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My sister, who is in her 40s, had a stroke that left her with aphasia and paralysis on one side of her body, which left us finding a skilled nursing facility (or nursing home).  It is an arduous task.  With her aphasia there was so much to consider and with her age, there was even more.  The harder part was she only had Medicaid and she was in a state where none of us were living, however, we were close enough to keep a watchful eye.

Being that stroke is the leading cause of serious, long-term disabilities in the U.S., are higher for African Americans, 87% are ischemic, and the third leading cause of death, finding the best place for her was imperative.  Of all stroke victims, 25% are under the age of 65%.  Well, she fit a few of these statistics and she is still here.  I was her primary power of attorney so that was a heavy responsibility to take on.

When selecting a nursing home there are two items that are key:  preserving as much healthy mental health as possible and the level of competency and communication with administration, directors, social worker, and medical staff.  I want to share a bit of what I did to make her (and our) transition as successful as possible; and it did turn out successful.  Planning for her long-term care is not what I had plan on doing but it had to be done and we did the best we could.

Make sure you or someone you trust goes with you or for you to present an intelligent representation.  Not having money for private pay rooms should never equate to stupid.  The organized and more on point you are, the better off your loved one will be.

Here are the basic steps to successful placement:

1.Make sure you have about 12 pocket folders, a few packages of Post-Its, a few notebooks to record all conversations, visitation, and progress, and some paper clips and binder clips.  You will need them for all the forms from all the places.  All of this can be bought at the dollar store.
a.Organize your folders by facility/hospital and make sure you note the date you received, finished, and submitted the forms on your copy.
b.Always make 2 copies of any forms you have to fill out and make sure that both copies are not kept in the same house for safety sake.  

2.First, let the social worker give you a list to begin with and call each place to schedule a tour.  

3.Look at for comparing nursing homes for ratings and deficiencies.

4.List all your questions from personal hygienic care to therapy to visiting hours and, if you can print them out, so you can write all the answers on the paper as you are touring.
a.Some places have skilled nursing care as well as residential care and they may be in different wings.  Long-term and short-term care patients are normally on separate wings.

5.Do a thorough inspection from cleanliness to how the patients look, even the food.  Sometimes you will be able to taste the food.
(I had a resident tell me the place was a dump and not to bring my sister there!)
a.Outside of employee areas, if you cannot see a room (except a patient's room for their privacy), that may be a problem.

6.Sometimes you can talk to the residents and their families, but I would suggest doing that coming or going versus when the "tour guide" is standing there watching and listening.

7.Always look for safety devices, grab rails and handles and items that are easy to reach from their bed.

8.Ask about staffing levels on nights and weekends and when the RNs or Nurse Supervisor are on duty and how many doctors are assigned to the facility and when they visit.

9.Ask for an activities schedule and ask to see that room.  It is best when you see the room actually being used AND it is full.  Bingo is the favorite.

10.Make sure you ask about the process for reporting issues or complaints.

11.When you are finishing, gather family members that are to give input in the decision and go over your notes.  Rate the places in order and there are some "oh no, not this one" places that you may experience.

12.Have your top 3 and then your next 3.  Never throw your "oh no" places into the hat, they very well could be selected, especially when the only insurance is Medicaid.

13.Keep in mind location, distance, and accessibility for all who are important.

14.Before submitting your choices to the social worker...pray and get some rest.

After the selection, you then have to wait to be "selected and approved" by the facility.  I know that is frustrating.  Once your loved one is placed, then there is your maintenance of your loved one while in the facility.  Make sure that when they are moved, you or someone you trust, pack up their clothes and leave them with only what they need transport and know when they leave one place and arrive at another.  This is a whole other article in itself.

My sister is located at a place that ended up being one of our first choices but I will say that with Medicaid only, it can be a long and frustrating road.  Persevere and you will be fine.

If you ever have questions, email me at [Link Removed]

Ldenise, Your links have been removed, please consider upgrading to premium membership.


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