Long-Term Care Planning: Nursing Homes and Assisted Living Facilities Your Step-By-Step Guide to Choosing a Home, Not an Institution www.hippofleming-ep.com Jeff Fleming, JD, CFP, CLU, ChFC, AEP, LUTCF of Hippo Fleming & Pertile Law Offices Estate Planning Attorney
Introduction As the Baby Boomer generation ages, more and more Americans are approaching retirement age and beyond. As this generation ages, many will encounter medical problems and other aspects of aging that may present the need for long-term care. While many of our nation’s elderly choose to remain independent, living in their homes with the assistance of family, friends, and even home healthcare workers, for many of these folks, moving into a nursing home or assisted living facility is the safer and more practical option. These facilities offer 24-hour supervision and medical care in a residential setting – a smart choice when athome options are limited or non-existent.
Searching for a nursing home or assisted living facility – for either yourself or a loved one, can be cause for trepidation. It is not an easy decision to move from your own home and into a residential situation, nor is it an easy choice to place a loved one in such a facility, even if it is in their best interest. Many other concerns exist as well, such as costs and quality of care. Moreover, with the number of nursing home horror stories floating around, it is © 2013 by Hippo, Fleming & Pertile
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understandable that opting for long-term care in a nursing home or assisted living facility is a difficult decision. Yet, with the right guidance and planning, it can also be a decision you will not regret. Once you have made the decision to seek this type of long-term care, it is time to decide which facility to call “home.” This step-by-step guide provides a fail-proof plan to help you choose the right facility.
Choices, Choices: Narrowing Down the Options Whether you live in a small town or a large city, chances are you have several nursing home and assisted living facilities in the immediate and surrounding areas from which to choose. Not all long-term care facilities are created – or operated – equally. Therefore, it is important to compile a list of options and begin narrowing them down based on your needs, preferences, and thorough scrutiny. Do not settle for a nursing home or assisted living facility simply because it is nearby or the price is right. Basing your decision on these factors alone could prove to be a regretful decision. Even if you have to pay a little more than you wish or have to drive a bit further, choosing a facility because of its proven reputation and superb offerings will make the sacrifices
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worthwhile. After all, you are seeking a new home, not an institution.
How to Narrow Down Your List: A physician or geriatrician can help you to determine the level of care needed, hence, determining the type of facility you should be looking at. Costs. You do not want a cut-rate facility that cuts corners and offers a poor standard of care. However, costs are important, so determine what you can afford based on your income, insurance, and any other coverage or assistance you may have, and compare facilities to determine which options fit into you budget. Location. Do not choose a facility because of its close proximity to your home or a loved one’s home. Even if your chosen facility is a little farther away than you had planned, it is far better to choose a stellar facility several miles away than to choose the low quality facility next door. Once you have a list of facilities fitting these basic criteria, it is time to dig a bit deeper to find the perfect fit for your long-term care needs.
Do Your Homework
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Check into the reputation of each facility you are
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Do Your Homework Check into the reputation of each facility you are considering. Ask for recommendations and reviews, but do not stop there. Check with your local health department and your state’s Department of Aging, as well as other regulatory authorities to see if any of the places you are considering have developed a bad reputation. Remember that a rare or occasional incident comes with the territory. What you are looking for is a pattern. If you do find such a pattern, cross this facility off of your list and move on.
Red Flags: Repeated incidents/claims of abuse or neglect Citations for any kind of hazards or unsafe environment Lack of cleanliness Medication errors/incidents An unusually high number of deaths, especially in a short period and any that are deemed questionable Wrongful death lawsuits
Ask and Observe Once you have narrowed down your options and have settled on
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a few acceptable faculties, it is time to visit those places to determine which would be the best home environment for yourself or a loved one. Visit the facility, take a tour, ask questions, and get a firsthand view.
Interview The nursing home or assisted living facility administration interviews prospective residents and/or their families. You, too, have the right to interview them. Prepare a list of both general and specific questions you want answered and ask away.
Ask Staff licensing and training requirements Staff turnover rates Accommodations and costs Resident safety and security Meals/menus On-staff or on-call doctors, psychologists, therapists, etc. Religious services or availability thereof(if applicable) Activities Any other questions you may have – do not be afraid to ask
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or allow any question, big or small, to go unanswered. Focus Watch the staff in action. How do they interact with the residents? Are they caring and compassionate, putting the residents needs first or do they react with some level of annoyance, impatience, or rudeness? Is the staff staying on-task or is there a lot of side conversation and inattention to their duties going on? Watch for call lights, located above or beside resident doors. Do they remain on for long periods or are they answered promptly? Are any residents in need of supervision left unattended for long periods? Does the facility look and smell clean? An occasional mess or odor is to be expected, but there is a big difference between that and built-up filth or the pervasive smell of urine, feces, and body odor. Are the nurses hands-on, or do they leave every aspect of patient care, aside from medication, up to the PCAs and CNAs? Nurses should be just as willing to get their hands dirty as any other member of the staff should. © 2013 by Hippo, Fleming & Pertile If possible, watch the med cart. Does the nurse or med tech prepare the
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dirty as any other member of the staff should. If possible, watch the med cart. Does the nurse or med tech prepare the medications prior to entering a room, and do they leave the med cart unattended in the hall? This is another huge red flag that signals patient danger and potential problems with the staff. A med cart should never be left unattended and unlocked in the hallway. The nurse or med tech should keep the cart with them at all times; including pushing it into each room they enter. Meds should never be prepared in advance – this can lead to contamination and medication errors. Some nurses and med techs tend to become too comfortable and trusting, leaving their med carts unlocked and unattended. They also begin thinking they “know” their residents’ medication regimens and can prepare in advance. This often results in failing to administer new medication orders or to discontinue discharged orders. In addition, even if the med cups are marked, it is still easy to grab the wrong med and give it to the wrong patient. And an unattended, unlocked med cart is an invitation for medication theft, especially by staff members with substance abuse issues. © 2013 by Hippo, Fleming & Pertile
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staff members with substance abuse issues.  Capacity. What is their legal resident to staff ratio, and does it seem as if the facility may be short-staffed? Many facilities often encounter shortages, but if the ratio is way off, this is a huge red flag that can result in lowered standards of care, burnout, abuse and neglect, and desperately poor hiring practices.  Observe the residents. How do they interact with one another? Is there a lot of conversation, smiling, and laughing? Do they interact well with the staff overall? Do they seem happy, especially when dining, participating in activities, or just conversing as they would in any place they called home? Are there plenty of visitors to the facility? Following these simple steps will help you to carefully consider your nursing home or assisted living facility options, and to find the perfect facility that you or your loved one can gladly call home.
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About Jeff Fleming and Our Law Firm Jeff is a partner at Hippo, Fleming & Pertile Law Offices and focuses his practice in estate planning, elder law, and estate and trust administration. He received his undergraduate degree from Washington and Jefferson College (1983) and his law degree from the Duquesne University School of Law (1990). He is admitted to practice law in PA. Jeff has also been providing for his clients’ insurance and financial services needs for over twenty years and owns V.I.P. Financial Group, LLC, an independent financial services firm in Altoona, PA. He is a Registered Representative and an Investment Advisor Representative with 1st Global Capital Corp. He is also a life insurance producer and qualifying member of the Million Dollar Round Table. Jeff co-authored a book titled Guiding Those Left Behind in Pennsylvania, 2nd Edition, published in 2006. His estate planning articles have also been published in a number of magazines and newspapers across the country. He was a Contributing Editor for Planet Newsletter, LLC and regularly wrote articles for the publication. He has also served as the lead instructor for the Society of Certified Retirement Financial Advisors and as the Money Insider for www.ThirdAge.com, a website providing resources relevant to the lives of individuals age fifty and older. Jeff is a member of the National Academy of Elder Law Attorneys and of the American Academy of Estate Planning Attorneys, an organization which promotes and fosters excellence in estate planning. He is also a member of the National Association of Estate Planners and Councils, the Blair County and Pennsylvania Bar Associations, and the National Association of Insurance and Financial Advisors. Jeff was the first elected president of the Blair County Bar Association and received the County Bar President’s Award for his outstanding leadership. He is a past president and national committeeperson of NAIFA-Pennsylvania, a past president of the Altoona Area Association of Insurance and Financial Advisors (AAAIFA) and a past chair of NAIFA’s Young Advisors Team (YAT). He also served on the board of the Allegheny Ballet Company in Altoona, PA. Hippo, Fleming, & Pertile is dedicated to providing you with quality estate planning and elder law resources, so you can become familiar with all of the existing options. When you visit or call our office, we want you to feel comfortable discussing such an important issue concerning both you and your family. We want to arm you with the information you need to make an informed decision about your family’s future. Long-term care planning is often an integral aspect of estate planning. If you need assistance with your estate or long-term care planning, you can reach us at: Historic Central Trust Building 1218 Eleventh Avenue P.O. Box 550 Altoona, PA 16603 Phone: (814) 943-5500 Fax: (814) 943-7656 jeff@lawandmoneymatters.com
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