a qualified physical therapist?


* Is analysis available to meet special requirements?


* Are services of an occupational psychotherapist or speech pathologist available?


Activities Program


* Are patient preferences observed?


* Are group and individual comings and goings available?


* Are residents encouraged to share?


* Are outside trips planned?


* Do volunteers work with patients?


Social Services


* Is a social worker available to assist residents and family?


Food


* Does a dietitian plan menus for patients on special diets?


* Are personal likes and dislikes taken into consideration?


* Does the menu rise and fall from meal to teatime?


* Is plenty of time allowed for each suppertime?


* Are snacks available?


* Is food delivered to patients unqualified or unwilling to eat surrounded by the dining room?


* Are warm foods served thaw?


* Does staff assist patients who need relief with ingestion?


Grooming


* Is assistance in bathing and grooming available?


* Are barbers and beauticians available?


Staff Attitudes


* Does staff show interest in and affection for individual patients?


* Is staff courteous?


* Is the administrator available to answer questions, hear complaints, or discuss problems?


* Does staff respond soon to patient call for assistance?


* Does staff know patients by name?


Patient Rights


* Does the facility hold a written description of patient rights and responsibilities?


* Is staff trained to protect forgiving dignity and privacy.


* Does the facility have a resident council?


Costs


* Are adjectives services covered in the chief daily charge?


* If not, is a document of specific services not covered in the rough and ready rate available? (Some homes have schedule covering linen, personal laundry, haircuts, shampoos, pedicures, dental protection, etc.)


* Are advance payments returned if the long-suffering leaves the home?


Your Part


* If you are selecting a nursing home for someone else, are you:


* Involving this creature in the choice?


* Prepared to glibness the patient's transition to the nursing home by one with him on entry day and staying a few hours to carry him settled in?


* Ready to drop by the patient frequently and to fashion sure that his friends make similar visit?


* Willing to provide the patient near the same amount of love contained by the nursing home as you would if he were at home?


Waiting For Placement


After you hold identified an appropriate facility, you may find there is no see. Put your name on the waiting chronicle. In the meantime, check alternatives such as day meticulousness, night thinking, home health agencies and other community resources that might give support to meet direct needs.

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