Are nursing homes really horrible? I've got to do smething.

Sandy22,
My heart cries out for you. It seems most of us on this forum have and feel the same pain, frustration, guilt, etc.., and yet I find it curious that the forum directors only show the responses they feel are the "most helpful". My personal (family) experiences with Nursing Home/Rehab/Care facilities has been nothing like the favorable things I read here. My wife worked as CNA in several from low income to fancy rich facilities that had expensive art and cushy furniture, and the one constant and ever present factor was jaded, sometimes shameless lack of care. When we would show up unannounced it would seem they would spring in to action, but sneak in, or hang around long enough to be unnoticed and things change. Just a couple weeks ago, my paw-paw called from his Nursing Home crying for help, and my wife packed and left for the 4.5 hour drive to see him, and found him dehydrated, 3rd degree burns in his groin area from coffee that he should not have had to begin with, and at a temperature that violated all Texas protocol for serving anywhere, he was completely rashed from mid-thigh to belt from laying in his urine and feces, and when he was rushed to hospital his blood showed a level of narcotics sufficient to stop a charging bull. My point is, if at all possible, try to find a way to do this where you can be an integral part of the process. At home would be best for your loved one, but maybe not for you if you need some separation from the stress. We went with the home because we ourselves have disabling conditions and can not lift or hold him up, but now we are trying to find a way to bring him back home due to the many moves to "5" different nursing homes in 3 different cities that all resulted in pitiful care and diminishing health.
Right now you need to take a break, and I mean fast. There MUST be someone who can give you an hour, a day, or two? I do understand, because we had nobody willing, although many family members. But if your health and mental stability suffers, then there will be nobody to handle it anyway, right?
I will make sure our entire Church Family has you and yours in our prayers daily. Every time I read your story, I cried and wish I could do more.
Stay strong, and make your "self" first, and most of all keep the Faith!
Blessings & Tender Mercies from our Lord. ----Big Hugs---

Some are so much reliable but i know horrible too. You can handle this by adopting a sitter at home.

sadly we only hear about horrible nursing homes... We have 3 in our area that are good!!! And I know that there are others that are good also. Do your homework and check them out first. If you have friends who have loved ones in a nursing home talk to them! I know it is not easy, take care...

My mother is in a very good one in Montana.

tinawee, start with figuring out which facility you like and then contact the admission director for that facility and they will guide you as to what is needed. For sure you will need to have her doctor precribe it and then they will need to send over the paperwork required.

My mom has Blue Cross Blue Shield and medicare. I will need to go out of town a few times for work next year. I have looked into a respite facility but how do I get insurance/medicare on board? How do I start? I live in Georgia.Mom has aiready had her TB shot required by the Senior Citizen Day Care I take her to during the day.

Here in Ca- we have families that will bring in mom leave her for 2 weeks and they will return exactly 30 days later.

Respite is a VERY good idea diavalon12! In Iowa medicare will pay for two weeks of respite in a facility...

I work for 2 different NH's and I can tell you that it really depends on what you are looking for. Best advise is to do your homework. You can go online and find out about complaints filed with the state etc. All facilities have a star rating by CMS, the lower the stars the lower the quality of the facility. Look for something 3 stars and above. Visit the facility meet the people, ask around.Ask to meet the social worker and the activity directors as they will become your eyes and ears when you cannot be there. Admissions is worried about filling the beds but the ssw and act dir will have the most impact. Been there done that so I wish you the best luck in finding a place for mom. Here in California you can receive repite care every 30 days paid by medical.

There are indeed some very good nursing homes available... Do some research. Often it seems that the smaller (not corporate owned) are actually better and I am sure there are exceptions. I know close to us is one that is owned by the community and is beautiful and very good!!! Do NOT beat yourself up if you need to place your loved one you should. My parents cared for one of my Grandmother's for years. They bought and farm and she would not go, she was 90 by that time so she went to the nursing home. She actually loved it. They were very good to her! take care!

As many have said, there are degrees in the quality of nursing homes. You should make appointments to visit those in the area. Money can be a factor. I visited three when we wanted to move my grandmother from a semi-assisted living facility to a nursing home. The one we chose had a country-club type of feel to it...in the common areas. It was clean and didn't smell. They had people two to a room with a half wall providing some separation. Another facility had more than two to a room with the beds pushed up against the wall. It appeared to be well-maintained but the atmosphere and feeling between the two was noticeable. The frame of mind of the person being moved also plays a role in how well the move will go. In my case, my grandmother (95) did not want to relocate, even though it was to the nicer facility that one of her friends lived at; so it was mentally and physically downhill from there. My grandmother died about 6 months later. For some, there is a stigma attached to being in a nursing home. It is not an easy situation to deal with for many people, the family putting the loved one in the home and the person going into the home. I like to think that I will react differently if I reach the point in my life that I would need that type of care but I think the brain changes when a certain age is reached (differs depending on the person) and what would have made sense and been acceptable when one is in their "right" mind, doesn't make sense and isn't acceptable when one is in their "older" mindset.

Prayers, hugs and good luck to you and your mom.

There are 2 systems for determining the need for hospice:
Functional Assessment Staging Test (FAST) & Mortality Risk Index (called the Mitchell score).

FAST has stages. Stages:

1. No difficulties;
2. Subjective forgetfulness;
3. Decreased job functioning and organizational capacity;
4. Difficulty with complex tasks and instrumental ADLs;
5. Requires supervision with ADLs;
6. Impaired ADLs, with incontinence;
7. A. Ability to speak limited to six words & B. Ability to speak limited to single word
& C. Loss of ambulation
& D. Inability to sit & E. Inability to smile &
F. Inability to hold head up.



Mortality Risk Index Score (Mitchell)

is points & % risk:
1.9 Complete dependence with ADLs;

1.9 Male gender;

1.7 Cancer;
1.6 Congestive heart failure;
1.5 Bowel incontinence;
1.6 O2 therapy needed w/in 14 days;

1.5 Shortness of breath;
1.5 less than 25% of food eaten at most meals;

1.5 Unstable medical condition;
1.5 Bedfast;
1.4 Age over 83 years;

1.4 Not awake most of the day. You add up their score and get their risk.



Risk estimate of death within 6 months
(Mitchell score):
Score Risk %

0 8.9

1-2 10.8

3-5 23.2

6-8 40.4

9-11 57.0

12 points or more 70.0 % risk of death w/in 6 months.
Mitchell can change over time. My mom was over 12 points in June (when she shattered her hip) and now is a 9 pointer. The hospice does a new score for Medicare renewal which are the first 2 90 days periods and then every 60 days thereafter. There is a lady @ my mom's NH who is hospice for almost 4 years, so hospice can go on for extended time if they meet the criteria.

Mitchell score gets used more as it is less subjective and can be done easier.
________________________

Sandy - you know we all feel and share your concern. None of this is easy. But 11 years is a long time & you realistically have done what you can. Mom now needs care at a higher level which a NH does. The days of NH = Snake Pit just do not exist anymore but you have to find one that meets your mom's needs

As your mom is bedridden (fyi called "bedfast" in NH speak), I bet she can be on hospice care @ the NH. The criteria for hospice is pretty specific but I bet she can score high enough to be OK for hospice. i will do another post on how hospice scores. Assuming she is good for hospice, I'd approach finding the NH differently. BTW my mom is in a NH for a couple of years now and just went onto hospice @ the NH in June from a hip shatter, she is on Medicaid too.

MediCARE pays for hospice - whether hospice is at your home or in a facility like a NH or a free-standing hospice building (the free-standing ones are usually for cancer patients or brain trauma or others who need massive pain management). Medicare hospice care means the NH is now having extra hands to do things for the resident which makes the NH staff freed-up. My mom has an hospice paid RN visit twice a week, an aide 5 days a week of which 2 of those days she gets bathed which the hospice aide does with a CNA from the NH. My mom gets lots more detailed attention now that she is on hospice. Now MediCARE does NOT pay for the residents room & board costs @ the NH, the r&b would need to be paid for either by private pay or LTC insurance or Medicaid. Medicaid will require it's own application - which you will have to do the financial documentation on - so if you need Medicaid to pay for the NH, you have to limit your choices to NH that take Medicaid AND do applications as "Medicaid Pending". Not all NH do that, "pending" is important because if there is a problem with the application, the costs billed to mom/you for the NH will be at Medicaid rate and NOT the higher private pay rate.

My thought is that you contact some hospice providers (VITAS & Compassus are bigger national groups and are very good) to tell them your situation. They will come to the house to do an evaluation on your mom. They will need an hospice evaluation request (done on a prescription form) from your mom's MD. They come out and score mom on her capabilities. Here's where you have to be direct with them, tell them you don't think you can maintain the at home care that hospice requires from family and that you think mom would be best @ a NH. The hospice will have a list of those NH they work at and from that list you contact admissions to see if there is room. Go and see the NH's. Really each NH is unique and what works best for you probably is not what I might like. Also if the NH just doesn't work out, you can move mom once she is on Medicaid and all OK for hospice & Medicare paying for it. BTW my mom's NH is paid by Medicaid about $ 4,500 a month for her r & b and Medicare pays about $ 4,000 a month to her hospice provider. So there is a financial incentive for both the NH and the hospice group to make all this work. Oh also my mom is in her 2nd NH, moved her from her first NH within her first year. So it can be done and all-in-all it was pretty easy.

There are lots of hospice groups too. I mention VITAS & Compassus as we dealt with them with other family. My mom is with a smaller regional hospice group. Hospice is Medicare paid so you can determine who the Medicare provider is to be. The advantage to a bigger hospice group is that they have the financial ability to get equipment asap while a smaller group may not be able too. My mom has a "breathing" bed which it moves 24/7 so that it lessens bedsores; they got mom a "geri-chair" and a "geri-bath seat" so that she can move to them to be strolled around the NH or go into the shower room to get a real bath; lightweight O2 dispenser (my mom is tiny and the normal ones are too heavy for her). All this stuff is specialized and expensive. A bigger hospice has the wherewithal to order this stuff and have it delivered yesterday. Plus a bigger group has a whole communications system set up for doing emails or Skype - which for me is important as I live out of state and travel. Good luck and take time for yourself.

I'm sorry, I said Assisted Living...I meant to say Memory Care. Having mom home, I have a baby monitor set up in her bedroom and I have had only 3 uninterrupted nights sleep in months. My eyes have dark circles and I am at my "all time" highest weight. No time to exercise. :(

I had my mother in an assisted living facility for 8 months. I purchased a nannycam through Brickhouse Security online. It was the SVAT Alarm Clock Hidden Camera and it worked well for me. It did prove the facility was not giving the care they said they were and charged me for, among other infractions. Mom is living with me now and I know I will have to put her somewhere again, but NEVER without a nannycam.

Like everything, there is good and there is horrible. I am a social worker in a nursing home in Wyoming. We endeavor to build a community of sharing lives with our residents and staff. We do this with patient centered care, outings into the community and activities to fill their day joy and to protect against boredom, hopelessness and helplessness.

Nursing homes are not horrible. My parents both received excellent, compassionate care in a nursing home (short term rehab wing), then my mother received excellent care at another facility. Shop around, get a feel for what is available in your area. My parents both hated staying in the first one despite the great care, so be prepared for that possibility; my mother was resigned to the second one until I was able to bring her home. I slept much better when they were in the nursing home than I do now with Mom at home.

my mother has been in a nursing home for a year. The place isn't flashy but the staff are wonderful - some have been there over 30 years.

It's not so much the NH that is horrible, but the state one is in to make it necessary to enter a NH is horrible.
It's all about the people, some workers are NH are exceptional. If you need one, it is the right thing, good luck in finding a good one,,,,,stay involved, drop by, be friendly to the workers and give yourself a break

The one mom is in is pretty good. Only once did I see an aide say something out of line and now I notice she is gone from the facility. The problem I see is that they charge an arm and 2 legs. The food isn't all that good either, too starchy. But it is one of the best in the Northwest.

I have worked in nursing homes for over 23yrs they are not all the horror stories u hear, u can get help to come into ur home and care for ur mom that's wat I do for my father, area agency on aging, homehealth agency, hospice care. The agency on aging is who is helping me, I'm getting ready to have hospice come in. If I can be any help let me know god bless u all is not lost.

http://www.medicare.gov/nursinghomecompare/search.html
For US nursing homes

Nursing homes are nursing homes. That being said, you are still the over seer of your family member where ever they are and the care your mother gets will depend on how much you keep up with where ever she is. You can visit her everyday if you so desire and still feel the relief that you emotionally need. Your relationship will probably take a turn for the better if you place her in a home. You can visit with her and do things for her then because you want to, not because you feel you have to. Be blessed.

I found a rating, like 1-5 stars on line, one time. I had googled "top rated nursing homes" or something like that.

The best thing to do about nursing homes is to try and find people who have a relative living there, and don't make a quick decision. In my town, the one with the best ratings from families is one that is not very flashy, but the residents gets attention and the staff tries to keep them busy. Pay attention to the smell and how many staff members are nearby. Find out how many complaints the nursing home had in the past, and look up your local ombudsman as they are very helpful. I have a relative who went to assisted living first - now they need more care, but they are stuck there because other family members will not deal with the situation.
I really think that one with headquarters locally, or in the same state, would be preferable, but so many now are run by large out of state corporations.

My father was in a nursing home and it was quite helpful for him. There are different levels of nursing homes and various levels of care. Be sure to check out any facilities that you wish to send your mother to. Go at different times of the day.

Best of luck to you. I imagine that having a bedridden parent is difficult.

It depends where you live. I know in the northeast, most of them do the best for their patients. Nonprofit are usually better than for profit. The for profit usually accepts more medicaid patients than the nonprofit. Medicaid does not pay what a private payer pays, thus the need to shift costs to a make a profit. Senior care is becoming big business at the cost of quality care. If you think it is bad now, wait until the babyboomers reach their very senior years. I am one of them. I dread what will be of my generation!

The nursing home that my Mother (94) is in has saved her life. I never would have believed it. There are friends there, hair dressers, nutritionists, CNAs and RNs. Mother was on her last legs, living at home. She was taken out by ambulance and then, to the hospital first, but she has been at the NH 6 months. (Central IL.)

I agree with both Sandy and Blannie. Agency on Aging has a program they will come to your house and bathe her and stay about 2 hours, twice a week. They may have changed what they offer but give them a call. I cared for my husband while a wound was healing from a surgery. It took one year before that wound healed so I was caregiver for everything. Nursing homes: He was put in one from hospital to be administered antibiotics every 4 hours in his vein and there 6 weeks. He is paraplegic and does drink LOTS of fluids. The staff was sweet and compassionate but ONLY brought ice water each change of shifts. I started bringing water and ice with me when visiting him. He has MRSA so I could not fill his pitcher myself or get his water in that facility. He got 3 delicious meals, medicines, bath each day, etc., and not turned every 2 hours and got a bed sore on foot. I know how much you need that time for yourself and you must do what you think. Best wishes to you and you are not alone..many are doing what you are doing for a parent. Consider ALL your options and then follow through. God bless you!

Sandy, in most places nursing homes have made huge strides and are no longer the old stereotype that is likely in your mind. If I were you, I'd visit some local nursing homes. I will say that some areas of the country have come father than others in elder care. Regardless of that fact, you really need to get help with your situation.

I agree with Blannie that you need interim help, too. Type you state name and the word "aging" into your browser. That should bring up your state site and some links where you'll find information you need. If you get to the wrong source, just ask for help finding support for caregivers.

In the end, a nursing home seems like a necessity. I hope you find a good one where you can visit often and keep an eye on things but also get your life and health back.

Take care of yourself by taking action,
Carol