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Is It Time for a Nursing Home? Maybe Not

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As your loved ones age and their conditions change, you may be faced with deciding whether it is time to place a family member in a nursing home. However, there may be facts and circumstances which mitigate against nursing home placement at a particular stage of an older adult’s life. In making this decision, consider the following questions:

(1) Can the individual walk without assistance?

An older individual who can walk well might be better served living at home rather than in a nursing home. The risk of falling in a nursing home is twice that of falling in the community. One way nursing homes try to reduce falls is by encouraging residents to use wheelchairs to get around the facility. When an older individual enters a nursing home able to walk, but becomes accustomed to getting around in a wheelchair, that individual loses leg strength, becomes deconditioned and eventually, loses the desire and ability to walk on his or her own.

(2) Is the individual safe at home?

There are a number of reasonable steps that can be taken to improve safety in the home of an older adult. For example, you can prevent falls or reduce the risks of falling by making sure all rooms in the home are well lit and free of clutter. You can also add equipment in bathrooms, such as grab bars, to reduce the risk of falling when toileting or bathing. Medical alert bracelets are another option that may enable an elderly individual to remain in the confines of his or her home rather than moving to a nursing home.

(3) Does the older adult need skilled nursing care?

Nursing homes are designed for people who require medical treatment, management or observation by skilled nursing staff. Skilled nursing staff include nurses, physical therapists, speech pathologists and dieticians. Skilled nursing care includes such care as physical therapy, IV injections, and wound care. An older adult may need assistance with certain things, such as bathing, toileting and grocery shopping, that can be provided by Certified Nursing Assistants (CNAs), sitters or other individuals who fall outside of the realm of skilled nursing staff. These types of needs are sometimes referred to as unskilled needs. If an older adult has unskilled needs only, it may not be time to move him or her into a nursing home.

(4) Can you hire enough help at home to meet the individual’s needs?

Private home care can be costly. However, nursing home care can be even more costly. Medicare does not pay for nursing home care after the first twenty days. Also, an older adult must typically have a need for skilled nursing care to qualify for nursing home benefits provided by Medicare or Medicaid. Unless the older adult is eligible for Medicaid benefits, he or she (or you as their guardian) would still be responsible for the cost of nursing home care. In that case, private home care may cost less and would enable your aging parent or loved one to remain in his or her home.

(5) Does the individual have a primary care physician who is familiar with his or her health care needs?

Many older adults have long-standing relationships with primary care physicians in their communities who are interested in helping their patients manage their health care over time. This important relationship sometimes ends when an individual moves into a nursing home. Often, nursing homes have their own Medical Directors, who are responsible for managing the care of the residents in the nursing home. These physicians may be required to follow the nursing home’s policies, procedures and protocols in caring for the residents. These physicians are also largely dependent upon the nursing home staff to inform them of changes in a resident’s condition or needs. If the communication between the nursing home staff and the physician breaks down or is lacking, it can have a significant, negative impact on the patient’s well-being.

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