How do you choose the type of care your loved one needs?
By Kathy Bradley
Our last discussion explored struggling with questions about the need for change in your loved one’s care needs. You’ve asked yourself, your family and your loved one the difficult questions. Now what? How do you find the right fit?
You may be encouraged to enlist the assistance of a professional “bed locator” or “care locator” service. Think of them as realtors for senior care facilities. Some charge the family for this service. Others advertise “no cost to you”, but are paid by providers when they place a person with that provider.
According to SCDHEC, SC has:
- over 193 nursing homes, 27 of which offer memory care with two having a dedicated memory care unit
- over 252 assisted living facilities (464 if we add those serving intellectual and developmental disabilities), including over 140 that offer memory care
- 96 in-home home health (medical)
- 972 in-home care (non-medical) agencies
- 13 hospice facilities
- 98 hospice programs, AND COUNTING!
It can seem overwhelming. But learning some basic facts, and knowing what to look for, can help.
Making Type of Care Decisions
- Obtain a thorough evaluation: Start by getting a comprehensive evaluation of your loved one’s current status across various domains: physical, emotional/mental/behavioral. Take into consideration cognitive issues, daily living skills, communication and any other concerns you may have.
- Understand the likely progression of your loved one’s condition: Discuss with evaluators how the condition may progress over time. This insight can help anticipate future care needs.
- Explore care options: Familiarize yourself with the different types of care available in your area, including in-home care, assisted living, skilled nursing, hospice, etc. Understand the types and levels of services each offers and whether they can adapt as needs change. Some providers are continuing care communities that accommodate changes in the living setting without necessitating a discharge or transfer.
- Consider finances: Facilities accepting Medicare and Medicaid must provide care beyond “clean, dry, dressed and fed” (which is the standard of some private-pay facilities). Such facilities have greater oversight and consequences for failure to comply with standards. Long-term care insurance may help offset costs. Private pay is another option, but does not assure quality. Assess your loved one’s resources and whether other family has or can commit, even if they do have the funds to supplement your loved one’s resources. Federal regulation prevents facilities accepting Medicare or Medicaid from holding the family financially responsible; only the resident’s funds may be billed.
- Know regulations: Access federal and state regulations applicable to the types of care you’re considering. Understand what standards facilities must meet, what is prohibited and how service quality is evaluated. Links to South Carolina state regulations for each type of care are listed here. Links to federal Medicare/Medicaid regulations for the different types of care can be found from this single resource page.
- Choosing in-home care: If in-home care will sufficiently support you and your loved one, select a care provider. Privately hired caregivers are an option; but when that caregiver isn’t available, the family has to provide the care. Agencies may provide non-medical, medical, or both types of care. Consider one that provides both to accommodate future needs. Use the “Tips & Checklists” on my website to assess providers (agencies and privately hired) and comparing which ones fit your needs.
- Exploring facility-based care: If in-home supported care isn’t sufficient or realistic, explore facility-based options. Once a type of care and the facilities that provide it are identified, visit a variety of facilities. If practical, take your loved one with you. Go during different shifts, days of the week, including weekends. Conditions are different on the Monday through Friday 8 to 5 shift from the evening and weekend shifts. Request to eat meals — breakfast, lunch, dinner. Observe activities and staff interactions with residents. Look for maintenance and sanitation conditions. But remember: a pretty, nice-smelling building doesn’t always indicate quality of care. Take notes or use these handy checklists in the drop-down list for assisted living or nursing home visits so you won’t have to rely on memory.
- Trust your instincts: Even if a provider meets all criteria, trust your gut feeling. If something doesn’t feel right, move on to the next option.
- Make the decision: Involve your loved one as much as possible to ease the transition. Take gradual steps and communicate regularly with your loved one, family, and the care provider. Take a deep breath.
This journey will have its challenges, but you’re not alone. Ask for help if you need it. Ultimately, your diligence and determination will guide you through the next chapter, ensuring the best care.
Kathy Bradley is the president of the advocacy nonprofit Our Mother’s Voice. For more information visit ourmothersvoice.org. Listen to her podcast interview.
