What is the first step I need to take when thinking about placing my loved one in a Nursing Home?

The first step is to decide which nursing homes (profit or non-profit) you wish to explore in your geographic area and select the top three. Tip: One should research selected nursing homes on the Rhode Island Department of Health website (Office of Facilities Regulation) to review Nursing homes CMS (Centers for Medicare & Medicaid Services) rating as well as any deficiencies that may have been cited to the facility during their annual inspection review.  When one has decided on a preferred nursing facility, the next step is to contact the Admissions Coordinator and/or Admissions Director to schedule a tour of the nursing facility.  When touring a nursing facility, one of the most important questions to ask the Admissions Coordinator is, “Can you tell me if you have had any cited deficiencies from the Department of Health Facilities Regulation”?  Tip: Every nursing facility is mandated to post their deficiencies in a public area for review (typically posting is located in the lobby area of a nursing facility).

When my loved one is admitted to a Nursing Home, will the staff accommodate my loved one's specialized diet?

There are very few specialized diets that nursing homes are unable to accommodate, however, the Registered Dietician and /or Dietary Manager would be able to answer specific questions related to your loved one’s dietary needs and/or restrictions. Tip: Every nursing facility is required to follow a weekly menu so feel free to ask the Admissions Coordinator or Dietary Manager if you could have a copy of the menu for review.

When my loved one is admitted to a Nursing Home, what are the staffing patterns and is there a visitation policy?

Every nursing facility must post their daily nursing staffing pattern in a visible area for family members/visitors to review. Tip: When touring a nursing facility, one very important question to ask the Admissions Coordinator/Director is, “What is the CNA (Certified Nursing Assistant) to patient ratio”?  In other words, how many patients is a CNA responsible to take care of on their designated shif t(varies from shift to shift: 7-3pm, 3-11pm, & 11-7am).  Every nursing facility will have their visitation policy available for your review and can also be reviewed by the Admissions Coordinator/Director during your tour and/or admissions process to the facility.

Do Nursing Homes provide social/recreational activities for Residents?

Every nursing facility is required to have scheduled activities for the residents with a monthly recreational calendar posted in the facility for residents/families to review.  Nursing homes are also required to hold a resident council meeting on a monthly basis which is facilitated by a designated staff member of the nursing facility (typically the Activities Director/designee and/or Social Worker).

Do Nursing Homes provide Religious services?

Nursing homes vary as to the type of religious services offered as some homes may provide Catholic mass, bible study, or non-denominational services.

What is the admission process for placing my loved one in a Nursing Home and what is the financial obligation?

Placing a loved one in a nursing facility is a difficult process.  However, once a family member or responsible party (e.g. Power of Attorney and/or Legal Guardian) has selected their nursing facility of their choice, an appointment would need to be scheduled with the Admissions Coordinator/Director to complete the admission application. Tip: You may want to ask the Admissions Coordinator the following question, “do you have a waiting list”?  In terms of the financial obligation for a loved one to reside in a nursing facility, cost will vary from each nursing facility with regard to their private rates.  However, if your loved one is unable to afford to pay privately in a nursing facility for Long Term Care then here are a few payor sources a patient can utilize: Long Term Care Insurance depending upon the Nursing facility’s policy and Medical Assistance (Medicaid) pending eligibility.  If your loved one requires skilled rehabilitative  services following a hospital stay, the nursing facility will bill the patient’s primary health insurance pending the facility’s contractual agreement with health insurance plans.  However, if your loved one’s primary health insurance is Medicare and the nursing facility has designated certified Medicare beds, the facility would bill Medicare for the cost.  Tip: It is best practice to speak with the Business Office Manager/designee in the nursing facility on the day of your loved one’s admission to ask any health insurance questions as well as co-pay/supplemental insurance costs if applicable.

What Level of Care do Nursing Homes provide, such as Memory Care, Long Term Care, or Rehabilitative services? Do Nursing Home provide End of Life Care and are there various companies that provide Hospice Care services?

The Level of Care services provided by a nursing facility varies from Long Term Care, Memory Care, and Skilled Rehabilitative services.  Every nursing facility is required to have a Hospice Care provider(s) for End of Life Care.  However, if a nursing facility has more than one Hospice provider per contractual agreement, the resident, family member, and/or legal representative has the right to choose their provider of preference.  Tip: A resident and/or family member also has the right to choose their loved one’s Attending Physician (if more than one M.D.) pending the Attending Physician’s decision to accept the patient/resident.  Nursing homes are required by regulatory standards to have a Medical Director employed at their facility.

My loved one resides at home, but my family needs assistance in coordination of supportive services.  How do we start the process and what type of home services are available?

The first step as a family member is to decide your loved one’s need (e.g. medical, emotional/psychological, social, safety) and once that decision has been made, a family member can contact agencies and/or companies that provide the needed service.  If your loved one is in need of assistance with their ADL’s (activities of daily living) and/or household tasks, a family member should contact a homecare agency/companion service. If your loved one requires a mental health evaluation, a family member should contact his/her Primary Care Physician (a Physician may make a referral to a Geriatric Specialist/Psychiatrist and/or evaluation in a Geri Psych facility depending upon your loved one’s symptoms/severity).  If your loved one has memory impairment, a Physician may recommend a Neuro-Cognitive evaluation.  If your loved one lacks social interaction, touring a local Senior Center or Adult Day Program may be beneficial.  If your loved one is a fall risk, making a referral to Lifeline Program and/or other Medical Alert Systems for fall prevention or scheduling an appointment with a representative from a Home Adaptation company can assist with your loved one’s safety needs.

My loved one is no longer able to reside alone at home any longer.  What is the process for setting up transitional care, particularly for Assisted Living and/or Nursing Home placement?

First and foremost, it is important for a family member to consult with their loved one’s Primary Care Physician regarding any type of change and/or decline with their loved one. A Physician’s evaluation/assessment is vital to the transitional care process and making recommendations related to your loved one’s health setting needs.  If your loved one is in need of Assisted Living placement, a family member should contact the Assisted Living Representative (typically a marketing staff member) to schedule an appointment/tour of facility.

Tip:  Not all Assisted Living facilities provide Memory Care so ask the representative if their Assisted Living would be able to meet your loved one’s needs.

When my loved one  is no longer able to reside in an Assisted Living facility, is there a Social Worker that can assist with the transition process to a Nursing Home?

Most Assisted Living facilities do not have a designated Social Worker on staff as part of their Interdisciplinary team.  The Resident Care Director (nurse) would most likely be in contact with the family member to inform he or she of their loved one’s decline and need for Long Term Care placement.

Tip: Make sure to ask the Resident Care Director and/or Assisted Living Representative their notification policy for discharge.

My loved one has had multiple falls at home—are there services we can set up to maintain my loved one's safety?

There are services available to maintain your loved one’s safety in the home and reduce fall risk.  A family member can contact local Lifeline service/program (Medical Alert System) and schedule installation in your loved one’s home.  There are also Home Adaptation companies that can come out to your loved one’s home to assess the environment and make necessary recommendations.  There are a wide array of Senior Care companies/agencies that can provide companion and/or private duty caregivers in the home for monitoring/supervision of your loved one.