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How to avoid nursing home mistakes

With luck, you won't ever have to put a loved one in a nursing home.

Wikipedia says that 1.3 million elderly, or 17 percent of the elderly population, were in nursing homes in 2005. With baby boomers coming of age and elder homes popping up all over, those numbers will surely rise. The worst day of my life was the day we put my aunt in a nursing home and I write this today so you might avoid the mistakes we made.

One big mistake was avoidance. We knew it had to be done; we just didn't want to do it. The second-worst mistake, born of the first, was not involving my aunt in the decision. We should have taken her around to more homes. We should have broached the subject with her earlier, planted the seed, eased into the decision. Instead, we waited until crisis struck, and it's not unusual for bad decisions to be made under stress, in haste.

Dr. Dennis McCullough has written a terrific little book called "My Mother, Your Mother" (2008, HarperCollins Publishers), which details how to care for your elders in later years; how to broach the subject of retirement homes and how (and when) to actually do it. I wish this book had been around 20 years ago.

In general, this is what we have learned about nursing homes:

1. They are institutions. They are mostly run by very dedicated, caring people, who want to do what is right, but in the final analysis, exist for the benefit of the institution. The rules, the hours of operation, the meal schedule, the activities, the day-to-day routines are in place to facilitate the needs of the institution, not the residents.

2. If you want to know what's going on in nursing homes, don't go to the administrator, don't go to the nurses, go to the CNAs (certified nursing assistants). They are the soul of the operation.

3. If you want your loved one to get good care, then you're going to have to become his or her advocate. You, or some other family member, will need to go there every day, at different times of the day, to make sure your loved one's needs are being met. That's what my wife has been doing for better than two years now. If you're not willing to invest the time and be a squeaky wheel, there's a good chance your elder will not receive the care you're paying for.

Here is what to look for when selecting an elder home:

* First, take a tour, preferably with your elder, of the entire facility, not just the first floor. The home must be clean and orderly. First impressions are important. If it looks or smells foul when you first enter, turn around and walk out.

* Get a feel for the place. Do not be impressed by the chandelier in the foyer. Get into the halls. Does the staff look happy or harried? Do the residents appear content? Check out the equipment closely. Look for state-of-the-art televisions. Wii games for exercise are becoming more popular. Do residents have access to computers and e-mail? Check out the menus and the activity schedule. Bland food and boredom are the bane of an elder's existence. Does the home engage elders in art and crafts, music and entertainment? Do they go on field trips to local theaters or parks?

* How many doctors are on staff? How often will they see your elder? Will those visits entail just a once-over or a full physical? Does the home use e-mail to keep far-flung family members informed? Who calls the shots for medication? (That's why a health-care proxy is so important.) How does the home handle eye and dental exams? How often?

* An elder home is a community. Residents, administrators, nurses and CNAs become part of a family. Does the home leave you with that type of feeling? What's the turnover rate for employees? Check the contract. How many CNAs are supposed to be on duty every day? How many actually are? Mom may be uncomfortable with male CNAs. Can she be served by women CNAs?

In the end, you are not going to know what you're in for until after you're in it. So a month or six weeks after your elder is in the home, check things out again, closely.

We recently began comparing what's on the menu at my mother-in-law's nursing home, to what appears on her tray, and found that very often she's being shortchanged. We're not accusing anyone of malfeasance, just bureaucratic bungling. But, if she's paying thousands of dollars a month to be there, she certainly should be getting what she's paying for. And so should you.


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