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What are the things that we should be looking for/into when considering a NH placement for very elderly parent with dementia and mobility issues? Has been cared for in home with 24/7 caregivers for several years. How to know that this is the best decision?

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Sometimes finances force a decision. If father cannot afford to continue 24/7 caregivers, then something has to change. Focus on making the best placement possible.

If it is financially possible to continue at home, and you want assurance that a move is the "best decision" I think you'll have to explain why you are considering the move.

In selecting a care center, location is important. If it is too far away for frequent visits that is a negative.

If staff have their own loved ones there, I take that as a good sign.

There is always high turnover in care centers, but if the center has a lot of long-term employees, I think that is positive.

Don't be too influenced by attractive settings. I'll bet dad would rather have friendly and compassionate care than a beautiful new building. (Not that you can't have both -- just don't give the setting a lot of weight.)

Will you be private pay? Does Dad want a private room? Is one available?

Look at the activities calendar. Is there anything on there that Dad might enjoy? Bingo? Live music? Movie night? Ask about how they encourage residents to participate. No one should be forced, but no one should be ignored.

My mother will eat anything as long as someone else cooks it and cleans up afterward. She loves the NH food. If your father is a little more fussy than that, look at the menus. Ask about what alternatives are available if he doesn't like the day's offering.

Here are some AgingCare articles on the subject:
https://www.agingcare.com/articles/checklist-to-find-a-nursing-home-for-elderly-parents-137428.htm

https://www.agingcare.com/questions/how-do-i-find-nursing-home-for-my-father-155070.htm

This is an emotionally charged issue. Try to work on it when you are feeling calm.

Keep us informed about how this is going for you.
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Other things to help your selection between centers will be asking questions like:
-what is the patient to aide/nurse ratio
-what kind of patients does the center accept (are there a lot of complicated wounds, behaviors, bariatric patients, tracheostomies, tube feeds etc). These will all take extra time away from your father and should be considered when looking at patient/staff ratio
-ask to see the citations the center was given by State surveyors.
-do the staff and patients seem tense or happy?
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Check if the nursing home is a for profit versus not for profit. My mother was in a for profit NH and all they cared about was the money. Go with the not for profit. Some NH have special floors for dementia and also ventilator patients. Make sure there is enough equipment for each patient. My mother was in a nursing home that didn't have enough chairs for the patients to sit in so patients were put into a chair every other day. Also check on physical therapy. The NH my mother was in refused to do physical therapy for after 6 weeks. She is now bed bound and needs extensive physical therapy in order for her to walk again. Do a google search as sometimes you can find reviews from families of patients. They can be more helpful than Medicaid/Medicare. Check out what hospitals the nursing home uses for patients that require a hospital visit. Vary your NH visits to different days and times. The more you know about the routine the better. One of the most important things I learned is to have a POA for your parent in place before your parent goes into the NH. There was an article the other day about NY NH who are having the patients signing over their homes and money to the NH without the knowledge of the family. The families now have to sue the NH. The premise is that the NH won't have to sue the patient for unpaid NH bills. Let them know that you have a POA. Good luck. I took my mother home from a NH after they were unable to wean her off the vent. After 8 months at home, she is now completely off the vent and the trach tube was removed as well. She is better now than when she was in the hospital. Good Luck.
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I concur with the comments above, especially the one about don't be overly impressed with a fancy building--care & staffing is so much more important! Also some new facilities are built in completely new setting--do you know what the building next door will be? Will that nice forested scene soon be bulldozed down for a big-box store, or strip mall or fast-food joint? Some people might like those conveniences, personally l would not want my view obstructed or look out on huge flat rooftops, or golden arches complete with french fry aroma.
The comment about for-profit vs non-profit is good, I would go further and say there's a huge difference between some in business for 50 yrs and are upstanding members of their communities (perhaps church-based but maybe not), and some who (if you research you can find out) is a bunch of investors who got together to build a money-making machine.
Also ask what plans are in place in case of building evacuation. If there's a hurricane, mudslide, chemical spill, etc, how do they plan to provide care in these situations?
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alot of good suggestions but staying at home may not be an option. Maybe the spouse isn't capable of taking care of their loved one, the stress on the caregiver is tremendouse (I know my mothers blood sugars were all over the place), maybe there is no other family member than can help (maybe they HAVE to work themselves). Not everyone that goes into a NH goes downhill. It depends on the family and how they make it a positive adventure. If a person is always down on everything and the OMG on stuff, sure negativity will take a person downhill. No one wants to go into a NH but you know what, I would rather be in a NH where everything is done for me and I don't have to depend on when my children can come help or have them put their lives on hold just to take care of me. Sure its not going to be all roses in a NH; there are pros and cons to anyplace you may have to go to. Even your own home. not everyone is a movie star or billionaire where you can afford to eat off a golden/silver spoon or have a servant for each thing (eating, changing, washing, etc) than you deal with what you have and be thankful. sorry nothing intended against anyone. Its just you can't always look for the negative because you might pass up the good things.
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I keep reminding my Mom it's MC, Not NH for dad!! Somehow that makes it sound better.... She was fixated on the old school thoughts of a NH, and dad's place is nothing like that. We know it;s not home, but it may be better. Yes we wish it was less expensive, but he is getting better (less stressed) care. He is only on his first week, and stuck in the AL part with a companion as the MC is closed for a GI bug, but I think once he is in the MC it will be even better! The staff is great and they have called once a day (even though we visited) to let us know how he is doing, and he looked great when we visited today. So visit, get a feel for a place.. and make the leap if you need to. You can always change your mind.. that is why we a doing a month of "respite care" to get used to the idea. Also, if we looking into full time care instead of the few hours a week we were using.. HC was actually going to cost more
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Regarding "home food tastes better than anywhere else": My mother has said all her life "I don't care what the food is. As long as I didn't have to cook it and cleanup after it, I like it!" And indeed she really likes her NH food. When I visited my aunt in her care center and asked her how she liked it the first words out of her mouth were, "The food here is very good." Another aunt in a care center also loved her meals.

Just pointing out that not all old folks hate the institutional food.
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They told us Dad had a big breakfast today.. he has never been picky! and when I look at the 4 course menu I freaking want to eat there!! Mom did not like the rehab food because she was on a special diet... but Dad eats everything!
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My father was private pay in two nursing homes in two different states. Both of them neglected and abused him. The first one turned him into a zombie with three antipsychotic drugs given simultaneously. When he was in a NH near me, I visited him at least once a day every day. (I wanted him in my home, but my husband would not agree.) I was so upset with what happened in his nursing homes that after my father died, I wrote a book about this journey with him, Before the Door Closes: A Daughter's Journey with Her Alcoholic Father. Please become informed before you make this life-threatening decision for your loved one.
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samara,
re ; the ' coffee '
i think its pencil shavings and black - ish ink .
my NH advice is ; let the staff know you are listening closely to the patient , relay the patients concerns to the staff but dont argue with them or try to push them around . they are generally following age old protocol and you are the one in the ' learners ' seat . try to be a team player and an asset to the patient and staff .
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