Published by the GRECC 1998
There are two kinds of moves to a nursing home: planned and unplanned. In many cases, placement in a nursing home is unplanned and takes place in a crisis. A person is admitted to a hospital for some urgent reason. The doctor says that a nursing home is the best place. The hospital social worker must quickly find a suitable home. In this case, the person's family is caught All in a kind of emotional whirlwind. They don't have much time to get their feelings sorted out. There isn't time to think about what they want or need in the nursing home setting.
Placing a person in your care into a nursing home is complex business. An unplanned nursing home placement makes it much harder to do things the way you want and to be clear about your feelings. You have invested a great deal of yourself in providing care to the person. You want to be sure that the home can provide the kind of care you want for the person. You want to know that the new setting will allow you to retain the kind of caregiving role you want with the person. You v/ill also have a great many feelings about placing the person. You may feel grief and loss, anger, sorrow and a loss of control. After the person is in the home, you may find yourself enjoying the freedom of days not filled with caregiving tasks. You might feel guilt along with this sense of release.
At some point, you will decide nursing home placement may be needed for the person in your care. This is the time to begin planning for that move. You need time to select a home that you can afford and that is best for the impaired person and you. Then, when the time comes to move the impaired person, you want be ready. Once you have prepared for it, the move will be smoother, whether it is from your home or from the hospital.
Once you have chosen a home, sign the person up on the home's admission waiting list. Depending on how long the waiting list is, you can tell roughly how much time you have to get ready for the move.
Preparing for the move
Three are three major factors in preparing to move a person to a nursing home. You have to make sure that all financial matters are taken care of. You will need to see to the person's medical care. And you will have to decide who will oversee that care.
Ask for a written agreement. Ask the home for a detailed written agreement about charges and services. This should be an agreement that is signed by someone in the nursing home with authority to make a contract. The agreement should spell out what the regular monthly fee will be and what services are included. The agreement should also say what regular extra charges you can expect to pay (for hair care, personal laundry service, physical therapy, etc.). Beyond this, you should receive a list of charges for all extra services available in the home.
Make careful payment arrangements
The details of this task will vary depending on how you plan to pay. You may, for instance, need to arrange to transfer Social Security payments to the home. You may need to apply for Medicaid on the patient's behalf. You may want to see a lawyer about setting up a trust account. Or you may need to get agreements from members of the family about sharing in the cost of care. These arrangements should all be in place by the day of the move. The home will expect you to pay in advance for the first month, so you should be prepared to do so.
Every nursing home patient must have an 'attending physician" This is the doctor who will be responsible for the care the person receives in the nursing home. Almost all aspects of nursing home care need an order signed by a doctor. The doctor must order the drugs a person receives and the activities the person takes part in. The doctor must say what physical therapy the person will get. The doctor must write an order that the person may be physically restrained (and for what reason). If the person falls and might need to be taken to an emergency room for X-rays and/or treatment, a doctor's order is needed. Even the kind of special diet a person may eat requires a doctor's order.
At the time of admission, the attending physician provides basic medical information about the patient, including results from a recent physical. The doctor sets up a plan of care, and visits the patient on a regular basis. The visit schedule will vary, but the doctor should come at least once every month or two. The rest of the time, the attending physician can talk with the staff by phone.
As caregiver, you decide who will serve as the attending physician. You may find the following ideas helpful. Find out in advance if the persons current doctor can serve as attending physician at the nursing home The nursing home may have a policy that all residents must switch to a doctor on staff at the home.
Find out, too, if your current doctor is willing to attend the patient in the nursing home. If the home you have chosen is not nearby, your doctor may not be able to be the attending physician. If you need choose a new doctor. you may have limited choices. There may be only a few doctors to choose from in the area or on the staff of the home. Try to meet and talk with these doctors. See which one knows the most about dementia patients. Ask your current doctor to help you decide Medical records. If a new doctor will be attending the patient in the nursing home, be sure all medical records are sent to him or her. Ask the impaired persons former doctor to call the new doctor and discuss the case. Your doctor should provide a summary of the patient's care up to this point. You may find you need to follow up with the doctor to be sure this is done. Consultations on care decisions Let the new doctor know that you expect to be fully consulted on care decisions and look forward to being helpful. You have a wealth of information about the person. You can be a resource to the attending physician. Be prepared: it takes time to learn to work well with a new doctor.
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