Families face tough decisions about nursing home

CLAREMORE, Okla. (AP) -- One of the most agonizing decisions many people face is -- if or when -- does a family member go to a nursing home.

LaShan Smith, Rolling Hills Care Center social services director, strives to make that decision as easy as possible.

"Some families still harbor a sense of guilt for having parents in a nursing home," Smith said.

She likes to tell the story of an unhappy resident who left and went back to her home.

"Then she came back saying she wanted her kids to enjoy the rest of their lives.

'"This is where I need to be,' she said. She accepted placement, does well. She made the decision to return on her own and has a great attitude."

Smith believes her calling is working with the elderly. She has worked in hospitals, home health and nursing homes, but finds the most satisfaction where she is now.

"People ask where I work, then ask 'isn't that depressing?' No, it's not depressing. I learn so much from them (residents)."

Her comfort level is obvious as she walks through the care center. She gets and gives, smiles and hugs.

"You build trust. I feel bad when I get caught up in paperwork and can't be with the residents," Smith said solemnly.

She came to Rolling Hills about a year ago and has more recently been responsible for the entire admissions procedure.

She knows all about the residents before they move.

The procedure for admission starts with a call from a family or hospital.

"We assess the needs to see if Rolling Hills is the proper place," Smith said.

Rolling Hills offers three levels of care -- regular interim care, skilled nursing or the Alzheimer's unit.

Families receive a packet of information about the facility and information that needs to be addressed ... "a lot of background history many may have never thought of."

Families and the nursing home work with caseworkers and physicians.

Finances, Smith said, is always the biggest concern. Medicare pays for hospital and medical service, Medicaid assists with room and board charges. There is also private pay and long-term insurance (which few people seem to have).

Smith provides families with a contact person in the Department of Human Services if financial help is needed.

There is strict criteria, according to Smith, for DHS aid, "especially for those under 65. Income and asset guidelines are considered. There is special consideration if a spouse is still independent and needs benefit of the couple's income."

From whatever income a resident has, they keep $50 each month for their personal needs.

Cost is generally $83 a day for semi-private, $105 for a private room. That includes basic cable television hookup and laundry.

Smith's top priority is health, safety and happiness of the resident.

"One of our priorities is to find a compatible roommate. We talk to the family and patient about likes and dislikes. They can change rooms any time."

Extensive background information is part of the admission process from a personal history to food preferences and sleep habits to mental status and funeral home choice.

"Is it an only child or big family with brothers and sisters, children and grandchildren coming to visit often. We ask about how they grew up, their marriage, their children, spiritual preferences, work history, anything we can do to make them more comfortable in their surroundings," Smith said.

"When I'm asking, I think, do I know that about my mother and father, my grandma? I didn't but I tend to ask my family more questions now."

Residents can personalize their room with things from home, pick their own decor while still being a safe environment. All personal items are labeled and recorded to alleviate missing items and confusion regarding ownership.

When a resident is making a move from a hospital, Smith talks to discharge planning at the hospital to be sure all the physical and social needs are met so the stay is comfortable.

Smith works closely with Sue Barnes, social activities director, on doing what patients like ... "bingo, have they always done arts and crafts? "Sue has special Alzheimer's training. Activities are a big issue. They (especially Alzheimer's patients) need a routine, stability in their life."

Tina Lewis is a new activities director in the Alzheimer's unit and works with Barnes.