Finding the right long-term care facility -- do your homework

Aging column by Dr. Michael Gordon (11-16-2001)
Reprinted with permission from the Toronto Star

It is one of life's difficult and heartbreaking decisions. You and your family realize that a parent or other aging relative requires the 24-hour care and supervision of a long-term care facility.

Hopefully, your family has sought the professional advice of a family doctor or social worker before reaching such a decision. Even more important, you have broached the subject with your aging relative and prepared him or her as best you can for the move.

It is not unusual during this difficult time to feel that you have "failed" by having to place a parent in a long-term care facility. You have not failed! Your care-giving responsibility does not stop after the move; it simply changes. You are still the primary caregiver and the most important person in your loved one's life. The facility move allows you to continue to care for the person you love in a way that ensures his or her safety and security while permitting you to continue functioning.

Before deciding on facilities to tour, it is important to understand the difference between a retirement home and a long-term care facility.

A retirement home is usually suitable for people who still maintain a level function that requires only limited assistance and not usually in the realm of personal care. Retirement homes are often excellent in terms of providing meals and social activities and some home cleaning and maintenance, so that the person does not have to worry about such matters. Some retirement homes may also be able to provide what is called assisted living. This means that, if necessary, enhanced personal care can be provided for a fee. Retirement homes are privately owned and operated as businesses. Waiting lists tend to be much shorter. To apply, you simply make an appointment with the administrator or health care staff at the home.

Long term care facilities (in Ontario, known as nursing homes and homes for the aged) are for people who need extensive physical and mental care, but are medically stable and therefore do not need to be in a chronic care hospital. They are also for people who need constant supervision and cannot live alone. Nursing homes are privately owned while homes for the aged are run by the municipality or religious or ethnic groups and are not-for-profit. Both receive funding from the provincial government.

One helpful source for information on choosing long term care facilities can be obtained from your local Alzheimer Society and from the web site: www.alzheimer.ca.

Placement is for long term care are handled by local Community Care Access Centres (CCAC), listed under that name in the phone book. There is no charge for the application process, which is funded by OHIP. Beds are limited and there is usually a waiting list for both private and not-for-profit facilities. You will be asked to list your top choices in order of preference on the application form.

How do you choose the "right" facility for your relative? Do your homework and tour as many facilities as you can. Compare environments and services of each facility. This will take time, but it's worth the effort and it's usually quite an eye opener.

Before you start your search, understand the level of care that your relative will need. Does your relative suffer from a dementia such as Alzheimer's? Does he/she wander, require heavy physical care, have urinary or faecal incontinence, or exhibit difficult behaviours.

Does your relative have ethnic or religious considerations that should be addressed or acknowledged in setting preferences? If there are several facilities in your area, look first for the one that has the "best fit" for your relative. Proximity is certainly a factor, but the best choice in terms of care and "best fit" may be farther from your home than you'd prefer - at least you know your relative will be well looked after.

Baycrest social worker Mona Munro recommends that when you are touring a prospective facility, you ask to be taken to another floor that is not on the regular tour so you can get a feel for the place and how residents are treated.

Mona suggests a checklist that includes the following:

Convenience and ease of travel to the facility. If location is important, make sure it is convenient for all family members and not just the principal caregiver.
Does the facility accept people with dementia? Some facilities actually specialize in caring for people with dementia and might be a better choice in the long run.
Does the facility appear clean and well maintained with good natural lighting?
Is it properly ventilated to minimize unpleasant odours?
Do residents generally look clean and content? Notice whether they are up and dressed and if they've been encouraged to wear their own clothes.
Look at residents and where they are. Are they engaged in any activity or just sitting passively?
Are any of the residents restrained? If so, ask why?
Ask to see the daily schedule of recreational activities. How often, who does them? Are there outings for residents?
Are staff members cheerful and willing to answer questions?
Watch how staff workers relate to the residents. Do they appear to be sensitive to resident needs or indifferent?
Is there a social worker available to consult with as needed?
What is the staff-to-resident ratio for various shifts?
What is the food like? Are there choices with each meal?
How does the facility control for infectious outbreaks?
Speak to families of other residents to determine what their experience with the facility has been. Family members who have good things to say usually reflect the quality of the institution.
Try and determine the organization of medical coverage and what level of medical care can be anticipated. It is common for long term care facilities to have limitations on the level and degree of medical coverage, but it is worth determining what you might expect to avoid unfulfilled expectations.

In the end you want your relative to receive the best care possible and live in an environment that is comfortable, bright, clean and safe. It may not be possible to have all your expectations fulfilled, but you should try and achieve the best fit possible and find ways to ensure that the care required will be met as effectively and humanely as possible.

Dr. Michael Gordon is Vice-President of Medical Service at Baycrest, a professor of Medicine at the University of Toronto, and a member of the National Advisory Council on Aging.

These columns appeared in The Toronto Star in 2001 and 2002 and are reprinted with permission.