The decision to place a loved one in a long-term care facility for the elderly can be a very difficult and emotionally demanding process. Both you and your loved one need to take an active role in the decision to maximize the health, safety and well-being of your loved one. Once you have narrowed down your search and thoroughly researched and toured the facility, you should consider the following set of guidelines put together by California Advocates for Nursing Home Reform to ensure your loved one receives the best possible care and treatment.
1. Support your loved one's transition to the care facility. Open communication is extremely important while your loved one transitions to their new home. There may be feelings of loss or abandonment by the person being placed in the facility, as well as mirrored feelings of guilt or neglect by the person assuming responsibility for the placement. Therefore, it is important to openly discuss these feelings. Make sure your loved one receives a comprehensive assessment upon admission and be attentive to any changes in needs, behaviors, attitudes, and affections during the transition.
2. Make your visits count. Vary your visiting schedule by going on different days and at different times. This will ensure you are able to meet various members of the staff, and observe how your loved one interacts with other residents and staff members at different times of the day. Also, make a plan before each visit. Try to discover new things, meet new residents and staff members, explore new areas of the facility, plan special events outside of the facility, and bring with you important talking points and your loved one's special interests.
3. Get to know the staff and build relationships. Make it a point to learn each staff member's first name and understand their position and what they do for your loved one on a daily basis. This will ensure that staff understands your level of caring and involvement and most likely will appreciate your insight or special concerns regarding your loved one's needs. Most importantly, get to know the Director of Nursing (DON) and Charge Nurses. These individuals play a key role in your loved one's everyday care. Also, familiarize yourself with the facility's policies and procedures regarding the care of your loved one, and request meetings with the Administrator immediately if you suspect any problems.
4. Be an active participant in all care plan meetings. Being present at the initial comprehensive assessment is vital, but being involved in all care-planning is essential to the quality of care your loved one receives. These care plan meetings provide you an opportunity to evaluate whether the plan is effectively meeting your loved one's needs or whether changes are necessary. This also allows you the opportunity to personalize the treatment, as well as voice your concerns about your loved one's experience. Always insist on concrete, measureable plans that include timetables, and follow up your meetings with written confirmation describing the issues discussed.
5. Monitor care. The facility has a duty to follow the care plan in good faith, so hold them accountable by diligently monitoring the treatment of your loved one. Check the facility's records and compare and contrast them by discussing the treatment with your loved one. Physically inspect your loved one in an inconspicuous way to ensure that physical abuse is not going unreported. Also, keep your own notes and engage your loved one's physician if you suspect any health issues.
6. Act as an advocate for loved ones. Both you and your loved one have specific rights that you should be aware of. The most important right you have is the right to express concerns, suggestions or to make complaints and to do so without retaliation. Make sure to follow up on all concerns made, and do so in a calm yet assertive manner. Maintain your face-to-face meetings and contact the facility's Ombudsman Program to assist you in exercising your rights. Always file complaints with the appropriate licensing agency (e.g., California Department of Public Health).
7. Prevent abuse. Learning signs of elder abuse is crucial to the health and well-being of your loved one. Look out for unexplained bruises, scratches or marks on their face, inner arms or legs, or on the breast and genital area. Look for signs of over-medication like drowsiness, dry and cracked lips, drooling or blank/vacant stares. Look for poor hygiene, the smell of urine, and unattended residents in the facility. Indicators of neglect include significant weight loss, dehydration, or malnutrition, frequent falling and signs of skin breakdown and bedsores. Be aware of your loved one's personal belongings and financial affairs and ensure there are no fraudulent billing practices.
8. Become active in quality care issues. You and your family members can join Family Councils. Also, encourage your loved one to join the Resident Council to become actively involved in not only their personal care, but the care of their peers. Supporting legislation that enhances residential rights and improves quality is also a great way to get involved.
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