Long-Term Care: Nursing Home Policy Details
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Choosing a nursing home might be part of your or your parent’s long-term care plan. Medicare’s nursing-home checklist and other similar checklists give you basic information about the nursing home. They may not tell you everything you want to know. Here are some important questions to ask:
What is the nursing home policy about transfer to an emergency department (ED)? Is a family member consulted? In the past six months, how many residents were transferred to the emergency room and then returned to the nursing home for “care in place” — that is, providing the needed medical care at the nursing home?
Sometimes family members request transfer to an ED when they suspect something is wrong. And sometimes they’re right because they notice small changes or big problems that staff may have ignored.
However, transfer to an ED is not necessarily a good move. As a general rule, you want to avoid these transfers, which can be unnecessary and result in confusion, frustration, and even deterioration in the resident’s condition.
Ongoing communication with staff will help you determine when a real emergency occurs, what can be handled at the nursing home, and when a physician needs to be called. But trust your own instinct as well. You may be seeing something new that staff have ignored. Improvements in this area have been demonstrated with the INTERACT training and interventions for reducing acute care transfers in nursing homes.
Does your family member have an advance directive that outlines the types of care he or she wants or does not want? Does it include preferences about CPR (cardiopulmonary resuscitation)? Is this information known to all staff and easily available for ambulance and ED personnel?
What is the nursing home’s policy or practice about feeding tubes? Sometimes feeding tubes are recommended (with accompanying risks) because feeding by hand takes too long, not because it is medically necessary. This is a complex decision that should be discussed thoroughly and not seen as routine practice.
What kind of training do staff receive for specific situations? Are they trained in dementia care? Do they receive sensitivity training about working with lesbian or gay residents or residents from different cultural or religious backgrounds?
Getting answers to these questions helps in streamlining your options and making the best choice possible.