Choosing long-term care

As a caregiver the responsibility of placing a loved one into a facility is a major decision not to be taken lightly. The decision to place a loved one into care has an emotional and economic impact. What the caregiver has to determine is your parent struggling to live alone in their home? The family or agencies that support your loved one may notice significant memory challenges, or their inability to manage the day-to-day creating a concern about their safety and care living at home. Now the emotion and family conversation occur about what and how do we support mom, dad, and/or spouse? The moment the need for additional care becomes the moment a series of questions need to be addressed by family while getting outside support to manage the best decision possible.

The questions are finding a long-term care home for your loved one. Where do you begin? The questions are complicated especially for Black and Hispanic families who do not typically place their family in care. “Health care utilization and, in particular, nursing home use varies by race and ethnicity. Blacks and Hispanics are less likely than Whites to use nursing home care despite having a greater need. Therefore, Blacks’ and Hispanics’ lower use is likely due to factors above and beyond need,” reports the Claude Pepper Center in 2021. Yet, as Black families are now 15% and Hispanics are 6% to those of Whites that are 75% in care. The fact is people of color placing their family members in care is on the rise yet still small enough to encounter inequities in healthcare. So, what are your options?

The next step is to contact an agency that can address some of the questions a family may have to make the best decision for their loved one and all concerned.

Locally serving the Cincinnati area your local long-term care ombudsman can help. Located within the nonprofit organization Pro Seniors, the ombudsman office can provide advice for the five-county area in Southwest Ohio—Butler, Clermont, Clinton, Hamilton, and Warren counties. Visit our website www.proseniors.org (Home Options – How to Select) or call 513-458-5518 to set an appointment to speak with an ombudsman specialist at Pro Seniors.

When you speak to the ombudsman, they will help educate you on available online search tools to narrow your options, key questions about quality of care and quality of life, understanding levels of care, and how to pay for long-term care. As part of a nonprofit and part of the state and federal Long-Term Care Ombudsman program, we do not charge for our services, and they do not receive commissions or other payments from long-term care providers for our advice.

Dementia and the African American community

African Americans are often at higher risk for Alzheimer’s and other forms of dementia, which can result in someone entering assisted living or nursing home care. Among Black Americans age 70+, 21.3% are living with Alzheimer’s high blood pressure is thought to be a contributing factor. “While older Black Americans are twice as likely as older Whites to have Alzheimer’s or another dementia, research hasn’t yet identified the cause. Higher cardiovascular (heart and blood vessels) disease rates may play a role. Some studies indicate that after correcting for overall health and socioeconomic status, these differences disappear.” (source: Alz.org)

Blacks and Hispanics are less likely to place their family members into care. As a caregiver, I elected not to place my mom into care unless for a short time such as respite or recovery when needed. In my experience the family member has to weigh what they can manage emotionally and financially when making these care decisions. It is important to note that all facilities are not equal, and many considerations need to be considered such as staff-to-patient ratios and the quality of time given to each patient. No matter if you place a loved one into a facility it is still necessary to manage their care strategically and daily.

One of the first decisions in choosing care is understanding the level of care needed. Memory care services can be offered in an assisted living setting or a nursing home level of care. Is help needed with showering, toileting, eating, dressing, walking, transferring to or from the bed, wheelchair, toilet, or taking medications? These are known as Activities for Daily Living (ADL). With one or two ADLs assisted living might be an appropriate level of care, but with three or more ADLs it’s likely a nursing home level of care is needed.

Next, your ombudsman can point you to public information about the past performance of a provider and show you how to compare based on your loved one’s needs. Those providers that hold themselves out as specifically providing “memory care” must meet certain state requirements as a certified memory care provider. In assisted living, for example, these include:

• Single-occupancy resident unit.

• At least three therapeutic, social, or recreational activities a day for individuals designed to meet individuals’ needs and preferences.

• Ensuring safe access to outdoor space for individuals.

• A sufficient number (20% greater than standard assisted living) of registered nurses (RN), or licensed practical nurses under the direction of an RN, on call or on site at all times for individuals receiving memory care.

A nursing or assisted living home visit is an essential next step. The ombudsman will arm you with key questions to ask. Visit in the evenings or weekends, when staffing is sometimes lighter. Observe how the staff treat the residents. Are the floors clean? Any unpleasant smells? Is there a calendar posted with resident activities for every day of the week? Visit during mealtime. How does the food look and smell? How responsive is the staff to call bells and requests for help? Don’t be afraid to approach residents in a common area and ask them about their living experience at this home. Remember, there is still bias in healthcare. National Institutes of Health (NIH) conducted research and “uncovered racial disparities in nursing home care, possibly due to unconscious bias, systemic issues, and other circumstances. These inequalities present a serious public health problem that deserves attention.

“The consensus from the existing literature is that minority [residents] do not receive nursing home care of comparable quality to white [residents].”— National Institutes of Health (NIH)

The actions of the family and caregiver are profound when making healthcare decisions. Here are some helpful tips when considering transitioning anyone into a facility:

1. How many aides to patient ratio. How many aides are on staff for every patient for all three shifts to accommodate patient care.

2. How often are patients bathed, cleaned, or assisted in hygiene functions.

3. What is the racial makeup of the facility, patients, and workers.

4.How many full-time aides to temporary aides, nursing staff are within the facility.

5. Have there been incidents of unsafe actions that led to harm to patients or a lack of safety in their environment?

6. What are the facilities safety and maintenance protocols. Unclean rooms and areas can lead to health problems.

7. How often does the doctor visit the facility? What is the turnaround time on labs, medicines, and return phone calls to families?

8. If a family has its own services, how can the family opt out of certain services that may have a price tag attached?

9. Review the payment structure and who is responsible for what bills such as private pay versus Medicare/Medicare or insurance.

10. Before you choose a facility, assess the asset transfer. Review the 5-year Medicaid asset transfer and the exceptions to the Look-Back period.

When placing someone into a facility do your due diligence. Pro Seniors is one step to answering some of the important questions all families need. For more information on how to select long-term care, visit our website (www.prosenior.org/LTCO/Home-Options) or call 513-458-5518 to set an appointment with an ombudsman.