Advice on Aging: Pre-Planning for Elder Care is Essential

By Toni Lynn Davis, Executive Director/President Green Hill Inc., MHA, CNHA, FACHCA

As the executive director and president of Green Hill and one who is active in the elder care advocacy community in New Jersey, I receive many calls from people looking for advice in caring for their elder parents. In the best-case scenario, the call is from an adult child who is working with their parent to plan for their future care. Either planning for when they might need assistance in their home, if they should suffer an unexpected illness or injury, or if they should become unable to care for themselves at home on a long term basis. Advance discussion and planning for the natural life cycle process is essential for families. Those who do not make plans in advance for how to care for their parents, will find themselves faced with frightening and incomprehensible choices at a time when they are highly stressed by the emotional toll of an ailing parent.

I received a frantic call from a woman who was given my name regarding her mother who was to be discharged from the hospital in 24hrs after suffering a broken hip. We did not know each other, but she was desperate for advice. Her mother was required by the hospital to be discharged to a nursing home and she was given a list of options to review. After quickly visiting the nursing homes on the list, she was distraught by her options. Only one facility met the minimal standards that she would accept for her mother and they had no available beds to receive her.

So the desperate call to me began with a relieved ‘THANK YOU for talking to me’ as she could not find anyone to assist her thus far, followed by a panicked and tearful “I don’t know what to do, they are discharging my mother from the hospital tomorrow. They want to make me send her to one of these horrible places!”

When faced with the unfamiliar pressures of doctors, hospitals, social workers and insurance companies, it is best to be well informed of your parent’s and your rights. Hospitals and their well meaning social workers can not force you to place your parent somewhere, anywhere, to merely release their bed. Check with your insurance company or plan administrator to understand more about your coverage for extra days in the hospital that may be needed to arrange for a smooth transition to nursing care. You are also not required to select a facility only from the list that the hospital provides to you. Facilities on the hospital list do not constitute an endorsement for the quality of the facility. Usually those on the list are facilities fairly close by, that provide the rehabilitation services that the hospital is recommending for your parent.

The first thing one should do is log on to the website Medicare.Gov Nursing Home Compare website for a list and comparison of nursing homes by state. By entering a zip code, you will see a list of facilities with star ratings apportioned to them – 5 is the best, 1 is the worst. You will see sub ratings for the different areas of service like staffing ratios, quality of care and latest inspection results from the state. This site is updated regularly.

Make a list of the communities that interest you and call to make appointments to view those locations as soon as possible. Take a list of questions that are important to you with you and note the answers and your observations of the facility.

Some important questions and observations are:
1. What is the ratio staff to residents? All nursing hours should be posted. Ask where they are and have a look.
2. If your loved one runs out of money, what will happen?
3. Ask for a complete breakdown of pricing and learn what is included and not included. For example, laundry, disposable undergarments, activities etc.
4. Ask to see most recent State, family and resident surveys and discuss any deficiencies.
5. Make sure you see staff smiling and acknowledging you as you walk through.
6. Assess the cleanliness of the facility and how well cared for the residents appear.

After your first tours, cull your list to your top three choices. Go back and visit them without an appointment and compare your observations. Talk to other residents and staff to understand what life is really like at the community. Once you have determined your finalists let the hospital know where they may send your parent. Hospital administrators may not have the latest information on beds available, so if they say there are no beds be sure to call the nursing homes directly to find out.

We at Green Hill provide outreach programs to community groups and others to provide information on planning and services for the time when we face caring for our parents and elders as they age. To learn more about future presentations near you call us at 1-866-788-7634.

It is such a hard and emotional time for both you and your loved one when dealing with an unexpected injury or illness that requires immediate decisions. Having the right information can make it so much easier. Knowing your options in advance can further empower you to best support your ailing parent.