If you have been following the thread of my recent articles (Part 1 and Part 2), you will have found some support and guidance if you have had to accept the painful reality that your loved one’s physical and/or mental well-being cannot be managed by you alone.
The decisions related to this realization can be overwhelming and are life-changing. Hopefully, you have gained an overview of some of the options open to you and how to evaluate them. Often, the choices you make define the last of their lives.
I make this statement to give emphasis to the importance of the evaluative stage of the process. As you read in the previous article, there are many questions to be addressed.
This article highlights additional considerations that are important to the decision you make; note that this is not an exhaustive list. As mentioned, the stage of the disease of your loved one will dictate the degree these considerations will affect your decisions.
Transitioning from Home to Facility
You may experience some resistance to the move from your home to the facility you have chosen. Feelings of fear, betrayal, confusion, and abandonment often dominate. If your loved one has been part of the choice and evaluation of the facility, these feelings may be mitigated. However, be prepared to acknowledge the strength of the attachment your loved one has to you and your home which may make the transition day especially difficult.
On the departure day, limit the number of people present at this time. Try to surround your loved one with 1-2 individuals she/he is most comfortable with; these friends/family should speak positively and optimistically about the benefits of the new experience. Avoid using words like ‘facility’ and ‘nursing home’; instead, refer to the new location as a “new place” where they can get more help. Messages of love, that you are close by, that their comfort is important to you, that phones and phone numbers are easy to access by them and for them by the staff are recommended. If possible, set a date you can keep for your first visit. Importantly, you must stay calm and positive.
Plan Ahead
Some facilities allow you to set up the new room before the patient arrives, so it feels more like home immediately. Bringing personal items from home, such as family photos, favorite blankets, or books, make the room feel familiar. (Re)introduce staff and other patients to provide a sense of connection. On arrival, an orientation to the room setup, individuals who are sharing spaces, and the facility are suggested.
Schedule the Move
Find a time of day when the patient is generally more relaxed and less likely to be confused or agitated, such as mid-morning or early afternoon.
Work Closely with the Facility
Partner with the staff to ensure the patient receives care that aligns with their personality, preferences, and needs. Share information about the person’s background, preferences, and routines.
Visit Regularly but Give Time to Adjust
Initially, frequent visits can provide reassurance and help with the adjustment, but monitor how your loved one reacts. Some may benefit from short visits, while others may need a longer period without too many visits to settle into the new environment. Communicate regularly with the staff to address any concerns early on.
Lastly, Give the Transition Time
Adjusting to a new environment can take time. It may take weeks or even months to get comfortable. Be patient and give them space. If needed, don’t hesitate to seek the professional guidance of a geriatric care manager or experienced social worker.
Know Your Rights
I want to underscore the necessity of thoroughly understanding your rights and those of your loved ones under the care of the facility/agency you choose. As mentioned in earlier articles, assisted living and memory care agencies are state-regulated; nursing homes are guided by federal laws. All three types of facilities are private entities functioning as businesses. How they do business can affect the care of the patients in their charge – over time, this can change. Here are four examples:
Private Pay vs. Medicaid Reimbursement
If a facility can earn more from private pay than Medicaid reimbursement, it might prefer to accommodate non-Medicaid residents, altering its policies at its discretion.
Hospitalization and Return Policies
An assisted living residence (or nursing home) may send a patient to the hospital for a medical issue that cannot be addressed at the facility, then refuse to let them return—even going so far as giving away their room or bed to a new tenant.
Reasons for Eviction
A nursing home might cite several “good causes” to evict your loved one. Legal eviction can occur if necessitated by medical reasons or if your loved one’s presence poses a threat to others’ well-being.
Eviction for Level of Care Changes
Additionally, eviction is permissible if your loved one no longer requires nursing home care or if they need more care than the facility can offer, such as hospice care.
Eviction for Non-payment
And ‘yes,’ failure to pay for care can result in eviction. However, most facilities are required to provide the resident and their family with written notice to proceed with eviction. This discharge notice should afford at least thirty days for the resident or their representatives to resolve the payment issues.
By law, the notice must also detail the reason for discharge, a summary of the resident’s condition, and a future care plan sufficiently detailed for use by a subsequent facility.
Eviction Rights and Protections
While evictions are relatively rare, knowing your patient’s rights when joining a community can serve as a shield against eviction. These rights extend beyond medical care and include privacy, financial, and access rights. It is strongly recommended that you completely understand your patient rights in writing and in a language you understand before moving in to prevent unexpected evictions.
These Are Just a Few Examples
These are just a few examples of the rights and protections you can expect and the questions you should ask.
Understand Upfront Costs
Be sure you know what you will be paying upfront. An inability to afford unexpected costs is one of the most common reasons for evictions. Most states require new residents to receive a disclosure of all possible fees. File this document in case you need it at a later date.
Clarify the Eviction Policy
Be clear on the eviction policy before moving in. What exactly will it take for the facility to say you must leave? What are the steps of that process? Specifics are important – a policy that is ambiguous is more likely to be used unfairly and the more likely you are to be surprised by an eviction. In particular, get a clear definition of ‘endangering behavior.’
Review the Admissions Agreement
Carefully review the admissions agreement and have an expert, like an elder law attorney, review it as well. Any promises made by management should be put into writing.
Ask About Hospital Visit and Bed Hold Policies
Ask how many days will your loved one’s bed be held if a hospital visit is required? Again, get this information in writing.
Information Sources for this Article
Information for this article comes largely from Clinical Tools, Inc. (an NC company) with funding from the National Institute on Aging (grant #R44AG026227).
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health. The site is currently managed by American Aging Care, LLC. AgingCare.com connects families who are caring for aging parents, spouses, or other elderly loved ones with the information and support they need to make informed caregiving decisions.
DementiaCareCentral is a resource center for dementia caregivers.
Centers for Medicare & Medicaid Services: CMS is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. CMS works in partnership with the entire health care community to improve quality, equity, and outcomes in the health care system.