What else do I have to offer? Nothing happens to me anymore. That’s the reality of getting old, and I guess that’s really the crux of the matter. I’m not ready to be old yet.― Sara Gruen, American and Canadian author, in Water for Elephants

The average cost in Maryland for a skilled nursing facility (nursing home) is between $85,000 and $100,000 per year. Scary figures. Sadly, they are not likely to start going down anytime soon.

From this writer’s perspective, everyone should investigate the purchase of long-term care insurance, possible veterans’ aid and assistance benefits, the possibility of helpful trusts, and anything else they can possibly think of to strengthen their position.  Talk with an elder law attorney about the appropriate time to begin your long term care planning.

If you or your loved one eventually requires nursing home placement, here are questions to help choose the best facility, though the situation is unfortunate.

Is the facility certified by Medicare and Medicaid?  How long has it been certified?

Does the facility have an Alzheimer’s unit or other special care area restricted to patients with special care needs?  Is the specialty unit separated from other areas of the facility?

How convenient is the location to family members and friends?  What are visiting hours?  Location is very important, because it can affect how often the patient is visited by family and friends.  Frequent visits generally will improve the patient’s mental and emotional well being, as well as ensure that quality-of-care issues can be addressed as problems arise.

Is the facility well lit, clean, safe and welcoming?  What diagnostic treatment facilities are available at the facility?  What bathing facilities are available and how is bathing handled when the person needs assistance?

What is the ratio of staff to residents during each shift?

What kinds of activities are planned each day for the residents?  A good activities program should have regularly scheduled events, such as a weekly movie or musical event – even if it is just a sing-a-long.  The facility should offer religious services, physical exercise activities such as dancing or exercise classes, bingo, educational classes and other social events.

Is there a library available for residents with large print and audio books?  Is there a small “store” for purchasing personal items, such as shaving cream, hair care products and snacks?

Is there a safe place for residents to enjoy outdoor areas, such as an enclosed garden?  Are plants, pets and other natural elements added to the resident’s environment?  Are residents taken to special community events and cultural activities?

Will the resident share a room or a bathroom with one or more other residents?

How are roommates and rooms selected?  If the resident is dissatisfied, can roommates be changed and how is that accomplished?

Can the resident bring some of his or her own furniture?

Current regulations mandate individual care plans for each resident.  How often is the care plan reviewed and changed?  What is the protocol for handling problems?

How are employees selected?  How are they screened for drug use, criminal records and other potential problems?  What is the turnover rate for skilled employees?  What is the turnover rate for employees who perform ancillary services, such as meal preparation and financial record keeping?

If there is a physician used by the majority of residents, what are his or her qualifications?  How often is the doctor on premises?  What is his or her bedside manner with residents?

Are meals served in a communal dining room or is each resident brought her meal in her room?  If communal, how are tables assigned in the dining room?  How long does it take for a meal to be delivered to a bedridden resident?  How does the food taste and how is it presented to the resident?  Is there a means of heating food that has become cold?

What financial information will the facility require during the admissions process?  Can the patient or his representative have copies in advance of all admissions documents and contracts for review?  How long does the process take?

What is included in the cost of care?  How are “extra” items billed?  Can laundry be taken off-premises and does this save the resident some costs?  How are prescription drugs handled?  What is the cost difference between a private room and a semi-private room?

If required non-emergency medical services are not available on premises (such as dialysis), how is transportation arranged?  What about transportation to other places, such as local stores and religious services?

In addition to the questions above, speak with the admissions director about residents’ rights, and how they are enforced in that facility’s culture.

I wish for you the happiest of holiday seasons, the love of friends and family, the remembrance of Christmases past, and the wonderful blessing of good health for the New Year.

Thank you for reading.  Stay Well.  See you next week.