You hope and pray the chosen nursing home is a good one. But the hard truth is that the first few weeks are bound to be difficult. And getting through them without trauma is no guarantee that the months and years ahead will be uneventful. You'll need to keep all of your powers of observation and diplomacy intact in order to monitor your loved one's care and be sure it remains as skilled and compassionate as possible. Here is time-tested advice from experts:
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Expect an adjustment period. Moving someone you care for into a nursing home will be tense and painful. "It was the worst day of my life because it was the beginning of the end," Barbara Gortych says of moving her mother from assisted living into a nursing home in Florida. At every turn, she says, she asked herself: "Am I doing the right thing?" It is simply inevitable that family members as well as the newly admitted resident will experience some difficulty in the transition. Still, says Cheryl Phillips, chief medical officer and geriatrician for California-based On Lok Inc., a provider of long-term care and services for the elderly: "If after the first month or so your mom still seems absolutely miserable, it may be time to talk [and ask yourself], 'Do we need to look for a different facility?' "
During the first few weeks, watch for dramatic changes in the health, disposition, or appearance of your loved one. While illness and accidents are facts of life in a nursing home, says Janet Wells, director of public policy for the advocacy group National Citizens' Coalition for Nursing Home Reform, "someone who is relatively active shouldn't experience a steep decline." A rapid change may be because of inadequate care or neglect or abuse. Is your mother losing weight? She may have an undetected medical condition, or she may not be getting enough calories. Malnutrition is a significant concern in nursing homes. Tremors can hamper the ability to feed one's self and medications can cause appetite loss—or worse.
Broaden your focus over the long term. If your sharp and active mom becomes dull and lethargic, suspect drugs. An ongoing concern in nursing homes, says Wells, is "the use of medications to keep people quiet so they're not a bother and don't require staff." Besides lessening mental acuity, anything that discourages residents from getting out of bed and being active can instigate pressure sores and muscle atrophy, she says. She points to January's news that pharmaceutical company Eli Lily & Co. agreed to a $1.42 billion settlement with the federal government and the states for marketing Zyprexa, an antipsychotic, as a drug for dementia. Zyprexa is not approved for such use. In addition, says Wells, it is among the drugs sometimes given to nursing home patients to make them easier to manage.
Check for special skills. You want the staff not only to be alert for health changes but to be able to manage them before they become major concerns. If your mother develops a painful pressure ulcer, is she treated by staff members specially trained in wound care? The federal Centers for Disease Control and Prevention reported in February that only 33 to 40 percent of nursing home residents with significant pressure ulcers received such care in 2004.
Be firm, but don't yell. Feeling guilty about having to admit a family member to a nursing home or distraught and helpless as a loved one's health declines, some families take out their emotions on nurses and aides—the very people charged with the resident's care. During her decades in the industry, Phillips, the California-based chief medical officer, has watched families explode at staff, shouting and making finger-wagging threats to sue. Bluster and anger never work, she says; "care for your loved one never becomes any better" because of such outbursts. The goal is to have these essential caregivers advocating on your dad's behalf—especially when you're not around.
One demand worth pressing, however, is that the same people care for your father regularly so that he gets to know them and vice versa. "A lot of nursing homes don't do that," says long-term care expert Charlene Harrington, professor of the University of California, San Francisco, because staff schedules traditionally rotate. "[You may have to] argue with the nursing director to get a consistent staff assignment," she says, but "I think facilities will respond if families ask."