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What's Your Question About Nursing Homes?
By Kathy Gannoe - January, 2009
Question:
I called your office and you wouldn’t tell me the best nursing home to move my mother into. Why didn’t you tell me? You must know.
Answer:
Well, actually I don’t know. There are many factors involved in choosing a facility which is best for the individual. My advice to families over the years has always been to choose a nursing home close to the family and friends who will spend the most time visiting the resident. My observation is that if it’s easy to just pop in for a visit, visits will be more frequent. Frequent visits are a real plus for everyone —the resident who then keeps in touch with family and friends and, the caregiver who gets a chance to see the entire scope of care being given at the facility. Qualities of a nursing facility vary. Staffing, activities, the therapy department, food service. Some facilities look lovely and have attractive buildings and decor. Others look rather grim and may even be in an “undesirable” part of the community. Folks really need to go to a facility and see for themselves how care is being given. Do the residents look cared for? Do they seem contented? Do staff members seem to be enjoying their work? Are they interacting with residents in a relaxed and friendly manner? What about administrative staff; are they happy to see you pop in for a surprise visit? Do they welcome you and offer to answer your questions? These are important things to check out. The federal government has just instituted a new five-star rating system. If you go on the internet to www.medicare.gov/nhcompare you will be able to find area nursing homes and see how they rank with others in the area. The system is new and isn’t perfect but it does give you some guidance as you try to make a good choice for your loved one.
Question:
Why are all these therapists working with my father?
Answer:
Skilled level nursing homes provide therapy services, usually paid for (at least for a time) by Medicare. Generally you will find physical therapists and speech therapists. Sometimes there are occupational and activity therapists. A few facilities may offer other services such as music therapy. Physical therapists (PTs) work with the total body, trying to restore or maintain function after some event such as a stroke. PTs help residents learn to walk again and to transfer in and out of chairs and beds. Speech therapists work on speech, of course, but they also assess a resident’s ability to eat and swallow. Occupational therapists (OT) work on small muscles, helping a person relearn how to do tasks like button a shirt or tie shoes. They also look to see if some special adaptive equipment would make daily activities easier. These might be weighted spoons, plates with side rails, specialized drinking cups. They will also help a resident relearn how to do daily activities such as cooking, getting in and out of a bath tub, combing their hair, working a microwave, and other daily tasks.
Question:
I can see how that might be a good thing for someone who is likely to go back home but my Dad is really demented and physically impaired. What use is therapy to him?
Answer:
There are probably two reasons for providing therapy services to your Dad. The first is that the more function he retains, the better the quality of his life. The therapists may believe that he has the capacity to regain some lost function. If he becomes immobile, he will be subject to getting painful bed sores. If he retains his ability to move his arms and to sit up in a chair, he can participate in some activities such as moving to music. Even if these activities are limited, they can provide him with some enjoyment and improve the quality of his life. The second reason to help him maintain as much function as possible is that it makes taking care of him easier. If he can assist a nursing assistant as she bathes him, it makes her job easier and he’s likely to get cleaner. If he can move some of his body weight, he can be repositioned more easily. “More easily” usually translates into more often, and that’s a good thing.
Question:
What about this speech therapist evaluation the nursing home wants him to have?
Answer:
Speech therapists look at a person to see if they still have the ability to swallow their food and drink. Small strokes, and other events, can impair a person’s ability to swallow fully. The “gold standard” for these evaluations involves the use of x-ray. It can be very difficult to detect a swallowing problem. Often the person can eat solid food and drink regular beverages. They don’t cough or choke. The trouble is, that the food goes down the wrong way and just lays on the vocal chords. As soon as they talk, the vocal chords open up and the food drops into the lungs. Next problem: aspiration pneumonia.
This column is presented as a public service of the Nursing Home Ombudsman Agency of the Bluegrass. If you have a question, send it to:
Kathy Gannoe
Nursing Home Ombudsman Agency
1530 Nicholasville Rd.
Lexington, KY, 40503