One of the most challenging conversations I help facilitate as a geriatric care manager is to address the prospect of nursing home care among elders and the family members who care for them. Much of the discussion comes down to point of view and what a caregiver may find important versus what the prospective resident will find important. In future postings I will also talk about timing and when to consider nursing home care as an alternative to independent living and the options in between. Let’s first look just at everybody’s points of view for a moment.
An article that recently appeared in Seniors Housing and Care Journal compared the opinions of residents and families as well as state agencies on the quality of nursing home care across 89 nursing homes. We all appreciate that nursing homes are regulated, and that the state surveyors that monitor the nursing home quality of care in most states use a fairly standard report card. This report card is called the Online Survey, Certification and Reporting (OSCAR), and you access the report cards for any nursing home you may be considering in your own family discussions. Each facility whom you interview should make a copy of the most recent state audit available for your review.
The authors of an article I came across (“Where Allies Part Ways and Strangers Converge: Nursing Home Performance in the Eyes of Residents, Families and State Surveyors”) found some interesting differences and similarities in evaluations of nursing homes as each of these groups looked at quality. First, whether families or residents would recommend a nursing home was highly correlated with the ratings state surveyors gave to the residences. Residents and families also agreed in their relatively high ratings of “staff show respect” and “ensured resident safety.” At the other end of the rating continuum, both families and residents rated “numbers of nursing staff” lower.
The differences came when residents and families were rating what could be termed quality of life versus quality of care. Residents rated quality of life components higher than families did. Families rated quality of care higher than the residents did. I see two lessons here. First, how State Surveyors rate the facilities you or your loved ones may be considering as a future home will be a pretty good indicator of how home will feel to the resident. Second, when having the family discussion about a potential move, caregivers need to be aware that what is most important to them (quality of care) will not have the same importance for the loved one (quality of life). If you as a caregiver want your loved one to “own” the decision, it is important to keep a focus on quality of life in your discussions with them. I will be talking more about this decision process in future postings.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.,geriatric care manager Chicago, geriatric care Chicago