A Guide to Nursing Homes

Choosing Skilled Nursing Facilities and Convalescent Homes

As the population ages, more of us are faced with the prospect of moving either ourselves or an older family member into a nursing or convalescent home. It may be a decision that arrives suddenly following hospitalization, or gradually as needs become more difficult to meet in other types of housing. Deciding to move can be stressful, but by learning all you can about nursing homes, you can ease your fears and make a decision that’s right for you or a loved one.

What is a nursing home or skilled nursing facility?

A nursing home is normally the highest level of care for older adults outside of a hospital. Nursing homes provide what is called custodial care, including getting in and out of bed, and providing assistance with feeding, bathing, and dressing. However, nursing homes differ from other senior housing facilities in that they also provide a high level of medical care. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care is available on site, usually 24 hours a day. Other medical professionals, such as occupational or physical therapists, are also available. This allows the delivery of medical procedures and therapies on site that would not be possible in other housing.

The label “nursing home” can have negative connotations for many people. Yet nursing homes provide medical practices and therapies not available in other senior housing options, so it’s important to separate nursing home myths from facts.

Myths about nursing homes
Myth: If I can’t take care of myself at home, a nursing home is the only option. Fact: Today, there are many options to help older adults stay in their homes, ranging from help with shopping and laundry to caregiving and visiting home health services. If home care options are no longer possible, other options, such as assisted living, may be a better fit if the primary need is custodial care rather than skilled medical care. Even if you’re considering hospice care, that can often be done at home.
Myth: Nursing homes are for people whose families don’t care about them. Fact: Many cultures have strong beliefs that it is a family’s duty to care for elders. However, in today’s world of smaller families living farther apart and people living longer with more chronic illness, it simply may not be possible. Considering a nursing home for an elderly family member doesn’t mean you don’t care about them. If you cannot provide the necessary care, it is the responsible decision to find a place where your loved one’s needs will be met.
Myth: Nursing homes are poorly run and provide awful care. Fact: While it is key to research homes thoroughly and visit your family member frequently, it is not true that all nursing homes provide poor care. There are more and more safeguards in place, and a facility’s staffing information and any previous violations are available to the public, which can aid your decision-making.
Myth: Once I’m in a nursing home, I’ll never leave. Fact: Sometimes an illness or injury progresses to the point where you’ll need both ongoing medical and custodial care through to the end of your life. However, many people encounter a nursing home for the first time after a sudden hospitalization, such as from a fall or stroke. After rehabilitative care, you may be able to either return home or choose a more appropriate housing option.

When should you consider a nursing home?

Whether you and your family are facing a quick decision about a nursing home due to a recent event, or have been coping with a worsening progressive disease such as Alzheimer’s or Parkinson’s, considering a nursing home is not an easy decision. Emotions such as guilt, sadness, frustration, and anger are normal. But by working through your housing, financial, and medical options, you and your family make can make an informed decision.

Whether you’re looking for yourself or an older family member, here are some questions to ask when considering a nursing home:

Have you had a recent medical assessment? If you’re considering a nursing home as the next step after hospitalization, this has likely been done. However, if you’re considering a move from your home or another facility, a more formal assessment by a medical team can help clarify your needs and see if other housing options may be a possibility.

Can your needs be met safely in a different housing situation? If you need 24-hour supervision, or are in danger of wandering off or forgetting about a hot stove, for example, a skilled nursing facility may be the best option. If your needs are solely custodial, though, an assisted living facility may be a better fit.

Can your primary caregiver meet your needs? Caregivers are often juggling the needs of work, their own family responsibilities, and their own health. It’s not possible for one person to be awake and responsive 24 hours a day. Sometimes other family members can help fill in the gap, or day programs, home care services, and respite care can provide the necessary caregiver support. However, there may come a point where medical needs become too great and home care services are insufficient or become too expensive.

Would the need for a nursing home be temporary or permanent? Sometimes, a temporary situation may be covered through home care, or family members might be able to rotate care on a short-term basis. However, if the level of care is expected to be permanent, this may be too expensive or coverage might not be enough.

Nursing home vs. other types of senior housing

Nursing homes provide some of the highest levels of care, both medical and custodial. If you’re not sure that you or your loved one needs that level of care for the long term, learn more about other types of senior housing, including home care, to see what will best fit your needs.

Handling the emotions of moving to a nursing home

Moving can be a stressful experience, even at the best of times. Moving to a nursing home can bring with it a whole host of additional, difficult emotions.

If you’re the one moving

You’re leaving behind a familiar place with lots of memories. If the nursing home move was due to a hospitalization, the transition may have been abrupt and you may not have had time to even process what has happened. Add to that your increased medical needs and decreased mobility, and moving to a nursing home can become a very stressful time. You may even feel angry and abandoned by your family members, even if you realize they can no longer provide the level of care you need. These are perfectly normal emotions.

Accept your feelings. Everyone needs time to adjust and come to terms with their own their feelings. Trying to sweep anger and grief under the rug—or refusing to acknowledge the difficulties of the transition—will only intensify these feelings.

Remember that you’re not alone in this. Many of us over the age of 65 will require some type of long-term care services. And there’s nothing to be ashamed about in admitting you need more help than you used to.

Be patient with yourself. Losses are a normal part of aging and losing your independence is not a sign of weakness. Allow yourself to feel sad or frustrated about changes in your housing situation without beating yourself up or labeling yourself a failure.

Be open to new possibilities. By keeping your mind open to new ways to make life easier, you’ll be able to cope with your change in situation better. Sometimes, new experiences and situations can lead to you developing new friendships or finding new interests that you’ve never considered before.

If it’s your family member who’s moving

You may feel guilty for being unable to care for them, or sad that your loved one has to go through this forced transition. Any relief that you feel about your loved one now getting the care they need may be tempered with guilt that you’re somehow letting them down. You and other family members may have been arguing about whether a nursing home is necessary or over details such as where it should be located or who should be the point of contact.

Allow your loved one to take the lead. As much as possible, the person making the move should be the one making decisions about which nursing home is most suitable. Whenever possible, they should come along on visits to different nursing homes, and make the choices about what to bring from home and how to personalize their room. If the older adult is unable to do so, family members should try to think about what their wishes might have been. A familiar blanket, a treasured picture, or a favorite piece of music, for example, may provide comfort even if the senior is unable to verbalize it.

Help your loved one cope with their loss of independence. Encourage them to maintain relationships with friends and family, and to keep an open mind about new interests.

After the move, keep in regular contact. Regular visits by family and friends help to ease your loved one’s transition. Even if you live far away, frequent calls, letters, and emails can make a big difference. Keep your loved one in the loop about family events as much as possible.

Stay involved

Regular contact not only reassures your loved one, but allows you to serve as an advocate for their needs. Even if you’ve chosen the finest facility, you want to make sure your loved one’s care continues to be of the highest standard, so visit at irregular hours to make spot checks, and get to know the staff. The more engaged they feel you are, the more attentive they are likely to be towards your family member. If the nursing home has a family council—a group of relatives and friends who meet on a regular basis to discuss concerns and issues—consider joining.

Tips on choosing a nursing home

Choosing the right nursing home is not easy, and you may be under pressure to move quickly due to a recent hospitalization or deterioration in your health. The more information you have, the greater your chances of finding the right fit.

Start with referrals. Does your family physician or specialist have any recommendations? Or do you know any friends who have used different homes? Knowing someone with first-hand experience of a nursing home can help you narrow your choices. However, remember your needs may differ; one size does not fit all.

Educate yourself. Online resources for nursing homes include ranking sites that utilize existing state data to rate nursing homes. In the U.S., every state has what is called a long-term care ombudsman, which can be a valuable resource about the current condition of a nursing home. Advocacy groups for specific illnesses can also provide hints on finding the right facility.

Consider your medical needs. Different nursing homes may have more expertise in different areas. Are they experienced in handling your specific health condition?

Factor in distance. In general, the more convenient the home, the easier it is for family and friends to visit.

Planning a visit to a nursing home

Visiting is key to understanding if a home is right for you. As with other senior housing options, it’s the people that make the place, both the residents and staff. In a nursing home, you’ll also need to make sure that the medical care is delivered appropriately and promptly.

What to look for in a nursing home staff:

How frequently does the staff turnover?
What is the staffing level on weekdays, weekends, and evenings? Do they have time to speak with you, or does it feel rushed?
How would they manage your health condition? How are medications and procedures arranged? And how do they handle emergencies or accidents such as falls?
Do they appear genuinely interested in you, and do you see them interacting warmly with current residents?

What to look for in current residents and their families:

Do the residents appear happy, engaged? Or excessively groggy and overmedicated? Do they seem clean and well groomed? Do they seem like people you’d enjoy getting to know? How do they respond to you?
Try to observe social gatherings such as meals or other activities. If needed, are residents getting timely help to eat, and with getting to and from the gathering areas?
If you see a family visiting, you can ask them about their impressions of the home and how their loved one has been treated.
Ask if there is a Family Council operated by families of the residents—and if you could attend.

What to look for in the nursing home facility:

Cleanliness. Does the facility appear clean? Do you smell urine or strong deodorizers that may be covering up the smell of urine?
Food. What kinds of meals are normally served? Does it look nutritious and appetizing? How are special diets handled? What kind of help is available with meals, and do they have to be eaten at the same time or in a common area?
Layout. Some nursing homes resemble more of a medical facility, while others offer smaller communities and communal areas with a more homely feel.
Activities. What events and activities are available for residents? Are outside activities also arranged, health permitting?
Experience with your condition. If a loved one has Alzheimer’s, for example, is there a special care unit or specialized staff and activities? How does staff handle behavioral problems like agitation or wandering?

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