>From: Naomi Meyer <[log in to unmask]> Subject: The Nursing Home
> Hello, all. I've been reading
>all the communications on the list, but I haven't written anything
>for a long time because I've been trying to deal with the Nursing
>Home admission of my husband, Dave, since January. After he was
>hospitalized for 2 weeks from a psychotic reaction to zyprexa, I
>came to the conclusion that I could no longer manage at home
>without help around the clock. If he fell, I was unable to pick
>him up by myself. I could not leave him alone at all. Since I
>have a job and for various other reasons, my only solution was the
>nursing home. We had more or less expected this -- Dave has had
>Parkinsons since 1972 -- and knew this might ultimately be where
>he would find himself.
My father (77/4) has been in a nursing home for about 2.5 months,
after a month's
hospitalization. An associate suggested caring for him at home, by
hiring
nurses' aides. This does not appear practical. Dad could probably
hire aides for
$9 or $10 an hour (including Social Security tax and benefits), but
this would
come to $1680 a week (168 hours for round-the-clock availability).
The nursing
home costs about $966 a week. Dad currently has one shift of private
duty
aides, who put him through range-of-motion exercises. I am currently
getting these aides through an agency, but this is expensive; since
it looks like
Dad will need long term care, I will probably look for some
independent
aides. 56 hours a week would add about $560, for a total of about
$1526.
(The only reason I have kept the agency this long is to get one
particularly
good aide for 40 hours a week, but she is taking the summer off.)
The primary consideration here is quality of care, not cost (Dad can
fortunately afford the nursing home and a private duty aide, at least
for now; he also has a 3-year nursing home policy that kicks in after
100 days). The nursing home has the following, which would not be
available at home:
-a registered nurse on duty 24 hours a day
-medical equipment for response to emergencies
-a lift for transferring non-ambulatory patients
-facilities for bathing non-ambulatory patients
-social activities during which Dad sees other people (at home, he
would
see only me and the nurse's aides)
It is very important to monitor the nursing home (or hospital) to
assure
quality of care. I visit Dad, not only to see him, but to make sure
the
staff is taking care of him properly. The private duty aides also
report
to me when something has not been done, and I make the nursing home
aware of it. This is apparently one of the better places in the area,
but
they still miss things; e.g. my father's dentist thought his teeth
were not
being cleaned properly. I informed the home verbally and in writing
that
Dad's teeth were to be brushed and flossed daily, and I supplied an
Interplak toothbrush for this purpose. (You also have to keep an eye
on
the hospitals; I arranged the private duty aides because I did not
think
the hospital staff was caring for him adequately.)
The home, however, is not giving him physical therapy (he did not
respond to it, so the therapist discharged him). This would
apparently
be a problem anywhere, though, due to Medicare restrictions. The
therapist did train the private duty aides to give Dad range of
motion
exercises. The doctor may try to get physical therapy for him again
in
a few months.
In retrospect, I think it was a mistake for Dad to stay at home for
as long
as he did. We wanted to avoid the cost of a personal care residence
(about $18,000 a year), but there would have been people around all
the time. We were hoping to rely on taxicabs to get Dad to social
activities, but his walking became so poor that he hardly dared step
out the door (even with assistance, and a side rail).
-Bill
