Franciscan Caring People Caring For People

Questions & Answers About Nursing Home Care


When people are considering nursing home care, they often have many questions related -- not to a particular facility -- but to nursing home care in general. This section of our website addresses a range of issues, including:

1. How do you prepare a loved one for entering a nursing home?

2. How is long-term care financed?

3. What should you look for in choosing a nursing home?

4. What is assisted living?

5. What is a holistic approach to long-term care?

6. How can I get more information?


1. How do you prepare a loved one for entering a nursing home?

In approaching this challenge, you should ease your loved one into the change. Although families often go to great lengths to keep aged loved ones at home, they may not be able to provide the best physical and emotional care. And, even if they are able, this type of intense caring may cause undue stress within the family. When home care and community services are no longer adequate, a decision must be made concerning the best alternative arrangement for meeting personal and healthcare needs.

It's advisable to take plenty of time beforehand to ensure a smooth transition for your loved one from his or her own home to a nursing home. This decision should be made carefully and thoughtfully -- with as much consideration and consultation as possible with your loved one. Often there isn't enough notice to evaluate all of the available information, so it's helpful to have made as many preparations as possible well in advance.

The transition can be traumatic for a new resident. The stress of adapting to a new environment can be great, and can trigger illness or a depressive episode. So, it's vital for everyone's well-being to decide early on the best new arrangement -- one that meets both your family's needs and those of your loved one. And, then to prepare for taking that decision.

It's not easy, nor wise, to attempt making such an important decision completely on your own. Prior to you and your family making this difficult choice, a healthcare professional should assess the level of care that the person needs and determine what combination of services is required.

You can begin the process by asking yourself what your loved one wants. This important question is overlooked far too often. Older people whose mental functioning is still fairly good should, by all means, be invited to participate in the decision. Many older people are attached to the familiar surroundings of their own homes and take a sudden turn for the worse if they think they're being forced to leave.

Your loved one will adjust much better to the trauma of leaving home if his or her feelings and wishes have been taken into account and respected.

With the elderly, it may be that they are capable of living somewhat independently, yet have become incapable of managing all of their affairs, and have needs you and other family members are unable to meet. For those who do not require comprehensive, full-time nursing care, several alternatives are available -- including assisted living in a nursing home.

Of course, if your loved one is very ill or mentally confused, you and your family members -- along with physician's advice -- will be required to make decisions on his or her behalf.

When dealing with your loved one, being as straightforward as possible may lessen the possibility of confusion or resentment in the future. Explain the decision -- and make promises that you can keep. It's important to let him or her know that you and others will visit as often as you're able. And, if you say you'll visit on a regular basis, do so. One way to make this promise easier to keep is to choose a facility that's within reasonable reach of you and your family.

The frequency of visits is an individual decision, but keep in mind that the presence of family members and friends greatly helps to create a more personal atmosphere in the nursing home -- and goes a long way toward minimizing the initial stress of moving into the facility. Family visits offer reassurance that someone still cares. In fact, those residents whose families are involved in their care usually have higher morale.

In addition, the transition will be smoother if the resident is allowed to take some of his or her furnishings and prized possessions along. A favorite chair or painting in the room at a nursing facility will help a resident feel more at home.

As you go through the decision-making process, you'll need to be aware of and deal with your own feelings. Deciding to place a loved one in a nursing home will be stressful for you and your family. Be aware that you may feel anger, resentment and especially guilt. Such feelings are normal during a family member's transition to a nursing home, and you should openly deal with:


Helplessness -- As you watch a loved one grow frail, you may feel frustrated because you are unable to help. You also may experience the anguish of realizing that their time with you is limited.

Guilt -- You may think you haven't been understanding enough or patient enough with your loved one. And, your siblings or other relatives -- who may not have had to deal with the day-to-day difficulties as you have -- may accuse you of callousness.

Fear of Aging -- This is often a source of anger as we experience the realization that we all will face the same changes someday.

Anger -- Often directed at the loved one for not having taken better care of himself or herself, responsibility if assigned to the person for his or her frail condition.

Resentment -- You may feel that your loved one has become too much of a drain on your time, energy and financial resources. And, you may choose, consciously or unconsciously, to act on this feeling by avoiding visits.

It can be frustrating when someone you've had as a source of strength has become dependent upon you. Understanding your feelings about the situation will help you to be more supportive during this difficult time.


2. How is long-term care financed?

Making the decision to place a loved one in a long-term care facility may be one of the most difficult you'll have to make. What facility is going to care for your loved one like you would? Isn't long-term care expensive? What does Medicare and Medicaid cover? How much is it going to cost, and where will the money come from?

Generally, there are four ways -- or combinations of ways -- in which the costs of nursing home care can be covered: 1) Self-pay through existing resources, including retirement plan funds, CDs, stocks, bonds, as well as social security, 2) Self-pay through long-term care insurance, 3) Medicare, and 4) Medicaid.

Overall, at least half the costs of long-term care are borne by families' personal finances. Some people prepare for the possibility of long-term care as diligently as they prepared for retirement. The have put enough money away, they have retirement income, and their children or others are prepared to shoulder any additional financial burden there may be.
Others do not make the necessary preparations and, although their intentions are good, they may end up unprepared to finance needed long-term care.

What is the best way to set about getting ready for the possibility that nursing home care will be needed? Short of inexhaustible resources, there are few simple financial plans. There are, however, many pitfalls to avoid.


Long-Term Care Insurance

Beginning in the 1980s, long-term care insurance (LTC) became available, although it remained controversial for many years with some less-than-reputable companies offering the product. However, sales of LTC have grown dramatically, and many well known insurance companies now offer this privately purchased protection.

Buying an LTC policy can be an investment that helps protect people against the possible loss of all of their assets when they need long-term care. Before purchasing LTC, it's important to investigate the various types of policies available and the benefits they offer. Trusted financial advisors, a family's insurance agents and brokers, and others should be consulted when considering this type of protection.

Just as many consumers have been misguided by the notion that Medicare will pay most expenses at a nursing facility, misconceptions about LTC also exist. For example, people often don't realize that they could be denied benefits if the policy specifies skilled care, but the level of care they require is not "skilled."

Since policies are bought before the need for care arises, people may not understand the policy restrictions to which they've agreed -- until it's too late. Many of the daily benefit rates are often too low to cover the real costs and, many policies have no inflation protection.

When selecting an LTC policy, take care to: 1) buy from a company that has strong financial stability, 2) avoid policies that exclude pre-existing conditions or diagnoses, and 3) buy a policy that's easy to understand -- one that's clear about coverage and payment.


Medicare Has Its Limitations

In order to qualify for Part A Medicare coverage, four criteria must be met. Foremost, the patient must require and receive a skilled nursing or rehabilitative service provided directly by, or under the supervision of, a nurse of licensed therapist. Second, the service must be provided daily. Third, the service performed must be reasonable and necessary in light of the patient's medical condition. Finally, the service must need to be performed on an inpatient basis.

It's important to note that most services covered by Medicare are short-term in nature. For example, rehabilitation services are required only until the patient stabilizes or learns a specific task. Services that might continue for a longer period of time are limited by a 100-day coverage period. Hence, while Medicare may help to finance early stays in a nursing home, it does not provide for long-term care.


Medicare's limitations are consistent with the purpose of its nursing facility benefit, i.e., to cover services required in the recovery phase of an acute illness. Truly long-term and chronic-care services that many people need -- such as assistance with daily living activities, care for people with diminished mental capacity, and the administration of medications -- are considered custodial and, therefore, not reimbursable by Medicare.

People very often don't understand that the custodial needs of most nursing home residents are not considered "skilled" under Medicare's guidelines. And, most residents don't qualify for Medicare funding.

Additional information on the federal Medicare program and the assistance it provides can be accessed at the Medicare website.


Medicaid Can Fill in the Gaps

Missouri's Medicaid program will indefinitely assist those who financially qualify, in contrast to Medicare's short-term benefits. Medicaid also differs in that residents of long-term care facilities can be helped if their needs are skilled or intermediate. Generally, individuals can qualify financially as long as their assets and/or income (minus deductions) do not exceed the facility's service rate, since this income (minus deductions) must be paid to the facility.


Prepare for the Possibility of Needing Long-Term Care

Long before you or a loved one needs long-term care, you should plan for how such care will be covered financially. You should determine whether assets and income will be sufficient to pay for long-term care. And, you should make sure you understand the complexities and various restrictions of both long-term care insurance and government programs.


3. What should you look for when choosing a nursing home?

It's important to prepare now for the possibility of needing long-term care, even though you or a loved one may not need it until much further down the road. A sizable percentage of people will spend some time in a nursing home during their lives, and the chances are good that you or a member of your family will eventually require such care.
Making preparations in advance will make the transition to long-term care easier -- for you, your loved one and other family members. Plus, doing some preliminary investigating now -- instead of at the last minute -- will help you to arrive at the right questions to ask at facilities you're considering.


Not All Long-Term Care Is Alike

First and foremost, it's important to realize that there are several levels of care available to meet individual needs. Become familiar with what is involved at each level. Has it only become difficult for your loved one to live independently on a day-to-day basis so that he or she needs help with routine activities? Or, does his or her condition require more comprehensive assistance and frequent nursing attention? Individual needs vary widely, and you should consider whether a facility can meet current and foreseeable needs.


What to Look for in a Nursing Home

To begin the selection process, it's a good idea to prepare a checklist for use when you visit nursing homes. What do you want to pay particular attention to, and what questions do you want to ask? (See "Nursing Home Checklist"). Having your checklist available will help you to get all of the information you need -- and to compare apples with apples as you choose a nursing home.

As you prepare to gather information and to visit a facility, the following considerations may assist you in determining if a particular nursing home is well suited to your needs or those of your loved one.

• What provision is made for maintaining a resident's individuality and dignity? Do staff members know residents by name? Is care tailored to individual needs? Are there activities to help residents feel needed? Are they given an appropriate amount of privacy? Are residents dressed appropriately for their condition and the time of day? Does the home allow residents to bring some of their own furnishings?

• Is the nursing care satisfactory to meet your needs? Which staff professionals are involved in developing a resident's care plan? Is a registered nurse available to nursing staff members? What is the home's policy with regard to the use of physical restraints? Does the facility have a system for ensuring that residents don't wander away?

• What about treatment services that may be needed? Physical therapy? Speech therapy? Dental and eyecare services? Does the home have arrangements with nearby hospitals?


• Are residents involved in a variety of activities? Is there a schedule of events designed to help keep residents active? What about daily, weekly and special events? Does the facility have a recreational therapy program? Are there opportunities for intellectual stimulation? Entertainment? Which kinds of activities at the home will be appropriate for your loved one?

• Are there opportunities for socializing? Do residents seem to enjoy being with staff members? Which activities involve socialization? How are roommates selected? Are there spaces conducive to resident interaction and to visits from family and friends?

• What about the food? Is it served attractively? What's the dining room like? Are personal likes and dislikes taken into account in planning meals? What do the daily menus offer? What about special meals, such as picnics and barbecues?

• Look at the physical facility. Is the outside clean and in good repair? Are the grounds kept well? Are there outdoor areas for the use of residents? Is the inside clean and attractive? Are there handrails in the hallways and grab-bars in the bathrooms? Is the home generally free of unpleasant and heavily scented odors? Is it easy for residents in wheelchairs to move around the facility?

• Where is the nursing home located? Is it within an easy drive for relatives and friends? Is it located in a peaceful environment? Are there attractive views for residents to enjoy? Is the home free of outside noises from commercial areas and traffic?

• Is the nursing home licensed by the State of Missouri? How has it fared in recent inspections? What professional memberships does the facility hold? Does it have a good reputation? Who manages the nursing home? Is it a profit-making institution or a non-profit facility? What is the management philosophy of the home and the care it provides?

• What kind of financial arrangements are there? Is the home certified for Medicare? Is it certified for Medicaid? How will your long-term care insurance be viewed by the home? Are there special arrangements for self-pay residents?

As you work to choose a nursing home that's right for you or your loved one, visit a number of facilities. Take your time and get all of your questions answered. Talk with staff members, residents and their families. If they make you feel at ease, it's likely that your loved one will come to feel the same way.


4. What is assisted living?

As people grow older, they many times need help with the activities of daily living. When they're living at home, assistance may be needed with bathing, dressing, shopping, preparing meals, eating, cleaning house, and getting around. Older people also can become forgetful and need assistance in remembering to follow daily routines such as taking medications.

Assisted living can be particularly important if an elderly person lives alone. Without a spouse, family members or other regular and continuing support, elderly people can reach a point where their well-being goes downhill. In some cases, their shortcomings can even lead to life-threatening situations such as setting the house on fire by forgetting to turn off ignition sources such as stoves and space heaters.

Most people want to retain their sense of independence and not rely on others for help with daily living. Family members often try to provide needed support in order to keep their loved ones at home -- and their efforts tend to succeed for a period of time until abilities slip further. However, providing such support can become a slippery slope that leads to overburdened and stressful situations. Assisted living can become the right choice when it provides the elderly person with the help they need -- and gives peace of mind to all concerned.

The assistance needed may not require the kind of round-the-clock, specialized care that a nursing home can provide. But, nursing homes like Price Memorial welcome residents who need varying degrees of assistance with daily living. While providing this care with the goal of helping residents to remain as active and independent as possible, there's also the added benefit of having greater levels of care available, should they become needed through the years.

Assisted living in a nursing home setting is designed primarily to meet an individual's personal and healthcare needs. Importantly, the loneliness that can accompany living alone at home can be replaced with the companionship of others and ongoing opportunities for socialization.

When you realistically examine the situation, you may find that assisted living is the right choice for yourself or for a family member. At that point -- or to help decide if it is the right choice -- consider visiting a facility such as Price Memorial.

Talk with the people who run the facility, nursing staff members, and the residents who live there. You may want to prepare some notes or a checklist in advance of your visit so that you'll remember what to look for and what to ask. Here are some suggestions:


• Find out what services the facility offers. Which are provided by its employees, and which are offered through arrangements with outside providers?

• How much does assisted living cost? What's included and what's extra? How will the costs be covered in your case?

• Ask about how much input you'll have into planning daily life and care. How much flexibility is there to tailor a care plan to specific needs?

• What kinds of accommodations are there? Single rooms? Double rooms? What about having personal possessions -- your favorite chair or TV?

• What about the location? Is the facility located in an attractive, peaceful area? Is it within relatively easy driving distance for relatives and friends?

• What about the facility itself? Is it clean, well-lit, and equipped with handrails? Is there a way to call for help if it's needed? What about systems and procedures for fire protection?

• What kinds of activities and recreation are provided? Parties? Picnics? Special events? How often are they offered?

• What kinds of services are available without having to leave the facility? Dining facilities? Religious services? Doctors? Dentists? Therapists? Hairdressers? Organized outings?

• What if you need additional assistance later on in life? Can the facility meet your increased needs, or will you have to move to another place?

Assisted living can be the best answer to many people's situations. Facilities such as and Price Memorial welcome questions from people who are considering this option -- and visitors who'd like to see the homes and talk in person.


5. What is a holistic approach to long-term care?

Care in a nursing home means attending to all the needs of a resident. While regular medical and nursing care -- along with three nutritious meals a day -- are an integral part of this, a holistic approach takes into account much more.

A resident's needs range from the spiritual and emotional to physical and social. Will the nursing home you're considering for a loved one provide religious services or pastoral care when desired? Do staff members visit often with each resident? Does the facility employ a licensed social worker who helps to address each resident's special needs? Are residents encouraged to interact with each other? Are regular outings planned? Is there a full schedule of varied activities? Are residents provided with opportunities to exercise if they're able?


Satisfying Spiritual Needs

Some long-term care facilities are affiliated with a religious denomination. Such is the case with Price Memorial. The Franciscan Missionary Brothers, however, have dedicated their lives to serving God by helping others, regardless of religious affiliation. Men and women of all faiths are welcomed.

The Brothers and those who work with them attend to all of a resident's needs. Included in this form of caring is dealing with questions of religious faith. Assistance is given unobtrusively and only when the resident requests it.

Many times, nursing-home residents who may never before have professed a strong religious belief find their feelings change later in life. It is important for a facility to allow residents to ask difficult spiritual questions, and to have on staff people who can address them or find someone else who can.

In choosing a long-term care facility, consider whether it provides its residents with the opportunity to attend religious services -- and to ask questions of clergy members if they desire.


What About a Person's Emotional Needs?

Regardless of how often family members and friends visit, nursing-home residents may feel lonely or experience a sense of abandonment on occasion. Staff members at the facility you are considering should be qualified to help residents through emotional difficulties, whether an occasional bout with the blues, the mood swings associated with old age, or a lingering depression.

Old age has been referred to as "the season of losses." Many nursing-home residents already have suffered the loss of much of the independence they enjoyed in life and in retirement. Family members and friends -- perhaps a spouse -- have passed away. Their ability to see, to hear -- and often to think clearly -- may have diminished.

Staff members at the long-term care facility -- from nurses to social workers -- need to be compassionate and well-acquainted with the season of losses. They need to be trained to address the emotional needs of people who may be overwhelmed by the unwelcome changes their later years have brought them.


Keeping Physically Fit and Alert

You should ensure that the nursing home you're considering offers frequent opportunities for residents to exercise. Many are capable of at least light stretching, short walks or other activities as their health permits.


Some facilities schedule regular sporting events designed especially for older adults. These may include "field days" outdoors that offer games and races, or such inside innovations as "basketball" -- played with balloons.

Whatever residents' capabilities, regularly scheduled activities should be provided to keep them as active as possible. A physical therapist should be involved to help create opportunities for remaining fit.



Social Interaction Is Vital

As you gather information and visit nursing homes, you should make certain that the facility you choose has made it easy for residents to interact. Are benches, tables and chairs located in common areas to encourage conversation? Is there an inviting and comfortable game room or activities center? Are residents frequently invited to participate in crafts projects, singalongs, discussion groups, bingo and other social activities?

Do residents congregate for meals in the dining room and on other occasions in other common areas of the facility? Are there activity schedules that offer a variety of possibilities for socialization?

Talk with staff members, residents and their families. Ask about their experiences at the facility. And, ensure that a holistic approach to long-term care is employed by the nursing home you choose.

You'll rest easier if the facility provides for any and all of your loved one's special needs -- spiritual, emotional, physical and social.


6. How can I get more information?

Additional information on nursing home care and Price Memorial can be found on this website by clicking on "Our Nursing Home" and other topics. If you have questions that aren't answered here, please let us know by clicking here "Contact Us" in the menu.


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