October 27, 2013 by
Photography by Bill Sitzmann

It’s never easy for a family to make the decision to move a senior into a care facility. But thanks to tighter regulations and consumer demand, the dreary institutions of decades past have been replaced with a spectrum of choices depending on the level of care the individual needs.

The senior’s personal physician or medical team, which often includes a social worker, is a good first resource to help guide the family in determining what type of facility is 
most appropriate.

“Safety concerns prompt us to think ‘facility’ instead of ‘stay at home’,” says Dr. Rebecca Reilly with the Methodist Geriatric Evaluation and Management Clinic. “Does the patient need to be reminded to eat? Are they capable of cooking? Do they wander? I’ve been doing this for 20 years and situations still come up that I could never have imagined. Are people being scammed? Are they going to get locked out in the snow and not know what to do? It’s people who need supervision for their safety.”

A skilled nursing facility offers the highest level of care, explains Reilly, and may not always be a permanent placement. In some cases, round-the-clock nursing care is needed only temporarily, such as during a medical recovery period.

Assisted living is a good solution for the individual who is relatively stable medically but needs assistance with activities of daily living such as dressing and bathing, or has some mobility limitations. Staff can assist with medications and help monitor medical conditions and care, such as physical therapy. Best of all, meals and housekeeping are provided in a community setting.

“Some folks don’t need to be in a skilled facility. They need to be in an environment where they are getting the care they need and still remaining independent,” says Lisa Arp of SilverRidge, a Gretna assisted living community started by her family 13 years ago. Arp says that assisted living care plans are highly variable and can be modified with changes in a senior’s condition.

“The family is totally involved in the care plan,” she emphasizes.

Memory care is a specialized type of assisted living care available for patients with dementia. For example, they may be otherwise physically healthy but need care that accommodates some of the special concerns associated with the condition (like wandering). Memory care also provides special activities that help these individuals retain as much independence as possible, Arp says.

Independent living communities may provide one or more daily meals and often offer housekeeping services as well, but staff do not assist with nursing and medical care. “This is more about living in a congregate site with activities and amenities,” Reilly explains.

Other options are in-home care, which can range from simple companionship to intense nursing care similar to what would be provided in a hospital; and adult daycare, which offers a supervised setting and 
social stimulation.

Eve Lewis is program manager for the Office of Long-Term Care Facilities, which is in the licensure unit of the Nebraska Department of Health and Human Services. She recommends that families looking into long-term care that involves regulated facilities—namely nursing homes and most assisted living facilities—take advantage of online resources such as the DHHS website at dhhs.ne.gov and the Medicare site at medicare.gov. Lewis also points out that citizens who have concerns about a particular facility can call DHHS at 800-942-7830 to talk to an ombudsman or launch a complaint.

Lewis says, however, that families should keep in mind that care facilities have different personalities depending on such factors as the communities in which they’re located or what activities they offer, and alternatives should be considered.

“There are a lot of things to look at in a facility to determine if it’s a good fit,” she says. “This is their home, and just like everyone’s home isn’t the same, not every facility’s going to fit your loved one.”

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