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Week of 12 February 1999

Vol. II, No. 23

Health Matters

Caring for the elderly: how to choose a nursing home.

My mother lives with me and is approaching her 90s. I feel it is time to consider a nursing home. How do I choose one?

Placing a loved one in a nursing home may be one of the most difficult decisions you have to make in your life. Choosing the right home may be one of the most important.

The first step in deciding if your mother needs to be placed in a nursing home is an evaluation of her independence. The next step is to evaluate the stress you are under from caring for your mother. If your mother is not independent enough to provide for her basic needs -- feeding, dressing, and bathing herself -- and if your stress level is high, then it is time to examine your options.

"This is an especially difficult period in people's lives," says Ellen B. Harrington, a social worker who specializes in geriatric patients at Boston Medical Center. "You have to do not only what's in your loved one's best interest, but what's in your best interest, too. If your health is in danger from caring for your loved one, then you will be unable to provide the best care possible."

Until recently, few alternatives to nursing homes existed for people who could no longer take care of themselves or who had family members who could no longer care for them. Now, however, more options for care are available. The best choice depends on several elements -- the patient's functional level, financial resources, and availability of other resources.

If an individual is functional enough to remain at home, an elder-service program or home-health aide is a good option. Federal and state programs subsidize housing for older people with low to moderate incomes who are largely independent but need help with chores such as shopping or laundry. For individuals needing only minimal help, an assisted-living facility, which provides meals, laundry services, and medication reminders, may be worth considering. Board and care homes and continuing care retirement communities are other alternatives that offer different levels of care to residents who do not need the services of a nursing home.

The Health Care Finance Administration (HCFA) defines a nursing home as a "residence that provides rooms, meals, recreational activities, help with daily living, and protective supervision of residents." These facilities generally have residents who are physically or mentally unable to care for themselves. Nursing homes are certified to provide different levels of care, from basic care to skilled nursing services that can only be administered by trained professionals. HCFA says that nursing homes care for about one in 20 Americans over the age of 65 and that nearly half of all Americans turning 65 this year will be admitted to a nursing home at least once in their lifetime. As individuals age, the likelihood of nursing home admission increases.

Paying for a nursing home can be as stressful to a caregiver, Harrington says, as making the decision to place a loved one in a home. If Medicare or Medicaid are available to you, make sure that the nursing home you choose accepts those payments. If you belong to a managed care plan, make sure the home you are considering has a contract with your health maintenance organization. Check to see if private insurance will cover any or all of the cost.

When choosing a home or assisted living facility, consider accessibility to family members. Also, take a tour to conduct your own physical evaluation and meet with the staff to learn their policies and philosophy of care.

Harrington says that caregivers should consult all available resources, including the loved one's physician, clergy, hospital-based social workers, and community elder service programs, when making the decision about a nursing home. She also recommends contacting the local long-term care ombudsman, who has extensive knowledge about the quality of life and care at nursing homes. Check your local telephone listing for the state long-term care ombudsman in your area.

"The bottom line," says Harrington, "is that the patient be well cared for and well looked after. It's very hard to accept that you can no longer care for a parent or other loved one. In the end, you have to do what's best for both of you."

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about nursing homes or other health matters, call 638-6767.