Guide to Moving into a Nursing Home

What to Expect When Moving a Loved One into a Nursing Home

Let’s be honest. There are few chapters in our lives more gut wrenching than moving a loved one into a nursing home.

No assurances from others will wipe out the guilt, anxiety and sadness that often accompanies the situation. Still, nursing homes provide a service that frequently is the best option.

You can’t control aging. What you can do is gather all the information possible about assisted care to make better choices and facilitate the transition.

Our team hopes this guide on what to expect when moving your loved one into a nursing home will help:

How You Know It’s Time

In the United States approximately 1.6 million elderly and disabled persons receive care in one of 17,000 nursing homes. One in three Americans over the age of 65 will probably require nursing home care at some point. In Macomb County, Michigan, alone there are 54 nursing home facilities within 25 miles of Macomb.

There are so many nursing homes for a reason. The problem is being sure when it’s time to make the nursing home the permanent home. Sometimes this decision is made for us on a doctor’s recommendation where there are health or recovery concerns. But often the decision is an inch by inch one as caregiver burnout becomes more accentuated.

A survey by the National Alliance for Caregiving found that one in three caregivers who provide care for at least 40 hours a week says that no one else helps. More than seven in 10 caregivers are women. An estimated 14.4 million full- and part-time workers balance caregiving and job responsibilities, which also leads to perpetual weariness.

Caregivers without a support system are more likely to suffer emotional strain and a whole host of problems such as depression, sleeplessness and back pain.

There are also specific signs pointing to nursing home care, according to a recent article in VeryWell:

  • You’re dropping the ball with other responsibilities
  • Your loved one has wandered outside and become lost
  • Your relationships are suffering
  • Your loved one has care needs that you really can’t handle very well
  • You’ve hurt yourself or fallen trying to lift or move your loved one
  • You’ve had friends or family members tell you it’s time.

How To Find The Right Nursing Home

With so many nursing homes to choose from, where do you start the vetting process? Obviously you will want to visit the facilities and talk with staff. But perhaps the best place to start is with Medicare’s Nursing Home Compare. This website will list all the nursing home facilities in your area, examine each one and evaluate health risks, level of staffing per resident, quality of care, Medicare/Medicaid process and give an overall rating.

According to AARP (American Association of Retired Persons) it’s important to ask the right questions when inspecting a nursing home. These questions should include things like:

  • Is transportation available so residents can visit their own doctor?
  • Does the nursing home offer physical therapy? If so please describe it.
  • Are the staff members trained to deal with dementia? If so, what level of training?
  • What about units or programs for special needs such as Alzheimer’s?

Factoring In Costs

According to Paying for Senior Care, in 2017, the national, daily average for nursing home care for a shared room was $235. The least expensive states are located in the Southeast and Midwest where the daily cost was closer to $165.  The most expensive area of the country, excluding Alaska and Hawaii, is the Northeast where the daily cost averages are closer to $350.

In Michigan, the average daily cost is $262.

Medicaid, through its state affiliates, is the largest single payer for nursing home care. While estimates vary, it is safe to say that Medicaid pays between 45 percent and 55 percent of the total nursing home costs in the United States. However, Medicaid’s eligibility requirements are a bit complicated. Age, marital status and financial resources factor into how much out of pocket expenses are involved.

Read more here about costs and Medicaid/Medicare coverage in Michigan. We also have a handy guide for Macomb County Veterans.

Download our Medicaid Checklists here

What items do you need to take with you when you (and your spouse if you are married) go to file a Medicaid Application? We often see clients who do not understand what forms they need or forget important forms and then are not able to complete the application process. The following Medicaid Checklists should provide insight on what forms you will need. Download them for FREE!

Medicaid Checklist – Single

The following items are needed to file a Medicaid Application for a single individual.

Medicaid Checklist – Married

This checklist provides items which are needed to file a Medicaid Application for a married couple.

Medicaid Misconceptions

We meet with families on a regular basis who face long term care issues, but make decisions based upon incomplete understanding of the laws and rules concerning Medicaid. For example, while Medicaid is a federal program, it is administered on a state level and it’s the state laws which impact its administration.

Also, different rules apply for a single person and a married couple. We often find a family is making decision based upon the rules, but as they would relate to a person of a different marital status. This sheet will answer most of the common misconceptions about Medicaid benefits we encounter.

Emotional Preparation – for Both of You

In many ways, for a caregiver, placing a loved one in a nursing home is a no win situation. You may know you’re doing the right thing, but it doesn’t feel that way, especially when your parent or spouse lashes out, “Why are you doing this to me?” or “You just want me to go away.”

Psychologists say much of what your loved one says is directed at the situation and not the caregiver. One way to avoid the anger and resentment is to emotionally prepare a loved one through a series of conversations over time. Something like this:

Conversation 1: Ask them how they feel about moving to senior care. Don’t try to convince them, just listen carefully.

Conversation 2: After they have had time to think about senior care, ask them again how they feel about it since the first conversation. This is where you can discuss the benefits of a nursing home.

Conversation 3: After your loved one has accepted senior care, be there for them. Answer questions and let them know you love them. It’s often recommended to make up a calendar of days that family members will visit. This reinforces plenty of support.

For the caregiver, look for emotional support from siblings and other family members. Knowing that you are all on the same page can go a long way to feel more solid about the situation. However, don’t be surprised if you still suffer from a swing of emotions. If your mental state is particularly delicate, you may want to see a therapist.

In the Macomb area, here is a list of mental health professionals.

What to Pack

And so begins the transition. Since your loved one cannot possibly take every possession to the facility, and because nursing homes have limited storage space, you as the caregiver should help decide what to pack and what to throw away.

Your loved one’s most cherished possessions is a good place to start with what to pack. This helps nursing home residents remain connected with their past. Family photos are especially comforting. Family members are encouraged to make collages of family photos that include messages and cards. However, it’s best to bring copies of photos rather than the originals. It’s also important to speak with nursing home staff regarding photograph rules. Some nursing homes require photos to be framed or spayed with fire proofing, which can ruin originals.

Senior Home Service says to be cautious about bringing items such as computers, cell phones, DVD players, etc. Most nursing homes will not reimburse seniors for these items if they’re lost.

Nursing homes are required to furnish basic items such as bedding and towels. Loved ones are encouraged to bring favorite blankets and quilts, etc.

Nursing homes often recommend bringing only three to five changes of clothing. Sweatpants, comfortable shirts, tennis shoes and comfortable sleepwear should be included. Every item of clothing should have the senior’s name written on it with permanent marker so it can be identified if lost.

Other common items to pack:

  • Deodorant
  • Electric razor or razors; shaving and aftershave lotions
  • Facial tissues
  • Washable, non-skid slippers and one robe
  • Medications
  • Casual outfits and two belts
  • Makeup and body powder
  • Flat, non-skid shoes and one coat or jacket
  • Souvenirs
  • Full sets of undergarments and two washable sweaters

Admissions/First Day

This is likely going to be a long, difficult day for you and your loved one. Older adults have a more difficult time letting go than younger people, especially when giving up a home of a lifetime.

Plan to take the day off. Bringing as many friends and family along as possible can help both of you. If your loved one is associated with a church, it’s not a bad idea to have the pastor or a close friend greet the senior upon arrival.

Be prepared to fill out a questionnaire, much like your first visit to a doctor’s office. Nursing home staff will want to know all they can about your loved one. According to Aged Carer, you will probably have to answer questions about:

  • Likes and dislikes
  • Medical history
  • Details of health funds/Medicare
  • Allergies to food and medications
  • Preferences for showering and bathing
  • Special dietary requirements
  • Incontinent problems
  • Funeral arrangements and terminal care options
  • Choice of doctor

One rather unpleasant matter you need to discuss with staff is about theft. It’s unfortunate, but in nursing homes, anything can become lost or stolen. In fact, missing items are quite common, and nursing homes spend thousands of dollars each year replacing missing items. It’s important to have the staff log all of the senior’s belongings onto the Facility Inventory form or it won’t be possible for the items to be replaced.

After all the paperwork has been completed, spend some time with your loved one at the nursing home. You can help arrange the room and talk about the facility’s programs and activities.

If you can, take a walk about the nursing home and orientate your loved one to the location of the dining room, toilets, nurses’ station and communal lounge rooms. Show them how to get nursing assistance. Make sure the call bell is in an easy to reach place and encourage a family member to use it before you leave. Taking timeout to talk with other residents and staff members are ways you can help someone adapt to a new environment.

Above all it’s important the senior feels loved. Tell them you love them. Hug them.

What to Expect in the First Few Weeks

Besides support from family and friends, your loved one may require a professional therapist to help with feelings of loss and anxiety. Most nursing homes do provide an on-site therapist or social worker to help with this big life adjustment.

You will also want to monitor how your parent, spouse or other loved one is eating, feeling and doing in general, especially for the first few weeks. Also check to make sure the correct therapies and medications are being provided.

Discuss the nursing home’s rules and regulations for taking your loved one away for brief periods of time to enjoy dinner in a restaurant or go to church.

It’s also a good idea to get to know the nursing home’s staff and build some trust there so when a problem comes up it can be resolved quickly and satisfactorily.

Once settled in, help your loved one become involved in the nursing home’s activities. Interacting with others should make the transition easier.

In a large-scale study performed by the Center for Medicare and Medicaid Services, 160 residents in 40 nursing homes were interviewed about what quality of life meant to them. The study found that residents “overwhelmingly assigned priority to dignity.”

The researchers determined that one underlying component of dignity was having a choice of activities. Residents most appreciated activities that produce or teach something; activities that use skills from residents’ former work; and religious activities.

Nursing home activities are considered so important that a federal regulation requires every facility to have them. Nursing Home Federal Requirements §483.15(f)(1) states:

“Facility must provide for an ongoing program of activities designed to meet, in accordance with the comprehensive assessment, the interests and the physical, mental and psychosocial well-being of each resident.”

“Activities” refer to any endeavor, other than routine ADLs (activities of daily living), in which a resident participates that is intended to enhance his/her sense of well-being and to promote or enhance physical, cognitive and emotional health. These include, but are not limited to, activities that promote self-esteem, pleasure, comfort, education, creativity, success and independence.

These activities can and should be both communal and individualized.

Be sure to regularly check the nursing home’s activity calendar.

If the activities listed do not meet the needs of your loved one, inform the activity’s director and ask for a new activity to be added to the calendar that best serves your loved one’s interests.