What To Do When Someone Is In a Nursing Home

At some point in your life, it’s likely that you will have a friend or family member who will reside in a nursing home.  This can be a very traumatic experience both for the person in the nursing home and for friends and family.  Here are some items to consider if this happens to you.

Is a Nursing Home the Right Option?

The first thing you need to know is that there are lots of other treatment options other than nursing homes which you need to be aware of.  These include:

  • Home Health Care– Home health care agencies provide skilled medical care in the home or other residential setting. This type of care is provided by licensed and trained health care professionals such as nurses, therapists, and home health aides. Services provided by home health care agencies may include wound care, medication management, physical therapy, and other skilled nursing services. Home health care agencies also provide non-medical services such as assistance with activities of daily living, light housekeeping, and transportation. Home health care agencies provide care for people of all ages, including adults and children. Home health care agencies also provide specialized services such as hospice care, mental health care, and home infusion therapy. You can search for home health care agencies here.
  • Assisted Living- Assisted living is a type of housing facility that provides assistance with activities of daily living for seniors or people with disabilities. Assisted living facilities are designed to provide assistance with activities of daily living such as bathing, dressing, grooming, and medication management. Assisted living facilities also provide social activities, housekeeping services, transportation, and 24-hour supervision. Assisted living facilities are a good option for individuals who need assistance with daily tasks but do not require the higher level of care provided by a nursing home. Assisted living is also a good option for individuals who wish to remain independent but need some assistance with daily activities.
  • Group Homes or Personal Care Homes (PCH)- An alternative to assisted living are group homes or personal care homes (PCHs).  PCHs are smaller residential facilities, often a single family residence, housing only a few residents.  PCHs serve a similar need as assisted living facilities but without the feel of an institution.  They provide assistance with activities of daily living for individuals who are unable to live independently and have someone on premise at all times. Services provided by personal care homes may include assistance with bathing, dressing, grooming, meal preparation, and medication management. Personal care homes also provide social activities, housekeeping services, and transportation. Personal care homes provide a safe and secure environment for individuals who may be at risk of falls, wandering, or other health-related issues. Personal care homes may also provide specialized services such as dementia care, respite care, and hospice care.
  • Hospice Care- Hospice care is a type of palliative care that is provided to patients with a terminal illness. The goal of hospice care is to provide comfort and support to a patient and their family while they are facing a terminal illness. Hospice care is provided in a variety of settings including the patient’s home, a hospice center, a nursing home, or a hospital. Services provided by hospice care may include physical, emotional, and spiritual support, pain and symptom management, and bereavement counseling. Hospice care is provided by a team of specially trained professionals including nurses, social workers, chaplains, and volunteers. Hospice care focuses on quality of life and helping the patient and their family to make the most of the time they have together. You can search for hospice agencies here.

Understanding the Basics of Nursing Home Care

Nursing home care is a special type of long-term care for elderly or disabled individuals who require specialized round-the-clock care for a longer period of time than a hospital can typically provide.  This can be either for a chronic condition or to recuperate after a  hospital visit.  It is typically for people 65 and older.  Nursing homes provide care both for ambulatory and non-ambulatory people.  It is important to note that while people may reside in nursing homes longer than in a hospital, nursing home care is still considered acute care and is not meant to be for long-term care.

Services provided at a nursing home include: 

  • 24-hour care and supervision, 
  • skilled nursing care, 
  • physical therapy, 
  • occupational therapy, 
  • speech therapy,
  • medical supplies and equipment, 
  • social activities, 
  • housekeeping services, 
  • transportation, 
  • meals, and 
  • medication management

Nursing homes may also provide specialized services such as:

  • dementia care, 
  • respite care, 
  • hospice care,
  • wound care,
  • assistance with bathing, grooming, dressing, and eating.

Supporting the Emotional and Mental Health of Someone in a Nursing Home

Nursing home stays can be especially difficult for residents, as they often come with a lot of emotional baggage. For many, it can be a difficult transition, as they are leaving behind the comfort and familiarity of their own home and being thrust into an unfamiliar environment. It can also be difficult to adjust to the changes in lifestyle, such as having to depend on others for assistance with daily activities such as meal preparation, bathing, and dressing. On top of that, whatever malady lead to the nursing home visit can have a big impact on their emotions, outlook, and abilities, leading to feelings of loneliness, depression, and anxiety. 

The most important contribution you can make when visiting someone in a nursing home is to simply be present. Taking time out of your own busy schedule to visit shows that you care and can provide a much needed emotional and social support. If you can, turn off your phone and store your phone or tablet somewhere where it will not draw your attention and you can focus on the visit. Ask questions, share stories, and listen. Make sure to let them know that they are cared for and that they are not forgotten. Reminisce about pleasant memories and talk about the future. It is important to remember that while they may not be able to respond as they did before, they still enjoy hearing from you and feeling your presence.

Finally bring things like:

  • Personal items like cards, flowers, and photos,
  • Games that you can play together like cards, dominos, or board games,
  • Puzzles!  No one ever thinks about this but puzzles can be a great way to keep someone’s mind active and while away the time.  (But, be mindful about the size of the puzzle as there is not always a large space that can be devoted to the puzzle.)

Making Meaningful Connections with Staff Members and Other Families at a Nursing Home 

Something that people often fail to do is to make meaningful connections with staff members and other families at a nursing home. It is often hard to know how to interact and build relationships with those in the facility. However, forming these connections can be very helpful in getting the staff to see your friend or relative in a fuller light, as a person not just a patient.  Working in a nursing home can be difficult both physically and emotionally, being acknowledged as a person can make the entire experience more pleasant.  These connections can also help when something goes wrong and you need to be notified.  Here are some tips for creating meaningful connections:

1. Introduce yourself: A good starting point is introducing yourself to the staff members and other families at the nursing home. Introducing yourself will show that you’re interested in building relationships with them, which can help create an atmosphere of trust between you all. 

2. Ask questions: Ask questions about their lives, interests, hobbies or anything else that may be relevant to your relationship with them. Asking questions will show that you’re interested in getting to know them better and create a sense of comfort between both parties involved in the conversation. 

3. Show appreciation: Expressing gratitude towards those who care for or visit your loved one on a regular basis will show that you appreciate their efforts and care deeply about your family member’s wellbeing while they are in their care . 

4. Connect through activities: Participating in activities together such as playing board games or doing arts & crafts can help foster relationships between everyone involved by bringing people closer together through shared experiences . 

5 . Offer support : Offering emotional support such as listening if someone needs someone to talk to can make all the difference when it comes

Practical Considerations When Visiting a Nursing Home

When visiting a nursing home, it is important to check the nursing home’s visitation policy beforehand. Most nursing homes have specific guidelines regarding visitors, including the number of visitors allowed at a time and the length of visits. It is also important to check the nursing home’s policy regarding masks and social distancing. It is important to respect the resident’s wishes and to be mindful of their comfort level during the visit. It is also important to bring any necessary items such as a change of clothes, medication, or toiletries. It is also important to check in with the nursing home staff to ensure the resident is receiving adequate care. 

Paying for Nursing Home Care- What Medicare Does and Does Not Cover

In order for a nursing home stay to be covered by Medicare, you have to meet the following requirements:

  • You must enter the nursing home no more than 30 days after a hospital stay that itself lasts for at least three days (not counting the day of discharge).
  • The care provided in the nursing home must be for the same condition that caused the hospitalization (or a condition medically related to it).
  • You must receive a “skilled” level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered “skilled,” nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis. (Few nursing home residents receive this level of care.)
  • Medicare only covers “acute” care as opposed to custodial care. This means it covers care only for people who are likely to recover from their conditions, not care for people who need ongoing help with performing everyday activities, such as bathing or dressing. Many nursing homes assume in error that if a patient has stopped making progress towards recovery, then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status (or to slow deterioration) then the care should be provided and is covered by Medicare.

If your condition requires frequent nursing care to keep it stable (or reduce deterioration), then Medicare will pay for those services. Moreover, a variety of treatments may not require continual nursing yet still necessitate expert oversight. In these situations, potential negative ramifications from combined remedies may need a medically competent individual to oversee a patient’s progression and render care accordingly—which merits coverage by Medicare.

When someone transitions from the hospital to a nursing home that accepts Medicare, paperwork alerting the individual if their skill level meets the criteria for full coverage must be provided in writing. With certified eligibility and continuous use of residence, Medicare pays for a semi-private living accommodations and sustenance, specialized nursing and recuperation services, along with any vital medical products for the first 20 days. Beginning on day 21 the patient is responsible for a daily copay of $200.  After 100 continuous days in a nursing home, the patient is responsible for all costs.  (It is important to note that you can restart the nursing home coverage.  Coverage restarts after the patient has been out for 60 consecutive days.  Remember though that coverage will still require a transfer from a qualified hospital stay.)

You cannot rely on Medicare to pay for your long-term care.