Contents

• Introduction
• The Case Example
• Managing the Practical Aspects
• Managing the Emotional Aspects
• What Formal Help Is There for the Transition?
• Resources

Medical Care

People who enter long-term care facilities must select a primary physician to visit them at the facility, and often this is the facility’s medical director. They may continue to see other physicians who have been involved in their care, but changes in medication or treatment must be coordinated through the new physician and facility’s nursing staff, who don’t have a history of working with the resident and family. Mr. M lost contact with Mrs. M’s previous doctors because he was worried that if he took her out of the facility to appointments, she would insist on going home, rather than back to the facility. Both of them had to develop new relationships with her new health care providers. Another source of stress for caregivers—particularly those who have learned how to manage complicated medical procedures or medication at home—is whether their family members are getting what they need when they need it. The unit manager reported Mrs. M’s blood sugar and weight to Mr. M each day when he visited, which helped develop a level of trust about her care.

Paying for It

The Ms were among the few who had ample resources to pay for care. Most families aren’t so fortunate—a major source of stress can be finding an affordable facility and identifying how to pay the bill. Medicare pays only for short stays in facilities for rehabilitation. Medicaid pays for about 70 percent of institutional care for older people, but “spending down” to qualify for Medicaid can take years, and some people find themselves in the difficult position of not having enough income to pay for care but having too much to qualify for assistance. Having more financial resources often allows more choice, but finding a suitable facility takes time and is stressful, regardless.

Visiting

The care manager helped the Ms find a suitable facility that was an easy drive from their home. Getting there, however, may be a large problem for any caregiver, because of the travel time, work schedule, expense, or lack of transportation. Caregivers often have to juggle their schedules to visit, decide how often to go, and fit this into the routine of the facility. Family members also may not know what to do when they visit, particularly if their family member has dementia.

Learning What Care to Provide

Early on, the CNAs explained to Mr. M that bringing incontinence supplies and personal care items would be cheaper than buying them at the facility. Because he visited daily, he could restock as necessary, and this was a straightforward type of care he could continue to provide. More frustrating though, he spent some part of every visit locating Mrs. M’s glasses and hearing aids and checking her clothing supply.

Planning and Advocating for Services

When Mrs. M entered the facility, Mr. M did participate in the care planning meeting and completed a lengthy questionnaire about Mrs. M’s habits and preferences. Although the discharge summary recommended physical therapy, he discovered that she wasn’t receiving it regularly. He was reluctant to ask about it at each visit—it seemed like nagging, and some days the unit manager wasn’t available. He found it easier to arrange for Mrs. M to have her hair done once a week in the facility’s beauty shop—something she had enjoyed when she was still at home.

Planning for the Future