Special to the Journal of Business


Suddenly, your mom has broken her hip, stayed her limit in the hospital, and now needs 24-hour care. The word nursing home becomes part of your vocabulary.


But I promised Id never put her in one of those, you say.


Lets hope you can find a bed for her, murmurs the hospital discharge planner. Guilt filters in.


Making decisions motivated by crisis is difficult at best. Later, you might offer this advice to friends with aging parents.


Making facility visitations


Start visiting homes the minute you suspect your parent is failing or in need of support.


All Spokane nursing homes hold the same license and are ranked by the same system, but they can differ greatly. When visiting a nursing home, ask to see copies of its most recent inspections and list of complaints, or call the states Residential Care Services program at (509) 458-3608 to obtain that information.


Dolores Young, a former nursing-home administrator who began her career as a housekeeper in a Spokane nursing facility and now is a nursing-home consultant based in Texas, says, When you consider Medicare-certified reputable facilities, remember that a beautiful physical plant or positive first impression of staff doesnt guarantee wonderful homes. If your gut tightens up when you walk into the residence, dont even take a tour.


She adds, Drop in unexpectedly and have a meal. Talk to residents and put yourself in your parents shoes. Remember that some nursing homes have been rated lower than others, but there could be many variables involved like an extraordinary load of heavy care.


For more information, contact the Eastern Washington Long Term Care Ombudsman Program. Representatives from that program visit nursing homes regularly, investigate complaints, advocate for residents, and mediate disputes.


Understanding funding


Next, consider ways to pay for nursing-home care. Primarily, they include private pay, in which you pay the costs out of your personal resources, and Medicaid, the joint state-federal program for low-income residents. Other funding sources include Medicare, the federal health insurance program that covers some nursing-home expenses and that can be supplemented with Medigap insurance, and long-term care insurance. Most such policies help cover nursing-home care.


After assessing your loved ones financial status, make sure you understand your options.


You really do need a translator to interpret the guidelines for Medicare, says Sherri Adams, director of nursing at Spokane Valley Good Samaritan Village. For instance, just because you are covered for Medicare does not mean you can just admit yourself to a facility. Eligibility depends on having spent at least three consecutive days in a hospital as well as meeting Medicares definition of required skilled services.


To learn more about Medicaid, you can attend one of the free half-hour forums held at the Washington state Department of Social and Health Services office at 1427 W. Gardner every second and fourth Tuesday of the month at 2 p.m.


Get organized


Youll need an advance-directives legal document spelling out your parents wishes regarding future medical care and denoting a power of attorney (POA) to act on his or her behalf if necessary, so if you dont have one, get busy.


This document is based on the values of the resident and basically determines if a cardiac or respiratory arrest happens, would they want CPR started and to be transferred to a hospital. It can be amended or changed by the resident or legal POA at any time, Adams says.


Bring other players in your family on board. Young says, Get together and have a family meeting. Sooner is better than later. Designate a spokesperson if the POA or guardian is not in place to protect nursing-home staff from trying to deal with too many people and inherit family conflict.


Create realistic expectations


Forming down-to-earth expectations is critical before narrowing the field. Its no secret the nursing-home industry is in crisis. Competing for nurses with hospitals and agencies that can pay higher wages, and receiving lowered Medicaid reimbursements, many facilities nationwide are gasping for air while regulations are tightened. Quality of care can be at risk.


Short-funded, administrators are left with an overwhelming juggling act as they attempt to make the business run and do the best for patients, says Young.


Adams says, The state Medicaid reimbursement system does not cover the actual cost of providing services to a resident. Nursing home staffing levels cannot compare with hospitals. Our day-shift, direct-care licensed nurses care for up to 20 residents. Hospital levels might be one nurse for one to eight residents depending on their activity. Residents may be turned away from a nursing home because of staffing levels or lack of qualified licensed nurses due to management shortage, or unavailable special equipment.


She adds, Staffing often determines how quickly a residents call light can be answered.


No matter how hard it tries, a nursing home will never be your parents old home. However, with comprehensive rehabilitation programs in many facilities today, it is a place people go more for recovery than to die.


Be a participant


Even though the residents should be involved in decisions about their care, your involvement is crucial at all levels.


If you suspect something isnt right, go to the administrator. Even though staff have more contact with your parent, he or she is not the one in charge, Young says. If you dont get results that make you feel good, appeal to the ombudsman as a go-between. If not successful there, you can always appeal to the state agency that handles elder abuse.


If you are unhappy with your parents experience, analyze the gravity of the problems.


Transitions can take a tremendous toll on an older person. No matter how hard you try to avoid it, there still will be risk, inconvenience, and emotional pain attached to this stage of life. Young says, Before admitting a parent, be confident in your decision rather than entering this new experience with lingering doubts.


Lastly, never make a promise to your parent you might not be able to keep. Just tell them youll do the best possible, whatever the circumstances.


Gail Goeller is founder and editorial consultant at Mature Matters Publishing, a division of Lawton Printing Inc., of Spokane. Mature Matters publishes The Complete Directory for Seniors and Their Families and provides seminars on aging and elder care.