Frequently Asked Questions
- Q. Why do most nursing homes have odors?
A. When you visit a long term care facility you may notice odors in the building. Although you did not specifically describe the odor, such as food odors from the kitchen, we will assume you mean those pesky odors of human waste that seem to be common in long term care facilities.
Often, the presence of urine or fecal odors may be indicators of poor quality of care. On the other hand, there may be factors present that many people do not take into consideration. First, is the odor "fresh" or has it been around for awhile? Is the facility experiencing an outbreak of the flu or other gastrointestinal disease?
Do you notice this odor only at specific times during the day? (i.e., shift changes, morning, after meals, etc.)
While there is not a single answer to this question, there are tell-tale signs everyone should look for. When you question the staff in a long term care facility and you get the same answer every time, you may not be getting the whole truth about the source of the odor. If you visit at different times of the day, and you consistently notice odors in a specific area
of the building, look around and see if there are dirty linen carts being stored in the hall. If you notice a particular resident with a persistent odor, it may be some form of disease process or that person's personal choice to refuse bathing.
If you feel that the care being provided is poor in quality, speak directly with the facility Administrator and Director of Nursing. If this does not resolve the problem, every state has an oversight agency that investigates complaints of substandard care.
- Q. Why can my mother not have her favorite hand lotion? She has been using it for years.
A. In most circumstances, it would be perfectly permissible for your mother to have her favorite hand lotion. However, in the long term care setting, there are certain regulations that prohibit any item labeled "For External Use Only" or "Keep Out of the Reach of Children" from being readily accessible.
While your mother may have all of her mental faculties, other residents may not. Many long term residents suffer from dementia and often do not comprehend that your mother's hand lotion is not mouthwash or toothpaste. It is the facility's responsibility to protect all residents.
- Q. When I visit my dad in the nursing home, there always seems to be a shortage of staff. Can you tell me why?
A. First, let me begin by saying that some homes do suffer from staffing shortages and may be reflected in the overall quality of care a resident receives.
There are "guidelines" established by each state which define the "minimum" staffing requirements for nursing homes. You might be suprised to find how low that number is when you spread
the requirement over a full twenty-four hour period. Generally, every owner of long term care facilities sets the shift scheduling in accordance with minimum standards. How this is accomplished is through
a process called distribution per patient per day - referred to as the P.P.D. The P.P.D. equates to the amount of time (in hours) that the entire nursing staff will be available to care for each resident per day.
A true indicator of the owner's commitment to quality will be reflected in the nursing P.P.D. If an owner sets the P.P.D. figure too low (generally, a P.P.D. below 2.90 in a skilled nursing facility should raise red flags) the
quality of care may suffer. On the other hand, if the owner sets the nursing P.P.D. too high, the owner may not be making viable or feasible business decisions. Defining the level of staffing is truly a balancing act for Administrators and Directors of Nursing.
- Q. Several years ago, my dad past away and mother continued to live alone on the family farm. Recently, we had to place mother in a nursing home due to her failing health. She is not rich by any means but the nearly $4,000 a month nursing home bill is wiping out her savings.
We have checked on her getting Medicaid, but the State says she does not qualify. She has too many assets. How can we afford to continue her care?
A. Unfortunately this situation arises too often. We must remember that Medicaid is a program that was designed as a safety net for our most impoverished citizens. This is the view that many states take in making Medicaid eligibility determinations.
On the other hand, many people believe that they should be able to keep the material things they have worked a lifetime to accumulate. This is especially true with the children of elderly parents. Many people think they are entitled to the inheritance that may be forthcoming.
Now for a dose of reality! Today, you are left with very few choices when it comes to paying for you mother's care. You can liquidate her assets, convert them to cash and utilize the money to continue paying for the care. There are some attorneys that have found loop-holes in the laws regulating the amount of assets that can be retained, but
each time a loop-hole is found, most states move rather quickly to close that loop-hole. More and more states are adopting legislation that allows the state to sieze the assets of an estate to help pay for health care cost.
Estate planning is essential in our long term care environment today. Assets cannot be transferred within three years prior to placement in a skilled nursing facility. One of the primary focus areas for functionalmed.org is a
redesign of the health delivery and payment system that does not cause families to "spend down" to a poverty level in order to receive care throughout life. We invite you to follow our quest.
Have a question for functionalmed.org? Click here to submit your question. A personal reply will be sent to you from a member of our staff.
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