With senior care costs at an all-time high, how do you know if your loved one is getting the quality care they’ve been promised? Investigations and media reports over the past few years have highlighted troubling gaps between care that senior facilities advertise and the actual services delivered.
If you’re considering long-term care, such as a nursing home, for a loved one, know how you can best stay engaged in their care and what strategies to pursue to ensure your loved one is getting the care they deserve.
[READ: How to Choose a Nursing Home: Qualities to Look For.]
Cost of Senior Care vs. Quality of Care
The cost of senior care in the U.S. has been steadily rising. Recent data from Genworth Financial’s Cost of Care Survey shows that the average cost for a private room in a nursing home is $116,800 per year and $104,025 per year for a semi-private room. Over the last two decades, that number has nearly doubled — average costs for a nursing home private room were $65,185 in 2004.
However, an increase in costs doesn’t always equal an increase in care. Numerous reports have featured cases where older adults in nursing homes and assisted living facilities are not receiving adequate care — despite high expenses to be there. Basic needs, such as assistance with activities of daily living like bathing, dressing or eating, are often unmet. Safety concerns are another issue, with instances of wandering, excessive bedsores, unsupervised falls or medication errors leading to severe injuries or even fatalities.
This disconnect between cost and quality of care is why you should remain involved in your loved one’s life, even after they’ve moved to a nursing home — and that involvement often starts with the care plan.
[How to Advocate for an Older Loved One in the ER or Hospital]
What to Know About Nursing Home Care Plans
People typically enter a nursing home for two reasons: either for rehabilitation — like if they’ve had a hip replacement or if they had an incident or fall that needs short-term skilled nursing care — or as the next phase of their long-term care, says Kate Granigan, CEO of LifeCare Advocates in Newton, Massachusetts, and president of the board of directors with the Aging Life Care Association.
When your loved one moves into a nursing home, the staff should immediately begin a health assessment as part of a basic care plan outlining how they will manage your loved one’s needs.
“You should be having a care plan meeting pretty quickly,” Granigan adds.
Once admitted, a care plan is regularly reevaluated and updated accordingly, particularly if your loved one’s medical status changes.
What’s included in a nursing home care plan?
For your loved one, nursing home care plans may outline:
— Health assessment results
— Needed personal or health care services, such as medication management, wound care, therapies and monitoring of chronic conditions
— Needed daily living assistance
— Frequency of services
— Essential support staff that’ll be part of your loved one’s care team
— Any supportive supplies or devices needed
— Dietary needs and food preferences
— Safety measures
A care plan is also a place for input from the resident, family or caregivers regarding care preferences.
Nursing home care plans and Medicare coverage
With a short-term rehab stay, if your loved one plans to return to their community, it’s really important to work with staff on establishing goals as part of the care plan.
“We always say discharge starts at admission,” Granigan says.
Original Medicare (Part A) only covers care in a skilled nursing facility if it’s medically necessary following a qualifying hospital stay. Medicare covers 100% of the costs up through day 20, then the patient pays a daily coinsurance rate from days 21 to 100, and after day 100, the patient is responsible for 100% of costs.
Many families read that 100 days and think their family member has plenty of time in a rehab setting, Granigan says. However, Medicare’s rules and regulations around what qualifies someone for that rehab stay varies, and the nursing home will judge whether that individual continues to advance in their care plan.
[Read: What Medicare Doesn’t Cover and How to Manage Costs]
8 Strategies to Ensure Your Loved One Is Receiving Quality Care
Here are ways you can stay involved in your loved one’s care and actions you can take if you have concerns:
— Research the facility
— Participate in the care plan
— Visit often
— Build relationships with staff
— Talk with staff
— Document your concerns
— Seek additional support services
— File a legal complaint
[READ: How to Choose a Nursing Home: Qualities to Look For.]
1. Research the facility
Although nursing homes are regulated at the federal level by the Centers for Medicare & Medicaid Services, an agency within the Department of Health and Human Services, regulations are enforced and overseen by surveyors operating at the state level.
Before your loved one is at the point of needing nursing home care, getting to know regulations and licensure requirements governing nursing homes will help you pick a facility with high-quality care. This may include looking into:
— Federal and state regulations. Nursing homes must adhere to specific regulations and licensure requirements, which include staffing ratio requirements, safety protocols and resident rights. Although federal regulations set a baseline, regulations and enforcement can vary from state to state, so quality of care can vary significantly across state lines. Be sure to familiarize yourself with protocols in your state when choosing a facility.
— Inspection and compliance. Nursing homes undergo regular inspections to ensure they comply with federal and state regulations. Inspections include assessments of aspects of care, such as cleanliness and safety, and facilities that don’t meet standards may face penalties, such as fines.
— Facility records. Before choosing a facility, look up its history of inspections, complaints and compliance. This information is available with CMS’s Nursing Home Compare tool or through state health department websites. U.S. News’ Best Nursing Homes can help you compare pricing, reviews and costs for nursing homes near you.
You should also visit nursing home facilities before choosing one.
While touring, beware of the “chandelier effect,” Granigan says.
You have this beautiful place, with a gorgeous entry way, she says. But the bottom line is they spent all their money on that chandelier, and their nursing staff is underpaid and underrepresented.
“The appearance does not equal good care,” Granigan emphasizes.
When you’re touring a nursing home facility, make sure to ask questions — particularly about nursing staff ratios, if the facility has had any complaints and how they’ve worked to resolve complaints.
2. Participate in the care plan
As mentioned, staying engaged with your loved one’s care plan is one of the best ways to know what type of care your loved one needs and if they’re getting the care they should over time.
If you can’t attend the initial care planning meeting, Granigan advises caregivers or family members to ask the nursing home staff if they can call you at another time while your loved one is available in the room to discuss their care plan.
Asking the right questions of your loved one’s care team can help foster a collaborate approach so that their needs are thoroughly addressed.
Questions include:
— How often will the care plan be reviewed and updated?
— How will you keep me informed about my loved one’s care and any changes in their condition?
— How often can I expect to participate in care plan meetings or receive updates about their care status?
— How can I best address concerns I may have about my loved one’s care?
3. Visit often
Visiting your loved one in a nursing home facility is the number one way to stay on top of their care.
Although a loved one shouldn’t receive different care whether they’re paying privately or with Medicaid, in reality every nursing home varies and some of them have pretty poor staffing, Granigan says.
“So, you have to be there visiting regularly, visiting unannounced and making sure that the care that your loved one needs is being performed,” she adds.
When you visit, watch out for nursing home red flags such as:
— Issues with staffing, such as inadequate staffing, high turnover rates or disrespectful behavior
— Lack of cleanliness in your loved one’s room or in common areas
— Limited socialization or extended periods of isolation for your loved one
[READ: Antipsychotic Use in Nursing Homes.]
4. Build relationships with nursing home staff
Whether your loved one is in a nursing home for short-term rehab or longer term, the key for communicating effectively is getting to know the staff, building rapport with them and appreciating their challenges while being able to hold a healthy level of expectation and advocacy, Granigan says.
Holly Harmon, senior vice president of quality, regulatory and clinical services at AHCA/NCAL, adds, “Family members are encouraged to make regular visits to their loved one’s nursing home to engage with them and develop relationships with their care team. Their insights can help staff better understand the resident’s health care needs and preferences, enhancing staff’s ability to provide person-centered care.”
Family involvement may also improve your loved one’s health outcomes, such as boosted life satisfaction, Harmon says.
5. Talk with staff
If caregivers or family members have concerns with their loved one’s care, step one should be to speak with the staff directly.
“Open communication and dialogue between family members and nursing home staff is key to foster a successful experience for both the resident and their loved ones,” Harmon says.
Granigan adds that it’s important to avoid screaming, yelling or burning bridges.
“We understand it’s highly charged, it’s very emotional, and so it is hard sometimes when things aren’t going well to keep your cool,” she says.
But she urges loved ones to be clear and kind — state what’s needed, and don’t beat around the bush.
“Share your concerns, ask how they might address that (and) ask when you should follow up,” Granigan says.
Harmon adds, “If staff receive any complaints or identify any problems, they seek to quickly address the issue and remedy the situation. Not only is it the right thing to do, but nursing homes have strict regulations in place that require them to take the necessary steps if an issue arises.”
Once you speak with staff, it’s reasonable to ask when you can expect change, and check back in regularly to ensure changes are happening.
6. Document your concerns
Keep a written log of any concerns or issues — big or small — including dates, times and any relevant details, to have a clear record for discussions with facility management or regulatory bodies. This helps avoid misunderstandings or discrepancies when discussing issues, making it easier to reference specific incidents and ensure nothing important is overlooked.
Although it takes extra thoughtfulness and planning, this proactive step helps empower you to advocate effectively for your loved one, ensuring accountability and effective communication for any future challenges that arise.
7. Seek additional support services
Within a nursing home facility, there are staff resources available to help support you beyond your loved one’s immediate care team:
— Ombudsperson. This is an independent monitor who should be available at every skilled nursing facility to hear complaints or help work through issues. They’re an advocate for residents’ rights and can help mediate conflicts among residents, families and staff.
— Nursing home administrator. An administrator oversees overall operation of the facility and can serve as a key point of contact in addressing broader concerns among residents, their families and the nursing staff, especially as it relates to the facility’s operations or policies.
Be sure to identify these resources upfront when your loved one enters the facility, rather than at the point when an issue arises.
Additionally, some scenarios might call for outside support, such as a care manager. Although consulting with a care manager comes with a cost, they’re someone with “no skin in the game” who’s there to work for the client and ensure they’re helping make the transition to nursing home care as effectively and smoothly as possible, Granigan says.
8. File a legal complaint
As a last resort or for very serious concerns, filing a legal complaint may be necessary.
Anything that involves abusive or neglectful behavior should be reported.
“That’s a hands down, no question,” Granigan says.
Generally, you’d file a complaint directly with your state’s health department or licensing agency. State-based agencies, who are responsible for inspecting facilities, will review and investigate the complaint and will take action if the facility is found in violation.
The Bottom Line
Visiting the nursing home facility, building a relationship with facility staff and staying engaged with your loved one’s care plan are the best ways to ensure your loved one is getting the care they should. If concerns arise, start with nursing home staff. If your issue is ongoing and isn’t resolved, there are resources available to help you address concerns effectively.
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How to Know Your Loved One Is Getting the Senior Care They’re Paying For originally appeared on usnews.com
