Family Questions: The First Thirty Days
Coping with the Transition

Visiting Policies and Trips Out of the Home

Can I take Mom out sometimes?

Of course. Residents are encouraged to go on outings as much as possible. Plan outings for your relative, especially on Sundays, holidays, and family birthdays and anniversaries. If overnight outings are planned, check with your facility regarding the policy on overnight stays.

If I take Mom out, does she need to be back by a certain time?

Not usually. However, the nursing staff needs to know when you are leaving and the estimated time of return. Medications may be given to you for your mom.

Clothing and Laundry

What personal items should I pack for my wife?

First ask your wife what clothes and special items she wants to bring. Then ask your facility for its recommended clothing list and if your wife's situation warrants additional items.

Should I send Mom's personal items and valuables with her?

Ask your mother if she would be upset if an item was broken or lost. If the answer is "yes," don't send it. Leave expensive jewelry, cash, credit cards and valuable collector's items at home.

Is there someone in the home I can leave some cash with, so Dad will have money if he needs it?

Your father may need cash for the gift shop or the barber shop. See the business office manager about setting up a personal account that he can access to cover these personal expenses.

How will my wife's clothing be laundered and how often?

Find out how the laundry is handled on the floor your wife is assigned to. There may be a particular bin or room for dirty clothes, and in the beginning it might help if you made sure your wife's clothes get there. Also, make sure she has plenty of clothes to wear while her dirty clothes are being laundered. If she is incontinent, she may need additional clothes.

How can I help keep Mom's clothes from getting lost?

In a facility the size of a nursing facility, responsible for laundering clothing and linens for scores of people, it can be a challenge to keep everything straight. Upon admission, the staff will begin an inventory of your mom's items that will be kept on her chart. After admission, you'll need to let the facility know if additional items are brought in or removed. It won't be long before staff members recognize her clothes themselves. Don't panic if something turns up missing. First check to make sure it wasn't taken home by another family member, then report the missing item to the staff

How should I mark Dad's clothing?

Since markings can wash out with repeated launderings, the best way to mark his clothes is with sewn-in labels, especially if the clothes are dark. Check his clothing periodically to see if the name tag is still legible, and be sure to get all clothing marked before it comes into the home.

Can I do my husband's laundry at home?

Probably, but check with the nursing facility. Make sure there's an adequate supply of clothes available to your husband while you're laundering his dirty clothes at home.

Food

Will Dad be made to eat food he doesn't like?

No, but the staff cannot be expected to know what those foods might be unless you or he tell them. The staff will try to encourage your father to try different foods, and will help him order and season his food the way he likes it as soon as they learn his preferences. Many nursing facilities now offer more selection so that each resident can choose what they feel like eating from two to three selections.

Who will help my aunt eat?

Every one who needs assistance in eating receives it. Your aunt will be encouraged to feed herself if at all possible, because eating can be a very important part of physical or occupational therapy Special equipment may be used to help her eat independently. If she is unable to do so, however, someone will help her.

Can I stay to eat supper with Dad occasionally?

Certainly! Your dining with him will add to his pleasure. Since each nursing facility has its own policies on guest meals, however, ask to meet with the dining services manager for details on advance notice, meal times, cost (if any), and any other services the facility might provide. For example, some facilities offer a special menu and a special dining room so that you can take your father "out to eat" without leaving the facility. Or he can take you and your family "out"!

Grandpa's supposed to be on a low-salt diet. Who will make sure he sticks to it?

There are really two issues here. One is that your grandfather is on a sodium (salt) restricted diet for health reasons. The other is that he has the right to choose whether or not to follow that diet. No one can force him to follow it. He will be provided with meals that are planned to meet the dietary restrictions ordered by his physician and that will also be nutritionally adequate. If he asks for food that is not allowed on his diet, or obtains food from other sources that is not allowed, he will be counseled on the potential negative consequences of not following his diet. You can assist by encouraging him to follow his diet.

I'd like to surprise my mother-in-law with some of her favorite foods occasionally. Is there any reason I cant bring her treats occasionally?

No, but discuss it with the dietitian or dining services manager first to make sure the item does not conflict with her diet. Each time you bring in an item, let the dining services manager or nurse know. Also try to time your visits so that your mother-in-law can eat the item. The facilities have strict regulations to follow on storing and refrigerating foods to keep them as safe as possible. If you bring in something for her to keep in her room that can be stored at room temperature, also bring in an airtight container to store it in (provided that the facility's policies allow this).

Personal Care

How fast will Mom's call light be answered?

Almost immediately, especially if the staff is aware of some problem your mother is experiencing, for example shortness of breath while she's fighting a cold. Moreover, the staff does not rely solely on residents' signals for help. The staff checks everyone on a regular basis, whether they have requested assistance or not.

How involved is my husband's doctor?

The nursing facility staff is in regular contact with your husband's doctor. Family members are encouraged to keep in close touch with the physician themselves, but must remember that it is the nursing staff that will be carrying out the medical orders that come directly from the doctor. If you're not sure that something got passed on to your husband's nurse, be sure and ask her about it.

My uncle is supposed to take half a dozen pills at all different times of the day. Will someone make sure he keeps to his schedule?

Yes, you can rest assured that medications are monitored very strictly in the nursing facility, and that the medical staff is continually checking and double-checking medication schedules.

How many people work a given shift? Is the weekend staff adequate? What is the staff-to-resident ratio?

Staffing requirements are set by federal guidelines designed to provide enough staff for the appropriate care level at all times. Ask the nurse in charge of your family member's floor for the specific statistics for your nursing facility.

Does the staff take everyone to group activities, or only those who express an interest? I know my mother-in-law would enjoy some of them, but I'm not sure she'll think to ask.

All residents able to attend activities will be encouraged to do so. In fact, the staff is required to have a personal plan of care for each resident that includes activities and programs. This plan of care will be personally tailored to your family member's physical and cognitive abilities. If your mother-in-law wishes, you can attend care planning meetings, usually held quarterly, and any group activities.

Who will be taking my grandmother to the bathroom and how often? Will someone get her up at night or will she use a bedpan?

The facility maintains appropriate staffing 24 hours a day, seven days a week. Members of that staff will continually check on your grandmother to monitor bathroom needs. At night, and depending on her condition, your grandmother may choose the bathroom or prefer a bedpan to getting out of bed. Some residents, of course, will require a bedpan.

Who will do my father-in-law's hair, teeth and nails? Is that up to the family?

No, this kind of care is also strictly mandated by federal guidelines. Hygienic guidelines are very specific, and nursing facility staff are fully responsible for making sure your father-in-law's body, hair and teeth are clean.

How frequently will my father be bathed, and by whom?

Your father's nurse should be able to answer this question for you but as a rule, residents are bathed once weekly, usually by an aide, but sometimes by a nurse. Individual needs may dictate a more frequent schedule, however, so check to see whether your father falls into this category.

Do residents receive any attention during the night, or only if they wake up and signal for help?

The nursing staff conducts regular rounds to check on each resident during the night. Check with your nurse to see how often they do this for your family member.

Will my wife's therapies continue on weekends?

Not usually. Most therapies are planned for Monday through Friday.

Complaints

How should I handle complaints?

If your family member complains, remember:

  • Never hastily dismiss a family member's complaint. Even if the complaint appears petty or simply a way to register dissatisfaction with his new limitations, ignoring complaints will only further damage your relative's morale.
  • In many cases, all the complainant wants is for you to listen, support and comfort him as he adjusts to his new environment.
  • Try to really listen to what he is trying to say. (See Helping your loved one adjust.) Don't prejudge the validity of the complaint, and pay particular attention to his verbal cues, body language, facial expressions, posture and gestures. All can help you determine the seriousness of his complaint.
  • Complaining is not limited to verbal expression. The onset of depression, an increase in anxiety, or the development of a tendency to withdraw into hostility and unresponsiveness can themselves be forms of complaint.
  • Always respond to complaints, whether they are well founded or not. Use facial expressions, gestures, statements, questions and comments to show you're listening. Don't get upset and don't be condescending or patronizing. Treat your family member as an equal in the conversation.
  • If you do feel a complaint could be warranted, bring it up to a staff member you're comfortable dealing with. Lingering or more serious complaints should be taken up with the home's administration. Most homes have a specific complaint procedure. If you're uncertain, ask.
  • Be sure your relative is kept informed that everyone is working on the complaint and give him status reports.
  • Although you should always bring complaints to the attention of the staff first, you should also be aware of the other avenues available to you for resolving problems. Amendments made in 1978 to the Federal Older Americans Act set up an ombudsman program in each state to help family members who have complaints about nursing facilities and long-term care facilities. Residents or relatives should be encouraged to report any unresolved complaints to this or similar programs in their area.

Insurance

What does Medicare cover?

Medicare is a short-term federal program providing funds according to medical need. To qualify, the resident must meet strict medical guidelines requiring a skilled nursing facility. Your facility will determine if your family member qualifies and will fill out the forms. When your family member is on Medicare, his case is continually monitored by a team of staff members to make sure he qualifies. The home will notify you when Medicare benefits will end.

What is Medicaid?

Medicaid is a federal program administered by state agencies, based on financial need, and the medical necessity for nursing facility care. Although the benefits last indefinitely, the state reviews all Medicaid residents periodically to make sure they continue to qualify both financially and medically.

What does supplemental or long-term insurance cover?

Insurance coverage is available to cover certain costs of nursing facility care. Some plans will supplement Medicare or Medicaid coverage and cover expenses beyond what these plans cover. Others pay for a portion of daily expense for a set amount of days in a nursing facility. These policies may be in the form of supplemental or long-term insurance.

If your family member has such insurance coverage, bring a copy of the policy to the attention of the nursing facility. Work with the administrative staff to discuss how they want to file claims to get the best benefits.

Advance Directives

What are Advance Directives?

Advance directives are documents which permit an adult to convey health care instructions in the event the person subsequently loses the ability to make or communicate decisions.

Although there are some language and provision differences between states, the two most common forms of advance directives are a Living Will (LW, or a Directive to Physicians), and a Durable Power of Attorney for Health Care (DPOA).

What is a living will?

A living will communicates health care preferences should an individual ever suffer from a terminal condition and be unable to indicate those preferences for himself Before a living will can go into effect, not only must the patient's attending physician document both the terminal diagnosis and the patient's inability to make his own decisions, but a second physician must make an independent assessment of the patient and concur on both the terminal condition and the decisional incapacity. Living wills are used most often to indicate preferences about life sustaining treatment when death is imminent.

What is durable power of attorney for health care?

A durable power of attorney is a document in which a person names another individual to make his health care decisions for him, should he ever become incapable of making them himself Like the living will, the durable power of attorney cannot be invoked unless the patient's attending physician - as well as a second physician or, in some states, an accredited psychologist documents the patient's decisional incapacity.

What does this mean in terms of self-determination?

The sole purpose of advance directives is to ensure a person's right to make his own decisions regarding his health care options. For example, even after all the requirements have been met to activate a living will, if the patient regains decisional capacity, even temporarily, his wishes take precedence over any previously executed advance directive.

As the 1990 Patient Self-Determination Act makes clear, the law requires that in the case of an individual's mental incapacitation, his physicians and family are not to make the decision they consider best for the patient, but rather to determine what the patient's own preferences would be, and to act accordingly.

It is important to remember that no one is required to have advance directives. Furthermore, healthcare providers are required to take a neutral position regarding their merit. In fact, advance directives have advantages and disadvantages. If you are interested in having advance directives for yourself, it may be useful to consult with your physician and a health care attorney to help ensure that your concerns are adequately addressed.

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