When Christine Taylor’s family decided her grandmother needed full-time care, she found herself on the opposite side of a very familiar desk.
Taylor, who has an MA in Gerontology and had worked as a nursing-home administrator, was faced with helping her dad choose a facility that would keep her grandmother safe and happy. The problem: “I realized that we didn’t have enough information to make a decision,” she says.
Of course, long-term care homes across Canada provide brochures and tours. And, in Ontario at least, the government makes its nursing-home inspections public (check them out here). But, says Taylor, who is based in Toronto, “when the government walks into the home, everyone is on their best behavior.”
What would really help, she thought, was to hear from family members of nursing-home residents. “Family members are there sometimes 24/7,” she says.
“They’re there in the evening and on weekends and holidays when management is in short supply. That’s when things can happen that normally wouldn’t.”
Establish a ratings site
Taylor’s response was to set up the website www.nursinghomeratings.ca in 2007 to allow family members to give feedback on the residences where their loved ones live.
Rating categories include questions meant to suss out whether a facility is well kept and residents are treated with respect, as well as whether there are good programs and services, and excellent medical and nursing care.
Currently the site covers most Canadian provinces and territories and has ratings for 550 nursing homes. Taylor recently branched out with a sister site (www.informedsenior.ca ) that covers all seniors’ services, from retirement homes to real estate agents, caregivers and grocery delivery services, among others.
When your loved one has dementia
In the United States, the 2013 Seniors Housing Construction Trends Report reported that the number of construction starts for both senior housing and senior care units in that country increased year-over-year and is now on par with pre-recession levels. The report noted that there were a total of 31,462 beds under construction, including independent living, assisted living and nursing care.
In Canada, RBC Dominion Securities Inc. forecast that potential nationwide demand for an additional 4,000 to 5,000 private-pay suites annually for the next 15 years.
This sector is growing rapidly to house the aging population. There has been a 38-percent increase in the number of seniors living in nursing homes or other collective dwellings over the last decade, according to census figures released in 2011 by Statistics Canada. Those residents have an average age of 85 and nearly 60 percent of them have Alzheimer’s Disease or dementia.
If your loved one is among that cohort, Taylor advises asking specifically about the facilities, programs and services are available for them. “The number of people with Alzheimer’s or dementia in nursing homes is just skyrocketing,” she says. “If there is a home out there that can’t deal with it, I would be shocked.”
The key thing when looking for the best in long-term care? Security. Not every long-term care home will have a secure unit for those who are, as Taylor puts it, “exit-seeking.”
“If I had a loved one with Alzheimer’s, I would want to make sure they had a secure unit,” says Taylor. “You don’t want your mother or grandmother wandering out on the street in the night in a nightgown.”
At the nursing home where Taylor once worked, the secure unit was on the second floor. That meant residents who wandered had to get out of that unit and then past the front door. “It’s nice if there are two barriers to exit,” she says.
Signs, signs everywhere there’s signs
When assessing a nursing home, you’re wise to use all of your senses, says Taylor. Here are a few things to watch for:
The pee-ew factor
Is there a strong odor in the air? That could mean that residents aren’t “toileted” frequently enough or that staff are slow to clean up accidents.
I’m in the room!
Listen carefully to the way staff members talk to residents. Do they really listen? Is that the way you want your loved one spoken to?
Jungle breath and other clues.
Look at the nursing home’s residents with a critical eye. Are their teeth and hair clean? Are they properly dressed for the season?
Not just the boob tube.
Ask to see the home’s activity and social schedule. Do they offer tai chi and pub night? Music sessions and crafts? Are there activities your loved one enjoys? If residents seem to be always plunked in front of a TV, it may not be a good sign.
What kind of staff training do they do?
Patients with dementia can present challenges, says Taylor, and it takes well-trained staff to determine the underlying cause and distract the patient or prevent the behavior. Ask staff members how they deal with aggressive or agitated residents.
How many volunteers do they have?
The more the better. Volunteers can supplement the activity staff and provide one-on-one interaction with residents. Says Taylor: “If you have a loved one who is geographically separated from you – which is very common – you want to know that volunteers are there to help.”
Look for signs that staff know the residents.
“When I was doing my internship, there was a patient who was agitated and wandering,” explains Taylor. “She had been a homemaker.” Quite by accident, staff discovered that the resident loved folding laundry. It calmed and soothed her. Their response: So, “they would bring her laundry and she would fold and fold and fold,” says Taylor. “You want a home where staff takes the time to understand the resident.”
Chat as you go.
As you’re walking through the home, chat with those who are really in the know – the family members. “They will want to help,” says Taylor. “After all, they’ve been in your shoes.”
Camilla Cornell is a health writer based in Toronto
For an idea about costs in Canada, read A Moving Experience
For a great book about the costs of the Alzheimer’s journey, from diagnosis to the final stage, read Doris Inc. by Shirley Roberts.
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