Becoming a Partner in Your Loved One's Nursing Home Care

How can you make sure that a love one receives the best care during a nursing home stay? Read on to learn more about nursing home care planning, staffing, quality care, and more.

The Importance of the Care Plan Meeting

Each nursing home resident has a care plan that is essentially a roadmap to their care. Residents and their families have a right to be involved in developing that plan. As a family caregiver, your participation is very important. In fact, it's vital that you attend the care plan meeting because this is where you become a member of the team responsible for your loved one's care.

During the meeting, you will meet the heads of the departments who are responsible for developing the care plan for your loved one. It's where you can share the little details about your family member that will make the care plan personalized and customized for your loved one. Share as much information as you can.

The nursing home staff will then make a list of all the areas where care planning is needed and will probably have some priority areas. Finally, the staff will give each resident, regardless of condition, the opportunity to attend a care planning meeting. If the resident does not attend the care planning conference, he or she should be kept informed and consulted about preferences. If it is okay with the resident, a family member may come with the resident or represent him or her. Others can be invited to the meeting too. The certified nursing assistant (CNA) who is closest to the resident may also attend.

The purpose of this conference is to be sure that the care plan will meet each resident’s individual needs and preferences. It’s important to understand that the care plan will likely change over time. Be sure you have a copy of the completed care plan.

Nursing homes are different than hospitals. Physicians visit regularly but are not necessarily there every day. The director of nursing is in charge of health issues. The nursing home administrator is in charge of all of the departments. Get to know them both. Be sure to say when care is good. Speak up if you have concerns, questions or suggestions. 

Questions You Can Ask to Promote Good Nursing Home Care

What ongoing training is available to staff?

Continuing professional training helps staff learn new skills and techniques for improved care and can translate into increased job satisfaction. This can help ensure stable staffing, which, in turn can make for higher quality care.

How many caregivers does each resident have?

A resident should have as few different caregivers as possible. Staff members who consistently care for a resident often develop strong bonds that make for better care. Consistent care assignments are important for all residents, but especially for people living with Alzheimer’s or those with other dementia who can become distressed when faced with someone unfamiliar.

Is staff trained to handle special conditions such as behaviors associated with dementia or Alzheimer’s disease?

Staff trained to care for residents with these conditions are more likely to understand the meaning of behaviors such as wandering and yelling and can better meet resident needs. You want to hear that staff receives training to meet the needs of the residents they care for.

What is your plan for pressure ulcer prevention?

The skin, like the heart and lungs, can fail over time. Residents who can’t move by themselves, or who have dementia are more likely to have pressure ulcers. Pressure ulcers can develop on hips, heels, tailbone, ankles, elbows, shoulders, head, ears or wherever pressure is on the skin too long (as little as two hours) when nutrients and oxygen are cut off. Staff help to prevent them by inspecting the skin daily. They should also carefully turn or move a resident, or remind them to move themselves, as scheduled. Staff should keep residents clean and dry from incontinence and make sure they eat and drink nutritious food and fluid. Residents and families are full partners in making sure this happens. The schedule for these preventive measures should be included in the care plan.

How do you assess and treat residents’ pain?

Pain can be difficult to assess and measure. Staff should ask all residents about their comfort or level of pain daily. For a person with dementia, they should watch for pain signs like pacing, holding a body part, grimacing, or shouting. Understand that staff is attentive but cannot see everything. Help watch for signs that a resident may be uncomfortable or in pain and alert the nursing staff. Check to be sure the pain was treated.

How are medications handled?

Residents often take many drugs. Some are prescribed, while others are over-the-counter medications like vitamins. The more medications someone takes, the more likely they are to have a drug interaction. Nursing home staff continually assess the benefits and complications of these drugs. The addition of any new medication needs monitoring by the nursing staff. Families should alert the staff if they notice sleepiness or confusion, or any changes since it could be from a medication.

Are staff familiar with your family member’s routine, medical background, and preferences?

As noted in the discussion of the care plan above, residents and families should share as much information as possible about a resident’s preferences. For example, if staff is alerted that a resident enjoys sleeping late, they won’t schedule physical therapy then. If the resident wants dinner early, a bedtime snack should be built into the care plan. If he or she wishes to listen to the radio in the afternoon, staff should try to accommodate this preference. Ask questions about monitoring and satisfaction.

How are suggestions handled?

Residents and families offer a second pair of eyes and ears. Collaboration with the staff will improve resident satisfaction and result in better care. If continual issues arise, alert the nursing home administration and attend the care plan meeting to get more information.

Does the nursing home have a long-term plan to improve care for everyone?

It is important for nursing homes to set goals to continually improve care and to address issues as they arise. How often are quality assurance meetings held? Does the nursing home have a process to identify potential problems? What issues are they currently working on? Ask if families can be involved.

Does the facility have a consumer satisfaction survey?

If so, ask to see it. A high-satisfaction rating by residents and family members often correlates with higher quality care.

Above all, stay informed and involved.

Visit your loved one as frequently as you can. Express your opinion. Know what’s going on with your family member. Get more information about the various conditions your loved one has so you can know what to expect. Get to know the caregivers and other residents and their families. If you have questions about any of the above and the nursing home is not able to answer them, contact your local ombudsman (www.ltcombudsman.org). 

If you need more help, Takacs McGinnis Elder Care Law may be able to assist. Just give us a call at 615.824.2571.

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