This is the thirty-eighth in a series of articles intended to demystify retirement living options.
Previous articles mentioned that you can read your loved one’s medical chart and participate in care planning conferences. This article offers additional suggestions about how you might get -- and keep -- yourself in the loop.
First, ask a knowledgeable member of staff (typically a nurse) to tell you what records and care plans for your relative are maintained outside of his chart. For example, it is customary to weigh residents once a month. It is easier for the staff to record weights for 30 people on one piece of paper, rather than haul 30 resident’s three-ring binders down the hall to the scale area and record the weights in those 30 different binders.
As a result, they may have a notebook that has one page per month and lists everyone’s weight on that page. As another example, aides typically care for several residents. They may have care instructions for all the people they take care of printed out on one piece of paper, instead of having a separate page for each resident. That’s more convenient for them, and saves on printing costs. But those instructions won’t appear in your relative’s chart.
Thus, it’s useful to ask what records are grouped by record type (e.g., weight) or staff member or shift (e.g., care instructions), and ask how you can get copies of those records as they pertain to your relative. If anything in those records seems out of place, ask the staff to confirm that they are the notes for your relative. Because the records are grouped by record type instead of by resident, it is easy for a mistake to be made and for you to be told information that belongs to a resident other than the one you are asking about.
Second, read the resident’s contract with the facility. This should be available when the resident moves in; at times, it might not be available for about two weeks. Look for care that is described as excluded from the contract. You might think that the daily or monthly fee would cover all routine medical care for a resident in a nursing (long-term care) facility. But that’s often not the case.
For example, the contract for one continuing care community (which offers all levels of care from independent living to skilled nursing) notes that the resident is responsible for paying for refractions done during eye exams, glasses or contact lenses, podiatry (foot care), hearing tests and hearing aids, dental care, psychiatric care, treatment for addictions, dialysis, most durable medical equipment, and anything that Medicare won’t pay for.
Faced with such a list, it would be reasonable for you to ask how arrangements are made for periodic eye exams, new glasses, dental care, and so forth. Because these fall outside the scope of the facility’s responsibilities, arranging for these items may easily fall through the cracks, so it is important to agree on what care is needed and then check to make sure that the care is being delivered as intended.
Third, ask if the facility has a family council – a group of family members of residents who get together periodically to share experiences, learn from each other, and get support for the difficult task of being the responsible party for a family member who is no longer able to handle his own affairs. If a council exists, attend at least one or two meetings to see if you can learn from others’ experiences. If such a council doesn’t exist and the idea interests you, one option is to propose such a council, understanding that you might be asked to lead it.
Fourth, get to know the people involved in caring for or making decisions about your relative. Keep track of their names. Get their business cards if they have them. Note their phone numbers and email addresses, if they have them. A great deal of information about residents is communicated among staff members orally, so sometimes the only way to find out what has been happening with your loved one is to talk with the staff.
Next week’s column will discuss what happens if you run into roadblocks.