-Lise Cloutier-Steele
The placement of my father in a long term care facility was one of the most difficult decisions I have ever had to make. He needed health care that I could not provide on my own, and knowing that home services would be difficult to get on a regular basis, a nursing home was my best option.
Now that my father has been residing in a long term care facility for almost 2 years, I often find myself discussing what works, and what doesn’t, with others overseeing the care of an ailing relative or friend. It’s hard not to make these observations when visiting my father as regularly as I do.
What follows is information you might find useful in the selection of a placement that will be satisfactory to you and your loved one.
Location is key to the guardian as he or she will need to visit often.
The friendliness of the administrative, health care personnel and other residents is an important factor. Make an appointment to speak to a charge nurse or someone in an executive capacity at the home. If someone is short with you, or appears to be dismissive of your concerns, you may not be at the right place.
Private accommodation versus a basic room is another important consideration. I realize, of course, that a private room is not feasible for everyone, but its advantage is greater privacy. Not only that, the waiting times for one are a lot shorter.
What about physician care? You should inquire about the availability of the physicians affiliated with the home. And, if your parent would like to retain the services of his or her own family physician, ask the home’s administrator how to proceed.
Medications may need to be adjusted from time to time. During the admission process, you may want to inquire about a care review meeting attended by one of the home’s charge nurses, a home administrator, and either your current or new physician directly involved in the care of your relative or friend.
As for healthy nutrition, the provincial government provides funding in the amount of approximately $8.00 per day per resident in a long term care facility. My father has no complaints about the food he eats, but I think I would. Ask to see the home’s menu and look for variety.
According to Statistics Canada, Ontario has the second worst long term care staffing levels in the country. Ask about the home’s personnel/resident ratio, and you will quickly deduce that the person you are responsible for may not get more than a few minutes of a personal support worker’s time in the morning and in the evening.
As is the case across the province, short staff days are a regular occurrence at the home where my father resides. There wouldn’t be any harm in asking for a record of short staff days at a home you are considering. Do replacement personnel get on site training? Are they closely monitored?
Regarding unpleasant smells, inquire about the home’s policy and commitment in keeping the smell of urine down throughout the facility.
Some homes stand by their policy regarding resident autonomy. Inquire about the home’s flexibility on its resident autonomy policy should your relative or friend be forced to eat next to an incontinent resident who refuses to get washed.
When touring a home, pay particular attention to the physical appearance of its residents. If you notice overly greasy faces with food bits around the mouth, dirty fingernails, hair growing out of their ears and noses, chances are your loved one may suffer the same fate.
What does basic care involve? According to a compliance advisor for the Ontario Ministry of Health and Long Term Care basic care entails a tub bath twice weekly, and everything from washing a resident from head to toe, cleaning glasses, removing and rinsing false teeth, cleaning or cutting fingernails and toe nails, changing diapers, changing and rinsing catheter bags, to changing beds when necessary, dressing residents in clean clothes and getting rid of the dirty laundry. Ask a health care aide or a home administrator how he or she would define basic care. It may be very different from the government standard and what you would expect.
Hair care is important, too. You should inquire about the cost, method of payment and arrangements to get your relative or friend to and from the salon within the home if he or she can’t manage the trip on his or her own.
Some homes offer foot care at no extra cost, but at my father’s home, the service costs $25.00 per session, with a session at approximately every 8 weeks. If the service is not available on site, and you can afford to hire a foot nurse, ask about any applicable policy with regard to an external service. Personal support workers are supposed to cut toe nails as part of the basic care package, but if your friend or relative is diabetic, home policy will prevent them from doing it for health safety reasons.
Physiotherapy for people who spend most of their time in bed is crucial to their physical welfare. How many physiotherapists work at the home on a full-time basis? How much time will a physiotherapist spend with your loved one on a daily or weekly basis?
Recreational activities provide a wonderful and necessary diversion. There should be daily activities at the home that you are considering. Ask about these. Ask about planned outings.
What about a place of worship and pastoral services? If there is a daily mass or prayer celebration, will your loved one be able to get to it on his or her own.
Overall cleanliness of the home. Ask to visit an occupied room. If you find thick dust bunnies under the bed, ground-in dirt at the bottom of a closet or dresser drawers, food stains on the night table, soiled bed linens, dirty windows, unsorted clothing, urine on the toilet seat or fecal matter stuck to the toilet bowl, it’s unlikely that the home would be any cleaner by the time your loved one resides there.
Inquire about the laundry service. If you have a good idea as to the quality of the laundry service at the home of your choice, it won’t be a surprise to you when you see your friend or relative in a crumpled shirt or blouse, or in a pair of pants or socks with bleached blotches, or worse, in clothing that belongs to someone else.
Quarantines can be imposed frequently over the winter months. Residents may be isolated for days, or weeks in some cases. If family and friends are discouraged from visiting, the days could feel like an eternity for the isolated residents. Inquire about the possibility of visiting your relative or friend during a quarantine to provide at least one pleasurable distraction in a day.
If there is one thing I have learned from my care giving experience, it’s that my husband and I needed a plan, supplementary health insurance coverage as well as savings to make sure that we can get the best possible care should one of us get sick. We had power of attorney documents drawn up so that our guardians will know exactly what to do if long term care is required. Wills, last wishes and important lists were completed and passed on to the children.
I don’t think that elders want to become a burden on anyone if they become ill, and most want to live independently for as long as they can. But in order for that to happen, you have to be ready. Are you?
Lise Cloutier-Steele is the author of Misinformed Consent, and Living and Learning with a Child who Stutters. Recently she completed a book project featuring the contemporary paintings of Blair Thomas Paul, to be published by Penumbra Press of Manotick in 2009.
