Articles by  Alice Reiter Feld

SENIOR HOUSING OPTIONS PART III - END OF LIFE

Nursing Facilities

 Nursing facilities are for elders who require skilled nursing care, monitoring and assistance 24 hours a day on a long-term basis. Usually these clients are quite elderly, need assistance with many activities of daily living and are also cognitively impaired.  Most Medicaid planning will be done for a nursing facility. Approximately 50% of nursing home bills are paid by Medicaid. Nursing facilities also provide rehabilitation services. About 5% of all persons over 65 live in nursing homes; 15% if over 85.

 One of the biggest complaints of nursing home residents is lack of staffing.  Other complaints include dehydration, poor hygiene, pressure sores and lack of independence.

 How does a family choose a nursing home? Note the interaction between staff and patients. How long have the staff been working there?  Ask a family member of a patient about the facility.  Is it clean and neat?  Are people attentive and friendly?  Taste the food.  Are there activities appropriate for your family member?

 Hospice

 Hospice is very misunderstood.  Hospice is care for the dying. It is a Medicare benefit.   Its primary purpose is to work with terminally ill patients and their families, providing physical, emotional and spiritual support for the patient and their family.  Hospice does not offer a cure and in fact does not treat the underlying decease.  Pain relief is a main part of Hospice care. Most prescription drugs are covered especially those drugs related to the terminal illness.

 Hospice care can be provided in a variety of settings.  The majority of Hospice patients remain at home. Hospice service is also provided in hospitals, assisted living facilities or nursing homes.

 Most Hospices have standard requirements for admission.  The patient must have received a diagnosis of a terminal illness with a prognosis of six months or less to live.  The patient must be seeking care and pain relief and not a cure.  Generally a “do not resuscitate order” is required.

 My experience is that Hospice is a very positive experience for the families, considering the circumstances. Most families are sorry they did not access it sooner. My further experience is that it is not unusual for a client to “graduate” from Hospice; that is to not die within 6 months as predicted!  Therefore, do not assume that death is imminent just because a client has opted for Hospice care.

 Conclusion

 Whatever level of care is chosen, it should be matched to the needs of the individual, and all available public benefits that will finance the cost should be explored.