It's Never Too Early to Consider Nursing Home Options

Amy Torres

Director of Training

If a person with dementia’s needs can no longer be met safely at home, or if they require rehabilitative services after a hospitalization, it may be time to consider a move to a long term care facility. It is best if you begin looking for a long term care facility before the person with dementia actually needs it, as the process often takes longer than expected.

In order to be eligible for nursing home care, the person with dementia must require 24-hour skilled nursing or custodial care. A person requiring custodial care needs assistance with daily activities such as eating, dressing, bathing, ambulating, and medication management. Individuals applying from hospitals generally have higher admission priority because they typically have higher skilled nursing needs. Skilled care is provided by licensed professionals such as a registered nurse. Examples of skilled care include intravenous injections, physical therapy, and medication administration.

Nursing homes use an assessment tool called the Patient Review Instrument (PRI), which is completed by a doctor or registered nurse to evaluate someone for admission. A family member should be present during the evaluation to report on one’s functioning and the level of care required. It is common for someone to spend months on a waiting list if he or she is moving from his or her home into a nursing home.
There are many things to consider when deciding on a new home for the person with dementia. It is important to look beyond the physical characteristics of a facility and to place emphasis on the quality of care provided to residents. If possible, look for a home that you feel will be responsive to your requests, and will try to accommodate the person’s daily routine.

When you are looking for a new home, you may notice facilities referring to a care perspective called “person-centered care” or “culture change.” These terms refer to a movement which aims to make long term care facilities more home-like and to encourage resident choice and respect of resident routine. These facilities will likely be more open to individual input from residents, family members, and friends when responding to daily care needs.

Taking the following steps will help you decide which long term care facility is the right fit for the person with dementia:

  • Visit Several Homes. When taking a tour, be sure you are shown a long term care floor. Facility staff may show visitors the sub-acute or rehabilitative floors, which may be better staffed and furnished. Ensure the facility is clean and odor free.

  • Choose a Place Convenient to You and Other Visitors. Visit frequently. The more visitors the person with dementia has, the more likely it is that issues with care will be noticed and addressed.

  • Meet the Person with Dementia’s Care Needs, Not Your Personal Preferences. People with dementia have very different care needs. Some may have high skilled nursing needs while others may require complete custodial care. For instance, if someone requires significant medical care, you may want to look for a facility that is affiliated with a hospital and is accustomed to caring for people with high medical needs. In this instance, it is more important to find a facility that can properly care for the person with dementia, rather than a facility that has many activities or a pleasant outside space.

  • Ensure Language and Cultural Needs Can Be Met. If the person with dementia has specific language, religious or dietary needs, it is important to inquire whether the facility can accommodate those needs prior to placement.

The Department of Health does not currently have any regulations determining the definition of a “dementia unit.” Although you may find that facilities advertise dementia units, without regulations this phrase is not necessarily helpful. It may be more important to find a facility providing quality care to other residents with similar needs to the person with dementia.

Caregivers often experience mixed emotions surrounding the decision to find a new home for the person for whom they have been caring. It is important to remember that moving someone to a long term care facility does not mean that you have failed in your caregiving efforts. Trust that you are making the best decisions for the person and for yourself. Although the transition to a long term care facility may be emotionally challenging, you can continue to have a rich relationship with that person.

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