My mom moved into a nursing home last week. Leaving her there “alone” was the bravest thing I’ve ever done. It felt like I was leaving her life in the hands of strangers…and I was. It was a heavy day. A move to skilled nursing isn’t a decision anyone takes lightly. You can be sure my mom wasn’t excited to give up her furniture, her high rise view, or her one bedroom apartment for a glorified hospital room. So how did we know it was time for a move to a nursing home?

How do you know it’s time to move to a nursing home?

In our case, several factors converged to make it (more or less) clear that it was time to move my mom to skilled nursing.

• Expense Last year, we crossed the “red line” of home care: it became more expensive to care for my mom at home than in a nursing home. She needs help with many daily activities, so we hired caregivers to help her. She also needs help managing medication and diabetes care, so we hired nurses to help with that (home health care workers are not licensed to provide medical care.) Add wellbeing checks several times a night, and next thing you know, we were basically running a skilled care unit out of apartment 32L. At great expense.
• Small changes My mom had extensive care at home, and she was “stable”. Yet there were small changes this year that made us think it might be time to move to skilled care. She had become a little less steady on her feet, and a little less able to assist her caregivers with transfers. It made me consider what would happen if she needed more than one person to help her move. I knew for sure we weren’t going to be able to manage that at home.
• Demand for Skilled Care After my mom’s 2016 hospitalization and the stress that dogged me through her recovery and eventual return home, I realized her next move was going to be to a skilled care facility. So I researched senior living communities in our area to see which ones might be a fit, toured several, and applied to the waiting list at one of them. There were five people on the list. One year later, there were four people on the list. Another facility that we liked had a waiting list 12 deep. In our market, private-pay, long-term skilled care is not always available “on-demand”. There are waiting lists. In some facilities, beds are reserved or prioritized for residents of the affiliated continuing care community. If we needed to move in a hurry, my “plan” wasn’t really a plan. And I really didn’t want to move in a hurry anyway! 

Assisted living vs skilled nursing?

Even with these signals, it wasn’t completely obvious that skilled nursing was the right choice. One of my brothers thought assisted living might be an option. This was a nice idea because then she could be cared for in a more “home-like” setting.

Assisted living facilities typically do an evaluation prior to “accepting” or qualifying someone to live there. The evaluation also determines what “level” of care someone needs. (Each tier of care in assisted living will include different services and have a different price.) These evaluations differ by the facility, and you probably won’t get a straight answer on whether your parent is qualified or not without going through the process.

One simple test to determine if someone is likely to be accepted to an assisted living facility is to ask yourself this question: if there were a fire in your parent’s assisted living apartment, would they be able to get to safety without help? This one question made it super clear to me that my mom was not going to qualify for assisted living.

Once we knew we were going to move to a nursing home, I had to find one with availability. The ones I liked were close to my home, but they didn’t have any rooms open. So I decided to look outside the city near one of my brothers. Once I relaxed the geographic constraint, I was able to find a place pretty quickly. The move was within 60 days of when we started the search (once again: this type of move is hard to do in a hurry!)

If you’re considering a move to a nursing home for your mom or dad, here are some tips to help with your search.

Tips for Finding a Nursing Home

• Trust yourself There’s a reason (likely several) you’re considering this move to skilled nursing. Avoid trying to label it a “good” or a “bad” reason. Once you make the decision to move, try not to punish yourself with guilty feelings or second-guessing games. You’re doing your best. Forget the rest.
• Use the right terms While many people use the term “nursing home” to talk about the level of care “above” assisted living, you won’t generally find a facility that refers to itself that way on their website. Using the search term “skilled nursing [city or neighborhood]”, or looking for those words on a senior living community website may help you find information faster.
• Constrain the search In areas with lots of choices for nursing home care, limiting the search can simplify the process. If there is a family history of dementia or you expect to need memory care at some point, look for a facility that offers that level of care (not all do.) If your parent wants to be near a relative, constrain the search to that area. You can always remove the constraints if this doesn’t help you. 
• Expect some ups and extras There will be a daily rate, and then there will be some other expenses. Ask for an “ancillary price list” which will include prices for things ranging from incontinence supplies to toothpaste. This will help you determine the “real” cost of care, and also show you very clearly what services are not included in the daily rate.
• Sign carefully Have a lawyer review the contract. While the contract may not be negotiable, an attorney can help you understand the implications of signing. An experienced attorney will also think of questions you didn’t know to ask. It cost us $275 to have someone review the contract. It felt like money well spent.
• Go before you’re “ready” Trust me: you want to make this move before there’s a crisis. Don’t expect to feel fully ready if you move before a crisis. Just know that you’ll have more — and better — options available if you do.

I know I didn’t feel ready for this move. While I had a hard time leaving that first day, since then something amazing has happened. Instead of saying “no” to activities as she did when she had her own apartment, she’s been saying “yes”. My mom participated in more activities in the past week than in the previous four years. She has more to say because she has more things to talk about. It occurs to me that in the weeks leading up to this move I spent a lot of time thinking about what we’d lose, and none about what we’d gain with a move like this.

I guess I underestimated those “strangers”!

Take care,

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