Long term care for your parents: What to consider

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Long term care for your parents: What to consider

Long term care — a Mayo Clinic specialist answers common questions.

photo of Kevin Fleming, M.D.You've decided your aging parents can no longer live on their own. You worry about their safety navigating the stairs in their home, and you have doubts as to their ability to take good care of themselves. If it's time to seek help for your parents in carrying out their daily activities, you have plenty of choices for long term care.

Sorting through the long term care choices and deciding what's best for your parents can be overwhelming. Here, Kevin Fleming, M.D., a geriatrician at Mayo Clinic, Rochester, Minn., shares his observations, concerns and advice.

What are the various types of long term care available?

You have many options when it comes to long term care. Nursing homes and assisted-living facilities are the most common, but other choices include hospices, home health care, foster care and group-living situations, such as apartment buildings with information networks of caregivers.

How do you know when someone needs long term care?

If they're living on their own and a physical or mental condition interferes with their ability to perform daily tasks, they need long term care. When you or someone in your family recognizes that your loved one's needs are going unmet or expresses concern for your loved one's safety or well-being, that's when getting help becomes an issue.

It can start with help in the home, which may or may not include medical assistance. Or the responsibility may fall to a particular family member. But when your loved one's needs become more complex, you might have to hire a caregiver, and that's particularly difficult when you live far away. Overall, concern for safety is probably the biggest reason to change your loved one's living situation and consider long term care.

What does assisted living entail?

Services range from places that offer little more than a supervisor to check in each morning, to places that offer help with taking medicines, bathing and getting dressed. Some assisted-living facilities specialize in helping people with specific diseases, such as Alzheimer's.

The range of services offered by various facilities is tremendous, and the cost can vary dramatically. Quality of care and staffing levels also can differ significantly among assisted-living facilities, as regulations are different from state to state.

The number of assisted-living facilities has grown the same way nursing homes once did. Not surprisingly, care problems once found exclusively in nursing homes are now occurring at assisted-living facilities.

Who needs to be in a nursing home?

People need nursing home care for two reasons. One is for rehabilitation for someone who, for example, breaks a hip. The other is for long term care. Traditionally that has been for people with severe dementia and problems caring for themselves.

How do you choose a nursing home?

Judging a nursing home is best done by visiting it first. Walk through it. If the place makes you nervous, leave. Trust your gut feeling. Is it clean? Does it smell? Observe those who live there. Do the residents look clean and healthy? Do they seem happy? What do their rooms look like? Select a facility that feels more like a home than an institution.

You're your own best judge of whether a nursing home will provide good care. For example, inevitably when you enter a nursing home, someone is yelling. What does the staff do about it? Is the facility understaffed? Is the staff short-tempered and short on caregiving? If so, keep looking.

When you walk through a nursing home, what are some red flags to watch for?

How are you treated? If they're so short-staffed that they forget you're waiting for a tour, they might forget about your mom's medications. How do the employees speak to you? Are people being handled in a humane manner?

What other tools are available for choosing a nursing home?

The federal government uses surveys to police nursing homes. You can look up the results using the Nursing Home Compare tool on the Medicare Web site. It's best to compare facilities within a region to one another. This gives you the best view of what's going on with nursing homes in your area.

Keep in mind that the data are often old, and the types of information you can gather are limited. Also, if you don't know how to interpret the information, you may end up thinking you wouldn't set foot in any nursing home. Over time every facility is going to have a deficiency. Learn how to interpret which deficiencies are minor and acceptable versus those that are life-threatening. The government can legislate a lot of things about nursing homes, but it can't legislate caring.

Books on choosing a nursing home are available, but most treat it like buying a car. They don't take into account the human element.

What's the best way to ensure your parents get good care?

If your attitude is that no one had better make a mistake with your mom, take her home. No one will care for her like you. Many people believe being in a nursing home or assisted-living facility is bad. Some think they'll get better service if they yell at the employees, spy on them or threaten to sue them. However, this approach guarantees failure. If you think negatively, you'll get negative results.

Instead, get involved with your loved one's care. Show up, help feed and wash her. The employees will be much more receptive to you.

Last Updated: 01/13/2006
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