Skilled Nursing Communities (Nursing Homes)

Many people with PD want to live at home for as long as possible. However, there may be important reasons why long-term skilled nursing care would provide a more suitable living situation for your care with PD.

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Although it is common to experience guilt and mixed feelings about transitioning yourself or a loved one to a skilled nursing facility, it can be the best option for the person with PD due to diminishing support from care providers, their physical limitations, or emotional health. Additionally, the household environment may not be the best option due to the layout of the home or the needs of other residents.

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Skilled Nursing Facilities (also known as nursing homes) provide the most extensive care of any other living alternatives. According to recent statistics, there are about 1.5 million Americans currently living in nursing homes. This may sound like a lot, but it does tell you that you're far from alone when deciding on when to move to a nursing home. It is never an easy choice, but in some cases may be the best choice.

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However, while a nursing home is a viable option, it isn't a good idea to immediately move into these facilities. Anything that is done at a nursing home can also be hired to be done in a home, and at a relatively lower cost.

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There are some advantages of at-home care that nursing homes can't provide. For one thing, you will be able to spend much more time with your family member. You can talk, play games, watch movies, and feel relaxed and loved in the comfort of your own home, and your care partner gets to stay in the comfort of the home rather than traveling so much back and forth between home and the facility to visit with you.

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At-home care provides a more comfortable and familiar environment to rest in and home care options can make your life easier and allow you to get the rest that you need and deserve, while also providing companionship and no visitation limits. It is also important to note that many skilled nursing facilities will encourage or require additional home care companions in the facility as well.  This is due to staffing shortages and the inability to care adequately for all residents. In this case, it could be more affordable to have the help at home without the additional expense associated with skilled nursing services.

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In-home care can provide you an alternative to nursing home care and is particularly a good choice when you are partially self-sufficient or when you have loved ones that can take over your care during some hours. Make sure that you do your research and consider this potentially more comfortable option before deciding on skilled nursing as an option.

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The reality is that if you cannot live in a safe environment in your own home, and you can't afford to hire the services needed in the home - a Skilled Nursing facility or Nursing Home may be your only option. This is particularly true if you become extra agitated, abusive, or have behaviors that can't be easily managed by your primary care partner or home care staff.

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5 Reasons You May Need to Consider a Nursing Home

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1. You can't take care of yourself: Some other signs that it is time to move to a nursing home may include:

   1. Needing help with eating, using the restroom, standing, walking, laying down, and performing personal hygiene routines.​

   2. No longer remembering to eat, bathe, or perform other important rituals.

   3. Become confused and forgetful, even in familiar situations

   4. End up in dangerous situations because of your confusion

2. Caregiver Burnout: When you need care from someone else, they will likely come out feeling drained and mentally unwell. After all, it's both physically demanding and emotionally grueling to oversee the care of someone you love when they're unable to do it for themselves. Making a nursing home placement decision may make your loved one feel guilty, but it truly is for your best interest. If you are unwell or unhappy, your mood will rub off onto your loved one and could further distress them.

3. Professional Care is Required: When professional care is required to ensure that you live comfortably, a nursing home may be a good choice. This is a completely valid decision because it allows you to get the opportunity for expert care 24/7. Nursing homes provide an established community that you can become a part of with hosted activities meant to keep you engaged.

4. Family Isn't Nearby: Jobs and other obligations may get in the way of providing care. If it isn't feasible to live near family and you wish to stay in your community, living where professional health is available 24x7 may be a better option for you.

5. You've Exhausted the Alternatives: While at home care is a more comfortable and generally a superior alternative to a nursing home, it can sometimes not be enough. After trying at-home alternatives, you may determine it is best to find a good community. When doing your research, look into the credentials of the professionals that work in the facility that you are considering. Also make sure that the reviews of the community are positive. You may even want to schedule a visit and make sure that the building is well-maintained and the residents are happy. 

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Even if you do not expect a transition in the near future, it can be a good idea to visit facilities before a move is required. Starting early will allow you time to get to know the skilled nursing facilities in your area in case you need to make a quick decision. Keep in mind that your options may be dependent upon factors such as availability or finances.

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Long-term care in a skilled nursing facility provides 24-hour assistance with advanced care needs. Staff assists with daily living activities and medication management. They also provide opportunities for social interactions and participating in recreational and wellness programs. Meals are offered in a group dining setting and housekeeping and laundry services are also included.

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You can schedule a tour for a skilled nursing facility where you can gather information about their services, resources, and costs. It is often helpful to take a family member, friend, or if financially feasible, an Aging Life Care Expert with you. You can find an Aging Life Care Expert in your area by calling 520.881.8008 or visiting https://www.aginglifecare.org/

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Placement services to help you determine the best facility for you or your loved are also available through: https://seniorplacementservicesllc.com/

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Questions to Ask a Potential Skilled Nursing Facility

Refer to the questions below for guidance. Try to make a second, unannounced visit in the evening or on a weekend. You may learn additional information that adds to your overall opinion of the facility.

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First Glance Considerations:

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• Is the environment in good repair, clean, and free of odors?

• Does the staff seem friendly and approachable?

• Can residents' access outdoor spaces? Are the outdoor spaces well maintained?

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Care Questions

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• What is the medication schedule? How can I be sure Parkinson's medications are administered on time, every time?

• What is the staff-to-resident ratio? Does this change during the overnight hours?

• Are there on-site rehabilitation services (physical, occupational, and speech therapies) and counseling services? If not, does the facility contract with an outside provider or can I hire one?

• In the event of a medical emergency, can I be taken to my preferred hospital?

• What kind of Parkinson's training does staff receive?

• How does the staff determine a care plan?

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Social & Wellness Opportunities

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• What spiritual and/or religious services are offered to residents?

• In what ways are residents lives enriched (music, therapy, art therapy, animal therapy, etc.)? Can I see an activities calendar?

• What programs provide cognitive stimulation?

• What types of fitness classes and fitness equipment are available?

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Dining Questions:

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• Can I see a food menu?

• Will you accommodate for my loved one's dietary needs?

• Are there snacks available and are they easily accessible?

• How does the staff accommodate special dining needs (diet, eating assistance and adaptive devices?)

• If you are unable to eat in the dining room, is there a charge for in-room meal service?

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Financial Questions

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• What are the monthly charges? Can I receive an itemized bill each month?

• Can additional services be added to my monthly bill without my permission?

• How often are grooming/salon services available on-site? What is the cost for a haircut, style, manicure, etc.?

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Some skilled nursing facilities will have a dedicated "memory care" section with security features that keep residents with dementia from leaving without assistance. Memory care staff are often required to complete state-regulated dementia training. Many memory care wings also offer a social and recreational program designed for people in various stages of dementia.

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Skilled nursing facilities serve residents with dementia in both the general and memory care wings, but the goal is to look for the setting that will best support you or your loved one. If feasible, visit various types of facilities nearby. While touring a non-memory care specific part of the building, try to gauge whether you or your loved one will receive the necessary support. For safety or interpersonal reasons, they may be supported more adequately in a memory care setting.

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See Memory Care  for additional questions to ask if your loved one is impacted by dementia or mild cognitive impairment.

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Disclaimer:  The Parkinson Association of Alabama (PAA) works to equip you with education and awareness to discern your own path. The PAA does not specifically endorse living at home or choosing to not live at home for advanced care needs. 

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Sources:

The Davis Phinney Foundation Chapter 15 - Long-term Care and Financial Planning. Every Victory Counts. Page 249. "Manual." Sixth Edition, 2021.

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