5 Qualities of a Great Nursing Home
Whether you’re there for rehab after surgery or due to a lifelong illness, here’s what makes a nursing home great.
Top nursing homes demonstrate genuine care for each and every resident.(GETTY IMAGES)
WHEN SUE JOHANSEN’S husband, Chris, 57, was in a catastrophic car accident in 2014, she had just 24 hours to find a good nursing home in the San Francisco Bay area that could handle his rehabilitation. Sue Johansen was unusually qualified to do the search. A senior living advisor with A Place for Mom, a Seattle-based senior care referral service, she has done legwork for countless families in need of a top-notch facility for loved ones who are dealing with a host of health issues.
With her husband’s discharge looming, Johansen, 54, refused to be rushed. “Everything unfolds day by day, and you’re dealing with new information and ill-equipped [to do so],” she says. She stretched the search to six days until she was satisfied with the facility that suited Chris’ needs.
Whether the goal is a nursing home for short-term rehabilitation following an accident, round-the-clock care after a stroke or long-term care for a disabling condition like the late stages of Alzheimer’s disease, great nursing homes all have five qualities:
They make it all about each resident. A genuine focus on each person as a unique individual is critical, says Susan Reinhard, senior vice president of AARP’s Public Policy Institute. A resident should never be defined by her illness or inability to grasp a fork. Treating residents like anyone else helps them feel like they’re in a safe, home-like environment.
The right nursing home can be a wonderful place, says nurse practitioner Barbara Resnick, a professor in the department of organizational systems and adult health at the University of Maryland School of Nursing and past president of the American Geriatrics Society. “It’s all about the love,” she says. “It can be a million-dollar place with the newest renovations, but if there is no love, it’s not a home.”
When you visit prospective nursing homes, says Resnick, observe whether staffers greet residents and visitors with a smile. “The staff should be happy, and if the staff isn’t happy, you have a problem. Either you love working with older adults or you don’t. And if you don’t, it doesn’t make a happy home,” Resnick says. The Alzheimer’s Association recommends asking the manager what the staff will say to a person with dementia who constantly requests to go home. The answer indicates how the staff responds to challenging individuals.
Kristine CraneMarch 5, 2015
Residents can make choices. They’re not ordered to go to sleep and wake up at certain times, and they have a say about what they can wear, the type of food on the menu and where they can eat. “I should be able to wear my own clothes and not a gown,” Reinhard says. “Does everyone have to get up at 7 a.m. if that’s not what they did their whole life? When it comes to meals, there should be a nice place to sit and be with others.” Ideally, for example, residents will have the choice between a big cafeteria and a smaller dining room. Some residents like to socialize at mealtime; others prefer to eat quietly by themselves or with one or two others at most. When visiting prospective facilities, shed light on this by asking: “Will Dad be able to share a meal with his family in private?” and “Can Mom eat alone if she feels like being left alone?”
There are lots of nurses and other professionals. There should be plenty of professionals, from physicians to registered nurses, family counselors, certified nursing assistants and aides, “especially for someone with pain medication needs or someone who requires a feeding tube,” says Sue Johansen. Residents in a nursing home to rehab after a hip replacement, for example, will need regular physical therapy tailored to the surgery; a stroke patient, on the other hand, may need a variety of specialists from a speech therapist to an occupational therapist in addition to ordinary nursing care.
Adequate numbers of medical staff can also help stave off trips to the emergency room. “Let’s say you were dehydrated,” Reinhard says. “Ideally, you could get IV treatment in the nursing home and not get shipped to the hospital.” In a study published March 24 in the Journal of Post-Acute and Long-Term Care Medicine, researchers found that almost half of all long-stay nursing home residents identified through records at Wishard Health Services (now known as Eskenazi Health Services) – a large public health system in Indianapolis – made at least one trip a year to the ER. That not only increases the risk for infection in seniors or people recovering from surgery, but adds stress for people with conditions like dementia.
They offer flexible extended visiting hours. The best nursing homes offer open visiting hours. “That’s something worth exploring, particularly if it’s important to the family member,” Resnick says. “Some nursing homes will help facilitate an overnight stay for you. So, say mom or dad had surgery or is sick. How well will the nursing home adapt to that? Will they bring in a cot for you? Is there a special room you could use?”
Plentiful and meaningful activities are offered. Bingo can be fun, but mindless games shouldn’t dominate the daily schedule. The best nursing homes offer myriad social, physical, interactive and educational activities and leave it up to residents to make choices. Is an outdoor area available for walking, eating or visiting family or friends? If your loved one has a disability, are activities offered for him? Some homes offer yoga classes for those in wheelchairs, for example. Will a staff member take someone in a wheelchair outside when a family member can’t come?
Exceptional homes give residents opportunities to engage in the meaningful tasks they once did at home. They might help deliver mail, or bring water pitchers to residents’ rooms, or read to others.
Some nursing homes bring in dogs or cats from local adoption or pet therapy groups. Others offer volunteer days, where community groups like the Boy Scouts visit. Or residents may be able to tutor young people in reading or sewing or model building. “For some, time spent in nursing homes is actually the best time in their life,” Resnick says. “It’s a community. That’s what you really want to feel when you walk in there. It’s a home.”
Good Afternoon Friends and Members of NOCSC:
This is a reminder that we are meeting tomorrow morning, Tuesday, 18 September from 8:30 a.m. – 10:00 a.m. @ 130 W. Bastanchury Rd., Fullerton. There will be current updates from Work Groups on:
- Policy and Advocacy (local, state and federal)
- Educational Forums (upcoming presentations)
- 2018 Unmet Needs Survey on Loneliness (survey data outcomes and next steps)
- Elder Abuse / Elder Justice
- Website and FaceBook
- Senior Care 101 Class, and
- 2018-2019 Senior Resource Guide
An opportunity will be provided to sign up for a Work Group if you have not already done so, or if you’d like to change from your current Work Group. Remember that members are expected to participate in at least one Work Group a year. I have attached both the flyer for the next Educational Forum (16 October) and a map in case you have never been to the meeting before (GPS struggles sometimes with our location).
Please feel free to park in the parking structure and we will happily validate your parking. See you tomorrow morning!
Step-By-Step Physical Health For Seniors
Physical health is a major concern for many aging Americans. Everyday Health shares the fifteen most common ailments for senior citizens. Are you interested in avoiding these ailments? The process is far simpler than you might think.
Rather than spending thousands of dollars on special doctors and equipment, focus on improving your physical health on a day-to-day basis using the following steps.
- Get regular exercise.
As children, we are told that daily exercise can make a huge difference when it comes to our future. This is true, but you don’t necessarily need to start when you’re young. It’s never too late to master a new habit.
Here’s some good news. If you’ve got a pup you walk regularly, you’re already ahead of the game. Walking a dog is actually one of the best ways for seniors to get exercise. Having a four-legged friend also has mental health benefits, such as offering more social opportunities and improving mood.
If you haven’t focused on daily exercise before, not to worry. There are many great ways to get started. Find an aerobics class or gym where you can strengthen your body. A simple swim, walk, or jog will do the trick. Learn more about exercise and fitness tips while you age through Help Guide.
- Never miss an appointment with your doctor.
While you don’t need to spend thousands of dollars on a specialist, you do need to meet with your primary care physician regularly. Missing these appointments can be seriously dangerous to your health, especially if you start making assumptions about what your body needs. Before making any final decisions about your physical health or needs, speak with a doctor. Your regular screenings will ensure your methods are working.
- Consider physical therapy, if necessary.
If you’ve faced a recent injury, consider going through physical therapy. The experts you’ll meet will be able to help keep your body safe and healthy at the same time. You’ll also gain confidence and strength as you work your way through the process. Physical therapy isn’t easy – but it will get you back on your feet and ready for the daily exercise you need to stay healthy. Not convinced? NIH Senior Health offers more information about the benefits of exercise for seniors.
- Be aware of the risks.
As a senior, you are more susceptible to mental illness. This doesn’t mean you should hide in a corner and avoid the real world. It means you should be aware of the risks, should you choose not to focus on your physical health. Daily exercise and healthy habits can decrease your risk of developing depression and even addiction.
Healthy physical activities for seniors above the age of sixty-five include walking, dancing, gardening, hiking, swimming, cycling, or household chores. You can also take part in games, sports, or community activities. While you should have more than two hours of physical activity each week, you should focus on twenty to twenty-five minutes of activity each day. Read more about recommended levels of physical activity for seniors through the World Health Organization.
- Maintain frequent and healthy physical habits.
The most important thing you can do while attempting to improve your physical health is to develop daily habits. These habits will become second nature to you, making them easier to accomplish on a regular basis. For example, if you have trouble with daily exercise, make a morning walk your newest habit. Once you’ve gone for a morning walk ten days in a row, you’ll start to feel obligated. This is how great, and healthy, habits are formed.
You can also use the ten-day rule to break bad habits. If you still eat too much sugar or sodium on a daily basis, try to decrease your consumption for ten days. You’ll find your appetite for junk food has significantly decreased.
Mastering new physical habits as a senior can be hard, but not impossible. Focus on your physical health and improve your outlook for the future.
Author: Jason Lewis
Consider an In-Patient Rehab Facility Before You Suffer a Fall
Researching your options may help you avoid a dilemma in a crisis situation.
Start with your insurance company and find out which facilities are covered under your plan.(ANDERSEN ROSS/GETTY IMAGES)
AS A SAVVY MEDICAL consumer, you may already know which hospital you’d go to in an emergency or which doctor you’d turn to for a particular procedure. But many people never plan where they’d go for a few weeks or months of in-patient rehabilitation to recuperate from a fall. That choice may not even occur to a family until Mom, Dad or a spouse winds up in the hospital. “The case manager comes in and says, ‘Look at these facilities and tell us where you want to go so we can start our paperwork.’ The family and patients are overwhelmed,” says Dr. Saket Saxena, a geriatrician at Cleveland Clinic.
But it may be time to give the scenario a little thought. This year 1 out of every 4 older adults will fall, according to the Centers for Disease Control and Prevention, and 20 percent of those people will suffer a serious injury, such as a broken hip or a head injury. While the best option is to go home after hospitalization for a fall, where you can rely on in-home or out-patient follow-up treatment, not everyone is well enough or has the support at home. It could help to know which rehab facility would be best for your family, should you ever need to stay in one.
What Are the Choices?
In-patient rehab is meant to be a temporary transition stage between the hospital and your return home. “After a fall, your ability to walk may be compromised. You may not be able to carry out the activities of daily living. You may need physical therapy and occupational therapy in order to go home again. Or you may have a wound that needs to be dressed every day,” explains Dr. Carla Perissinotto, associate chief for geriatric clinical programs at the University of California—San Francisco.
But acute rehab is intense. It’s only for patients who can tolerate more than three hours per day of rehabilitation. This type of rehab facility has doctors and specialists (like physiatrists) on staff or on-site every day to oversee treatment (skilled nursing facilities typically have fewer visits from doctors) and has more services (such as prosthetics departments and wheelchair clinics) and equipment (such as X-ray machines or high-tech physical therapy equipment) than a skilled nursing facility.
Before you’re discharged from the hospital, your doctor and a hospital physical therapist will determine which type of in-patient rehab is most appropriate for you.
Shopping in Advance
Because the quality of care and services at in-patient facilities varies, you may want to do some comparison shopping well in advance of an emergency – especially when you’re healthy and able to make decisions without stress or pressure.
Start by using Medicare tools to look up available facilities and see how they compare. The Inpatient Rehabilitation Facility Compare tool will enable you to look for acute care rehab facilities and view information about the kinds of ailments they treat and the number of infections, complications and hospital readmissions they report.
The Nursing Home Compare tool enables you to search for skilled nursing facilities and see how they rate in inspections and quality of care. You can even see how many minutes each type of staffer (like a nurse or physical therapist) usually spends with a patient.
Another idea: Start with your insurance company and find out which facilities are covered under your plan. From there, look up the ratings and services provided by each facility.
Once you find a few possibilities that interest you, consider visiting each one. “Go there and see how clean the facility looks and how friendly the people are. Ask to look at the rehabilitative space in terms of physical and occupational therapy and communal spaces for joint meals,” Perissinotto says. She also suggests that you consider a facility’s location. “If you have a choice, find a place that’s easy for your family to get to, so they can visit. Being in a rehab facility can be isolating.”
Saxena advises that you observe whether the staff seems overwhelmed, and recommends that you ask about the food (since patients may stay in a rehab facility for weeks or months).
Saxena also says it helps to consider a rehab facility that’s affiliated with your hospital. That way, the rehab facility physicians will have access to your hospital records and information about your treatment, medications, lab work and follow-up appointments that may be scheduled. “I think it helps in preventing many mistakes that can happen during the transition from the hospital to the rehab facility,” Saxena says.
The Best Laid Plans
Just because you have an idea of which facility you’d like to stay in, it doesn’t mean that there will be an available bed if you ever need it. Space may be limited at the facility you prefer. “Sometimes you just have to go where the bed is available,” Perissinotto says.
Your hospital caseworker will make sure a rehab facility has space for you and takes your insurance, if you haven’t already learned that information.
But both Perissinotto and Saxena say it’s reasonable to have some preferences for certain rehab facilities in your area, and to use those preferences as a starting place. For example, maybe through advance investigating you learn about a facility near your home that has a great reputation for care and the best food in town. Or you may learn about a facility not far from home that has the latest high-tech machines used in physical therapy. Knowing that information would help you make an informed decision, should the need ever arise. At the very least, it may be help ease a very stressful situation.
“We can’t recommend a facility. It’s all the patient’s choice,” Saxena says. “It’s a critical decision, and it’s a lot to handle for the patient and the family members.”
The Many Benefits of Meditation for Older Adults
Doctors often prescribe the practice for better health and wellness, even later in life.
You can start a meditation program at any time, even without a doctor’s OK.(WESTEND61/GETTY IMAGES)
WHEN DR. STEPHANIE Cheng conducts health exams with older adult patients, she often goes beyond reviewing their medications and determining treatment plans. Cheng incorporates meditation exercises into the visits. “If I notice they are overwhelmed or have emotional distress, I may do a brief meditation exercise with them, just so they can be exposed to it as a tool to feel a greater sense of well-being,” says Cheng, a palliative care physician in the division of geriatrics at the University of California—San Francisco.
Cheng’s approach isn’t unconventional. Meditation is a well-studied practice shown to have many health benefits. It’s commonly prescribed as a way to help treat chronic disease and mood disorders. That makes meditation a natural fit, Cheng says, when older age brings physical, mental and emotional changes.
What Is Meditation?
Meditation is a way to calm the mind and body. It requires that you sit or lie down, relax and pay little attention to thoughts as they drift in an out of your mind. “It can be viewed as an antidote to the fight-or-flight response,” Cheng says. “When you meditate, in general, the breath slows down, heart rate slows, blood pressure decreases, stress decreases, digestive function improves and the sense of tension in the body decreases.”
- Transcendental meditation: focusing on a word or sound that you repeat over and over (such as “peace” or “om”).
- Mindfulness meditation: concentrating on the present moment without judging it. Offshoots include mindfulness-based stress reduction, or MBSR, and mindfulness-based cognitive therapy, or MBCT. “MBSR is more to reduce stress. MBCT helps you cope with emotional stressors,” explains psychologist Moria Smoski, associate professor of psychiatry and behavioral sciences at Duke Health.
- Guided imagery: focusing on mental images, such as a beach or a calming environment.
- Centering prayer: a religious practice that uses a sacred word to focus on connecting to a higher power.
- Body scan: concentrating on one body part at a time and investigating its sensations, such as how it feels where it touches the floor or bed, whether it’s cold or hot and whether there is pain or tingling.
Benefits for Seniors
Meditation is associated with many psychological and physical benefits. “In general, it’s been shown to decrease blood pressure and inflammation. And there’s some data around improving coronary artery disease outcomes and helping with post-traumatic stress disorder, chronic painand headaches,” Cheng says.
Meditation is also associated with reductions in irritable bowel symptoms, depression, anxiety and insomnia, according to the National Center for Complementary and Integrative Health.
Several areas of research appear to be especially encouraging for older adults:
- Memory. “Meditation is associated with enhanced short- and long-term memory,” says neuropsychologist Jean Lengenfelder, assistant director of traumatic brain injury research at the Kessler Foundation.
- Cognitive decline. “Meditation may help preserve cognitive function in folks who are starting to have struggles with memory and cognition. It’s associated with maintaining function longer than if you didn’t have a meditation practice,” Smoski says. A 2014 review of a dozen studiesinvolving older adults, published in Annals of the New York Academy of Sciences, suggested that meditation was linked to positive effects on attention, memory, executive function, processing speed and general cognition.
- Digestion and circulation. “One study found that people who meditated had improved circulation and oxygen in their blood. For the elderly, that’s important because as we age, digestion and circulation problems develop,” Lengenfelder says.
- Stress. “Meditation has been shown to decrease stress and have a calming effect on older adults,” Lengenfelder notes. “That can help them organize their thinking and give them a clearer perspective. They have improved focus, and their mind is sharp.”
- Loneliness. A 2012 study published in Brain, Behavior, and Immunity linked eight weeks of mindfulness meditation with decreased loneliness in older adults.
“It can be transformative,” Smoski agrees. “I’ve seen meditation help people feel more grounded as they’re going through difficult situations. It improves their sense of resiliency.”
You can start a meditation program at any time, even without a doctor’s OK. You’ll find free meditation podcasts on the internet. Smoski recommends turning to academic mindfulness centers for those, like the UCLA Mindful Awareness Research Center.
If you’d like to try a meditation class geared toward older adults, look to local senior centers, hospitals, private studios and retirement facilities.
But you don’t have to limit yourself to a class that’s age-appropriate. Lengenfelder points out that you can adapt any kind of meditation to work with your physical and cognitive limits. For example:
- If you have trouble getting up and down from the floor, you can sit in a chair or lie in a bed. “Research has shown that meditation done in a chair still has that benefit of lowering blood pressure and heart rate and increasing feelings of well-being,” Lengenfelder says.
- If you have hearing impairment, you may feel more comfortable listening to a meditation podcast at a volume that’s best for you. In a classroom, you may want to sit in the front near the instructor so you can hear directions.
- If you have cognitive decline, it may be easier to practice guided meditation. “It will provide a lot of cuing, and you won’t have to rely on your own thoughts to get through the meditation,” Lengenfelder explains.
And some of the best parts about meditation: It’s pill-free, you can do it anywhere and it works fast. “We don’t know how long it takes to feel better; some people report improvements even after one meditation session. It enhances their mood and increases their energy,” Lengenfelder says. “The more frequently you meditate, the more benefits you can experience.”
“It’s so accessible,” Cheng says. “There are so many forms of meditation that everyone can find what resonates with them and weave it into their daily lives. I’m sure the trend will continue.”