When assisting client families, we are often involved in the decision to move an older loved one into a long-term-care facility. This usually occurs following a significant illness; time in an acute care hospital or short-term rehabilitation environment; time at home with private help or at an assisted living facility; or some combination of the above.
Generally, this occurs over a period of years, during which a situation may stabilize for a while, only to be followed by the next crises. At some point, it becomes clear that a long-term-care facility is the best option.
As the selection process begins, we encourage families to visit many facilities. Families want to feel they have the best care possible in place and that they are spending money wisely. It is important to take into account several key factors, including environment, cost, location and, of course, space availability (waiting list of months – or even years – are not unusual).
The cognitive abilities of your loved one will determine how involved he or she may be in the decision to move and in the choice of a facility. Typically, at the point at which long-term-care facilities are being considered, the loved one is not capable of involvement.
This unfortunate reality places a tremendous amount of responsibility, and possibly burden, on the family member(s) tasked with making the “right” decision in the best interest of the older adult. The amount of support in the family (or lack thereof), can contribute to an already stressful time, particularly if poor communication and family disagreement exists.
Develop a list of criteria
Over the years, we have had many clients move to long-term-care facilities. In general, the professionals who work in them are extremely motivated to provide excellent care. That said, there is a great deal of variation in staffing levels, physical environment, and the overall “culture of excellence” that may or may not exist.
In coaching families through the available options, therefore, we encourage them to develop a list of criteria for evaluating potential facilities. Here, for example, are a series of questions that speak directly to the question of, “How do you get to know our loved one?”
- How do you, as a team in this facility, come to know our loved one?
- Do you have a formal process by which you learn about a new resident’s history, their family, what they did for a living, what was important to them, what their interests were and what they are now, what their capabilities are now?
- What is that process and how do we participate in it?
- Who participates in the process? I am interested in the aides who provide most of the direct patient care, the activities director who plans activities, the nurses and nurse managers who oversee the care being delivered, and the administrators who support all of you.
- How does the information you gather make its way into the care plan so that all staff who interact with our loved one know this information?
- How do we participate in the development of that care plan?
- How do we provide feedback and tweak that care plan as our loved one’s status and capabilities change?
- Can we meet frequently (at least weekly) during the early transition, and then develop a regular meeting schedule with longer intervals in-between going forward?
- Who is the best person to share immediate feedback with?
- What are your recommendations for what we can do during the transition to assist you with getting to know our loved one?
The way in which these and other questions are answered will help family members gain great insight into the care that will be delivered. Ultimately, this may help one facility stand out above the others.
Once family members have made the decision to move a loved one to long-term-care and have helped that individual adjust to their new home, they generally breathe a sigh of relief and can again take on the role of being the husband, wife, daughter, son, granddaughter, or grandson of their loved one.
Their responsibilities do not go away, of course (next month, we’ll address the role of the family once the transition has occurred). Still, if all goes well, it gets easier as these responsibilities are shared with a professional staff.
After all, it takes a wide village to deliver the care that is often necessary as our loved ones age. The key is that we continue to learn from each other.
A Moving Letter
In preparation for an upcoming family meeting at a long-term-care facility at which her father resides, a client wrote a letter and shared it with us in advance of the meeting.
I must say, I was quite moved by her words, as it struck me that this daughter was desperate for her dad to be known as the man he had been his entire life – a dignified man who should be treated with the utmost respect. She was also struggling to hold the facility at which her father lived accountable for the care they promised to deliver.
Click here to read the letter in its entirety.