What Care Can You Expect from a Nursing Home?
Nursing homes must meet minimum standards of care required by state and federal laws. A team of nurses, usually referred to as surveyors, are sent in to survey and inspect the home every 12 to 15 months to make sure that they are meeting those standards. Here's what you should know about the care your parent will receive:
If your mom has extreme difficulty in feeding herself, the home might recommend tube feeding. This option should be used only as an absolute last resort. Make sure it's not being recommended purely as a means of staff convenience and not in the best interest of your mother.
Most homes try very hard to prevent bed sores, but it's something you should always be on guard for. Let the nurse know as soon as you see any redness on your parent's skin. You can help by giving your mom a massage on your visit and asking the nurse how you can be helpful with Mom's skin care.
- Independence. Nursing homes are supposed to help your Dad remain as independent as possible in performing daily tasks such as bathing, walking, eating, using the toilet, and speaking. Unless he has a medical condition that will cause him to deteriorate no matter what, the home's job is to keep him from diminishing for as long as possible.
- Incontinence. If your mom is incontinent (urinates involuntarily), the first response of the home should not be to just put her on a catheter (a tube inserted into the bladder that dispenses urine into a bag). The home should try a bladder training program first; if that isn't effective, it must keep your mom dry and prevent urinary tract infections.
- Bed or pressure sores. Here's something you have to be vigilant about. Because your mom's skin is more fragile, and she isn't moving around as much, she is susceptible to getting bruises from the pressure of her body's weight against her bed or a chair. This is especially true around bony areas like her tailbone, elbows, and heels. Reddened areas around the skin are the first sign. If these are not attended to Mom can end up with an open sore that can even expose the bone. At that stage, they are very stubborn to treat and are vulnerable to deadly infection.
Sometimes, bed sores are due to lack of turning someone who is bedridden, letting someone lay in urine for too long, or not taking care of the person's skin. As secretary of aging, I investigated several cases of outright neglect of nursing home patients who had such horrible bed sores that they died.
- Restraints. Nursing homes can't strap your mom to her bed or a chair, place her in a chair that she can't get out of, or use bed rails that she can't undo herself. Nor can they chemically restrain her by giving her drugs that sedate her all day long so she's not bothering anyone. Restraints cannot be used for disciplinary reasons or staff convenience. On the other hand, you may worry that if your mom falls out of bed she may break her hip. Ask the nursing home to share with you their practices on restraints and what alternatives they use to keep the patients from harming themselves.
- Medications. Nursing homes must provide pharmacy services to each resident, but that doesn't mean the home pays for the prescriptions. Remember, Medicare currently doesn't cover prescriptions, so unless your mom has special insurance, prescriptions are paid out of pocket. The nursing home also employs a pharmacist who reviews your mom's drug regimen at least once a month and alerts the doctor and nurse of any problems. A home is allowed no more than a 5 percent error rate in dispensing medications. Psychotropic drugs (mind-altering) should be prescribed only if clinically proven by a physician to be necessary.
- Therapies. The facility is required to offer your mom range-of-motion exercises to keep her joints and limbs limber, usually performed by a physical therapist. Mom should also receive dental, vision, and hearing treatment along with any assistive devices to help maintain her functioning. Mental health therapy, including help with psychosocial problems as a result of difficulties in adjusting to nursing home life, should also be offered. If your mom appears depressed, let the nurse know so that a consult can be arranged.
- Nutrition and hydration. Believe it or not, your mom is vulnerable to malnutrition and dehydration even in the nursing home. In fact a recent study by The Commonwealth Fund, found that one third of the 1.6 million nursing home residents in the United States may suffer from malnutrition and dehydration! The study contends that this is due in large part to lack of staff. So, if your mom can't feed herself, has lost her appetite (people begin losing their sense of taste and smell in their 60s), is depressed, or if the home isn't closely monitoring how much she's eating when they drop off her dinner tray, she can suffer from malnutrition. This can lead to confusion and a reduced immune system. Watch for unexplained weight loss. Let the nurses know that you want the aides to encourage your mom to eat and perhaps give her supplements. On your visits, be sure to check on whether or not she has access to fresh water. When you call her, be sure to ask her when she had her last drink of water and what she ate during her most recent meal.
If your mom is taking medications, the staff needs to make sure she's getting enough fresh water throughout the day because some medications can dehydrate her. She also might be restricting her own fluids because she finds it too difficult to get to the bathroom or she doesn't want to void in her adult brief. Being dehydrated can be very dangerous. So be on the lookout.
More on: Aging Parents
Excerpted from The Complete Idiot's Guide to Caring for Aging Parents © 2001 by Linda Colvin Rhodes, Ed.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.
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