Picking a nursing home requires research, on-site visits
Like so many adult children, Fred Clock was reluctant to talk to his mother about nursing homes. She actually initiated the conversation. Arthritis in Rosemary Clock’s hips and knees made getting around increasingly difficult and she was apprehensive about staying by herself at night even though her grown son lived in the same apartment building. Still, when the day finally came, Fred found it hard to walk away.
“You almost feel like you’ve failed somewhere along the way because you couldn’t do everything for her ... but you reach a point where you know you can’t,” Fred says. “You could try but you’re relinquishing your life.”
The aging population, the desire of many to stay at home and economic constraints have led to a boom in in-home care, which generally costs less per person than a nursing home. Many independent seniors wanting to stay home are doing just that, giving rise to naturally occurring retirement communities where basic services like transportation come to them.
But sometimes circumstances, such as great medical need or limits on what family can do, dictate that a nursing home, assisted living or independent living facility — often all part of the same campus — are better options.
About 1.6 million people over 65 live in nursing homes and roughly a million more, most in that age group, are in assisted living centers, according to the latest industry data. Those needing end-of-life care often get it without transferring to another facility, since many nursing homes and assisted living facilities provide hospice care or contract with others to offer it on-site.
On the other end of the spectrum, roughly 680,000 seniors living in the United States in 2009 are in independent living communities, according to the latest data from the American Seniors Housing Association.
Tips on choosing the right facility
Managing senior care
In 1983, Phyllis Mensh Brostoff co-founded one of the first private professional geriatric care management companies in the country. Today, the National Association of Geriatric Care Managers, of which she's also a founder, boasts about 1,900 members, just a slice of the total industry.
Experts say the difference between a nightmare elder care scenario and a satisfying one has much to do with staffing. Sights and smells can also speak volumes. Online research is a good place to start, but the final analysis requires on-site visits.
"The most important thing to do is to actually visit the nursing home," Pam Dickfoss says. "Is it clean? Does it smell like urine?"
Dickfoss is assistant deputy director of the Center for Health Care Quality in the California Department of Public Health, which regulates and licenses nursing homes in the Golden State. She recommends visiting at least three nursing homes multiple times.
Once there, observe how staff interact with residents. Are they respectful, looking residents in the eye? Are residents just sitting alone in wheelchairs or are they engaged? Do bed linens get changed regularly? Is resident hygiene a priority? The smell of urine is an obvious red flag, but subtler cues — like whether residents are enjoying their food or leaving it on their trays — should also be heeded, she says.
"This is my home now"
Rosemary likes the food at Hooverwood Indianapolis Jewish Home Inc. where she's been a resident for more than three years. The 92-year-old says she wouldn't be too happy if she were ever transferred. She's already moved once, after a short stint at another nursing home where she endured a difficult roommate — "a witch" by her son's account — and management unwilling to address the situation. She and her son declined to name the organization.
"It was a nursing home. That's all you can say about that," Rosemary says. "It's a terrible one."
By contrast, Hooverwood has a higher-than-industry average occupancy rate — an indication of popularity — plus a low staff turnover rate and an overall A-rating from Angie's List members, including the Clocks.
"Naturally, you'd like to be in your home," Rosemary says. But the staff is pleasant and nurses check on her regularly. She has her chair, pictures on the wall and a TV. Little touches that make it feel like home, group exercises that are wheelchair-friendly and standing bingo and blackjack games.
"This is my home now, so that's what I make it," Rosemary says.
For Fred, who describes himself as pretty protective, knowing his mom is happy and well cared for eases a great emotional burden.
An analysis of Angie's List member reports on nursing homes from July 2008 to July 2009, however, shows nearly 20 percent got a D or an F.
Member Peter Wallis gave a nursing home near Fort Lauderdale, Fla., an F. His mother, Orion Wallis, had been at Plantation Nursing and Rehabilitation Center in Plantation, Fla., no more than nine hours when she suffered a traumatic injury her son says hastened her death. She fractured her right femur, according to medical records. The fracture appeared to be caused by a fall, but exactly what happened to Orion at Plantation Nursing last August is unclear. She died three weeks afterward.
Her son speculates that her bed rail might not have been set properly and she fell out. His attorney, William A. Dean, a friend who took his case as a favor, also thinks some type of fall scenario is most likely and says the nursing home shares that basic assumption. Where Dean differs with the nursing home is that he thinks it's their fault. He doesn't think proper supervision and safety precautions were taken.
National average median rate for a year
|Nursing home (private room)||$74,208.15|
|Nursing home (semi-private room)||$66,886.25|
|Assisted living (private, one bedroom)||$33,903|
|Independent living-only communities||$25,177|
|Independent living in communities that also offer assisted living||$17,720|
Sources: Genworth Financial 2009 Cost of Care Survey, American Seniors Housing Association
To be sure, Orion, 88 when she died, was already in declining health. She had Alzheimer's and esophageal cancer and had been given six to 18 months to live, her son says. Peter eventually settled with Plantation Nursing for $5,000, a nominal amount considering what his mother endured, he says.
Attorney Adam Rabinowitz, who handled the case for Plantation Nursing, would only say that the case is resolved and the nursing home "emphatically denies any allegation of negligence."
Do your research
Each year, an average nursing home with 100 beds reports 100 to 200 falls, according to the Centers for Disease Control and Prevention. About 1,800 older adults living in nursing homes die annually from fall-related injuries.
The twist in Orion's case was that she was transferred to the nursing home at night, without her son's knowledge, by the hospital charged with her care, Peter says. Lyn Clark, a spokeswoman for North Broward Medical Center in Deerfield Beach, Fla., says administrators have met with Peter, who was his mother's health care surrogate, and it's investigating the matter. Clark didn't have more detail on why Orion was transferred.
"To actually see how she'd been treated," Peter says, "that's where the anger comes in."
Peter and his mother didn't have a chance to compare nursing homes before she was transferred to Plantation. But he urges those who do to do their homework, including background checks of the facilities they're considering.
Assisted living becoming more popular
Fortunately for many seniors, their options aren't so limited. On the advice of doctors, Bob and Evelyn Forgeng left their home on a golf course south of Portland, Ore., for a medically equipped upscale assisted living community in Longview, Wash. They moved into a two-bedroom apartment at Canterbury Inn in April 2007, joining a growing number of seniors turning to this type of care.
Even as the U.S. population has aged, the number of people 65 and older in nursing homes has dipped by about 150,000 since 1997, according to the Centers for Medicare and Medicaid Services, which regulates nursing homes. Over roughly the same period, about 300,000 more people — mostly seniors — took up residence in assisted living facilities, says Dave Kyllo, executive director of the National Center for Assisted Living in Washington, D.C.
"Assisted living is for folks who need help with their day-to-day life ... But, they're not folks who need round-the-clock nursing services," Kyllo says. Services include help with dressing, managing medications, meal preparation, bathing and other daily activities.
Evelyn, 90, has mild to moderate dementia, a condition that afflicts up to half of the nation's assisted living residents. Married 60 years, the couple takes Canterbury Inn transportation to the doctor's office and elsewhere. They have their medications delivered. Bob, also 90, occasionally gets his blood-oxygen levels checked by a nurse doing rounds.
Differing levels of care
The line between assisted living and independent living, which is generally less service intensive, is a blurry one. The two categories are loosely cited and often lumped together.
Robin Wright, the Forgengs' daughter, appreciates the different levels of care offered to her parents. "We were looking for something that would grow with my parents," she says. The facility has a 24-hour nursing staff. So if their health needs change, they'll have care to match.
Wright and her parents visited four other facilities in the region before they settled on Canterbury Inn. They say everyone is friendly and helpful. The food is very good, and the menu is varied. "We think it's A No. 1," Bob says. "We'd rather be in our own home, but this is a pretty good alternative."
Hy Berkoff can appreciate that sentiment. After Berkoff's wife died in 2005, it took his son, Ed, more than a year to convince him to move to Sandy Springs, Ga., so he could be nearby. "After living 91 years in Baltimore, I didn't want to leave," says Hy, now 94. Although his wife, Sylvia, had long since been buried, he says he felt like he'd be leaving her. And he didn't want to lose his independence.
The daughter of his late wife's friend referred him to Hammond Glen, a 170-apartment independent living facility where her in-laws had lived. It's a good fit for Hy, who only takes two prescription medications and says he doesn't need any special medical assistance. The facility's executive director, Kristy Foster, says it's planning to set aside a floor for assisted living by February.
Hy, who lives in a one-bedroom apartment, could hardly be more enthusiastic about the place as is — a fact that surprises him considering his initial hesitancy. "The staff here is unbelievable," says Hy, who offered himself more than once as a reference. "Everybody cares. It took me a year to get used to it."