Jewish Sacred Aging

It is preferable to begin the admissions process prior to actual need of a geriatric facility. This is not as odd as it might sound. Many geriatric care facilities have waiting lists and your loved one’s name can be added to that list. He/she would then have an improved chance for admission in time of need. It is easier to take one’s time, to meet with the admissions’ staff more than once if need be. The more groundwork that has been laid, the greater opportunity to focus on helping the loved one make the transition to the geriatric facility.

After determining the cost per day/month, the following items are important to consider when interviewing admissions’ staff:

Basic

• What agencies inspect the geriatric facility and what ratings have been given to it?
• If your family member has long term care insurance, does the facility accept it and what does it cover?
• How many Medicaid beds does it have and if appropriate, what are the eligibility requirements?
• Does your loved one’s primary care physician make visits to the facility? If not, ask for a list of physician who do.
• Who is the Medical Director?
• What other medical professionals make visits there, ie.podiatrists, dentists, etc.? if your family member wears glasses, does an optometrist make visits for such repairs?
• Is there a continuum of care available in case her status worsens?
• If she falls and breaks a hip, for example, are there Medicare beds available? If so, is rehab therapy available?
• If your family member will be in assisted living, does the facility provide temporary nursing care if needed in times of illness? If so, what is the cost?
• Is transportation provided for trips outside the facility and how is it coordinated?
• How is medication ordered? Is there a choice of pharmacy?

Quality of Life

• Ask to see a menu cycle. How are special diets and likes and dislikes addressed? Where do the residents eat? If assistance is needed with feeding, how is that handled?
• Is there flexibility in the bathing schedule, ie. If your family member prefers an evening bath?
• What services other than nursing are available? This includes meeting spiritual needs and activities in general. Ask to see the calendar of events. Ask about staffing, ie. Is there are social worker, how many activity aids are there, etc.
• If your family member is confused, how is that addressed?
• If a resident requires assistance in getting to an activity or to meals, what assistance is offered? Some facilities have volunteers who transport residents.
• Is there a beauty parlor in house?
• Are there laundry services available? Are clothes to be labeled so as to avoid loss?
• What support services are available to families?

Advocacy

• What is the chain of command within the facility for reporting problems? Is there a designated advocate on staff?
• If a problem cannot be resolved, then what is the next step?

During the admissions process, it is crucial to give an accurate assessment of your family member. She is either appropriate for admission to the facility or not, and if not, it is best that she not move into it. Although it might be difficult to describe her weaknesses, you will be increasing the chances for the staff to assist your loved one adjust if they are aware of both her strengths and weaknesses.

Other questions will come to mind during your meeting. There is no such thing as an unnecessary question. A responsible geriatric facility will wish to give you as complete a picture as possible.

Although the new resident is your family member, he/she most probably spends most of her time interacting with staff and other residents. You are a resource not only to your loved one but to the staff as well. Unlike you, they don’t see her within a lifetime of memories. Sometimes, residents will act livelier than usual around family members or more depressed. It is important to be part of the team and learn how she appears to non-family members. Both you and the staff have an opportunity to learn from each other.

The following items are presented for your consideration:

• Are there Care Plan meetings? If so, when are they and are you allowed to attend? Depending on the level of care, such plans are developed and cover specified periods of time. Each meeting evaluates prior plans and establishes a new one. They include both nursing and social services.
• Visit at different times of day and on varying days of the week. Not only do you meet more staff and gain insights into the facility at various times, but the staff possibly will be “on its toes” at all times, if it knows you could arrive unexpectedly.
• If your family member has a Living Will, make sure that the staff and the doctor agree with you and your family member about what constitutes “No Heroics”.
• Give your loved one the opportunity to make as many decisions for herself as possible. A sense of control over one’s life improves the quality of life. Similarly, do not talk about your family member in her presence in front of others. Give her the chance to speak for herself.
• Be aware of Fire Safety procedures, i.e. what to do in case of fire or fire drill.
• Relate to other families/residents with integrity. Confidentiality is a way of showing respect for the privacy of others. If you want to share a story about someone at the facility, then disguise any identifying information.

Even without talking to staff, an initial visit to a geriatric facility can yield essential information about the quality of life of its residents. Obviously, cleanliness will be easy to determine. The following questions will help you gather other data:

• Do the residents notice you, respond, and/or interact with you?
• Are the residents out in the hallways and congregate areas rather than in their rooms?
• What are the residents wearing? Bedclothes or day wear?
• Is the furniture accessible for persons with range of motion difficulties or does it appear to be there in order to make a favorable impression on visitors?
• Is it quiet or is there an appropriate noise level?
• Where are the dining areas and would your family member find at least one of them inviting? How well attended is it? Are there residents there with whom your loved one might feel congenial?
• Where are the activities and do the participants seem to be enjoying them? How well attended is it?
• Are menu’s and activities clearly posted and how would your family member relate to them?
• If appropriate, are there reality orientation components, such as the date, etc, positioned where the residents can see them?
• Does the staff notice you and if so, how do they interact with you? How do they seem to interact with the residents and other visitors as well as other staff members?
• When you look out of the windows, what do you see? Is it a view your family member would enjoy seeing on a daily basis?
• What do the grounds look like? Are they accessible and usable for taking your loved one on walks outside? What about the availability of seating/areas for outdoor visits?

Time of day and type of facility (level of care) need to be taken into account. However, the answers to these questions can reveal red flags to be taken into consideration when choosing a geriatric facility.

When you visit a geriatric facility, you are a guest in the residents’ home. Their world is a small one; the facility itself may be all they experience on a daily basis. Therefore, everything that happens there takes on an increased importance. You, as a visitor, are important. If you pass a resident without acknowledging him/her, you unintentionally could be giving the message that they are not worth acknowledging. A simple nod in a resident’s direction communicates that that individual matters. And that is good medicine.