MYTH:
A nursing facility is like a hospital.
REALITY:
A nursing facility is not a hospital. Many people enter a nursing facility
after a hospital stay and tend to think of the nursing facility as an
extension of hospital care. However, a nursing facility is much different.
Medical, rehabilitative and nursing care is provided as needed by health
care professionals and dedicated caregivers. Yet at the same time, nursing
facilities try to be homes - where people can feel comfortable, find
familiar faces, and continue life's activities appropriate to their age and
capabilities.
Nursing facilities do not have
restrictive visiting hours like hospitals. Family members and friends are
encouraged to visit. Whenever possible, residents eat in dining rooms rather
than in their rooms. Various activities and outings are offered each day to
stimulate and entertain residents mentally, physically and socially.
MYTH:
Nursing facility residents are confused.
REALITY:
Most people slow down physically as they age and perhaps get easily tired.
Some may slow down mentally as well. In fact, many people enter a nursing
facility, in part, because poor memory makes caring for themselves difficult
or impossible. However, with adequate nutrition, exercise, social
stimulation and properly controlled medication memory problems often can be
improved. It is important to take into consideration that a nursing facility
has professional caregivers that are extraordinarily capable of interacting
with the elderly or persons with a disability in a variety of situations.
It is true that a large number of
nursing facility residents have Alzheimer's, an irreversible disorder that
causes progressive mental difficulties. In many cases, Alzheimer's residents
live in distinct units where they can be among people having the same
limitations and receive the specialized care they require in a secure
setting.
MYTH:
There's no privacy in a nursing facility.
REALITY:
Nursing facilities must strike a balance between providing security and
adequate supervision while respecting a person's privacy. Common areas in
nursing facilities tend to be open, while resident rooms are considered
private. Staff members respect resident privacy by being courteous and by
knocking before entering the room.
MYTH:
Nursing facility residents never leave.
REALITY:
A primary goal of the nursing facility staff is to rehabilitate residents so
that they can return home or to an assisted living setting. Those who cannot
return home permanently may be able to make short visits, health permitting.
In most states, Medicaid-certified nursing facilities will hold beds for
residents while they make a short visit home. Check on how your state
government regulates a home visit by asking the admissions person at the
nursing facility that you are considering.
MYTH:
I will not be able to make my own decisions.
REALITY:
Nursing facility staffs strive to maximize independence and honor resident
preferences. It is a resident's legal right to make choices about activities,
schedules, health care and other aspects of their life. Yet it is important
to recognize that the facility must ensure an environment where people can
live together safely and harmoniously. Whatever an individual's physical
condition, the over-riding objective for the facility is respecting an
individual's rights and wishes and providing a supportive environment and
quality care.
Resident councils, which are
self-governing bodies in nursing facilities, provide an opportunity for
residents to become actively involved in addressing their concerns to staff
and to one another. When it comes to treatment decisions, some residents
choose to shift decision-making responsibilities to their children or
others. Residents, if they have not already done so, are encouraged to
prepare an advance directive. An advance directive is a legal document
designed to express an individual's wishes for treatment should he/she be
unable to communicate his/her preferences.
MYTH:
Nursing facilities have unpleasant odors.
REALITY:
Today's nursing facilities should not have persistent odors. In fact, with
the effective cleaning products available, a properly sanitized nursing
facility should smell pleasant. However, because some residents are
incontinent, an occasional odor may be noticeable, especially in the
morning, though it should not linger.
MYTH:
Nursing facilities do not provide quality care.
REALITY:
Family members are encouraged to participate in care planning meetings with
the staff and resident. By being involved in care decisions, the information
you can provide will help ensure quality and satisfaction of care.
Keep in mind that nursing
facilities are expected to meet government-quality standards, and they are
inspected to ensure that they do. When a problem is found, a plan for
correcting it is put into place promptly. In addition, most areas have an
active, government-supervised, Ombudsman program that provides advocates for
residents.
Family and friends also serve as
an important safety net by being regular visitors. If you feel that proper
attention or care is not being given to a specific situation, bring it to
the attention of the appropriate staff person, for example, the director of
nursing, social worker or administrator. If you are not satisfied with their
responses, you may wish to contact the facility's Ombudsman or other
authorities.
MYTH:
Husbands and wives must live apart in a nursing facility.
REALITY:
This is simply not true. Many couples enter nursing facilities together and
may share a room if they so choose. Staff members respect the privacy of
couples living in nursing facilities.
MYTH:
Nursing facility residents are not visited regularly by family and friends.
REALITY:
The majority of residents have frequent visits by family and friends.
In addition, staff members often become surrogate "extended-family" members
and friends to the residents. Staff members do recognize that there are some
residents who have limited family and try to encourage visits and to make
visitors feel welcome.
MYTH:
Meals are not appetizing.
REALITY:
The dietary staff makes every effort to ensure that meals are nutritionally
balanced, varied and appetizing. The fact is, however, it is difficult to
meet everyone's expectation of home cooked meals. Another impacting factor
is that many residents are placed on restrictive diets that may limit salt,
fat, cholesterol, or sugar. Some may require that their food be pureed due
to difficulty in swallowing or chewing. Because proper nutrition is so
important, discuss this matter with the facility's dietary manager.
MYTH:
Residents are controlled by medications.
REALITY:
Every person has the right to know what medication he or she is taking, to
refuse any or all treatment, and to be free of medication inappropriately
used to control behavior. Tranquilizers, pain relieving medications,
sleeping pills, and anti-depressants are all drugs that must be prescribed
by a physician for treating a medical condition. Properly prescribed, and
administered, these medications help individuals. For example, drugs are
often very beneficial to the elderly if they suffer from depression, which
is common.
Use of drugs in nursing
facilities is closely monitored. Government regulations require that a
consultant pharmacist review drug regimens monthly and state inspectors also
review medications. Residents and families are encouraged to participate in
care planning sessions to discuss pharmacy issues and ask questions about
prescription medications, especially if it is felt they are having a
negative effect.
MYTH:
Physical restraints/restrictive devices are common.
REALITY:
Nursing facilities have made great strides in promoting and fostering the
maximum physical potential of everyone in their care. Restrictive devices
are used only when necessary to treat medical symptoms under a physician's
order. In accordance with federal regulations, a family's desire to use a
restrictive device must also be medically indicated and ordered by a
physician. As more care options are developed and physical independence
strategies are enhanced, more residents are enjoying the freedom of movement
while also achieving improved functioning and safety. Long term care
professionals use devices as medically needed, and not as restraints.
For example, if a person who has
had a stroke has difficulty balancing while sitting, a therapeutic position
enabler may be prescribed to facilitate sitting, positioning for eating or
participation in activities or therapy.
MYTH:
Nursing facilities are expensive.
REALITY:
At first glance, nursing facility costs may appear high. The average daily
cost is in the range of $130 with geographic variations. This daily cost
covers a complete set of services, including room, board, medical and
personal care, health professionals on staff or on call, and a full range of
activity programming. Once the range of services is taken into
consideration, it becomes clear that the daily charge is reasonable.
It is also important to note that
the primary goal of nursing facilities is to maintain the individual's
quality of life while providing needed care, rehabilitation and a safe
environment. Staff members encourage residents toward self-reliance as much
as possible so that they can maintain or achieve the highest level of
independence possible.
MYTH:
Medicare or my health insurance will pay for a lengthy stay in a nursing
facility.
REALITY:
Because many people mistakenly believe that Medicare or health insurance
will cover their long term care costs, they are forced to spend down their
savings to cover the cost of care.
Consumers should be aware that
the government provides little financial assistance for nursing facility
care unless a person is impoverished and qualifies for Medicaid. Nursing
facility coverage falls under Part A of Medicare and is very limited. If
certain stringent conditions are met, Medicare pays for 100 percent of the
first 20 days of care in a skilled nursing facility (SNF) if that many days
are needed. For the 21st through the 100th days, the resident must share the
cost of care by paying a daily co-insurance rate that changes yearly. In
2002, the co-insurance payment was just over $101 per day. Medicare Part B
may help pay for covered services received from a doctor in a SNF, if the
person has chosen to participate in the Part B medical insurance program. If
they have used up their Part A coverage for a spell of illness, Part B also
covers a portion of services received in a SNF, such as physical and
occupational therapy.
Under the Part B program, they
must pay an annual premium and a deductible for all Part B services
including physician services, after which Medicare pays 80 percent of the
reasonable charges for covered services.
Long term care insurance offers a
more viable solution to accessing the facility or setting of your choice,
paying for it while preserving personal assets. However, due to lack of
public awareness about long term care and who pays for it, long term care
insurance is used by only five percent of the public.
Financing nursing facility care
should be approached with as much thought and preparation as any major
expense. Obtain in writing what the basic charge will be and understand
clearly all financial arrangements before signing a contract.
