Transition to Care

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Transitioning to a nursing home, professionally known as a Skilled Nursing Care center, can be an exhausting, emotionally challenging process. Your first few visits may be uncomfortable. Your loved one may be angry with you or you may feel guilty. Allow yourself some bad days. You both will need time to adjust. Lean on center staff for support. Talk with the center social worker if you feel the bad days last too long.

Transitions are usually easier to manage when you know what to expect and how to help a loved one feel more at home. View tips on successful visits, handling negative comments, information on outings, and recommendations on staying in touch below.

What to Expect

As each day passes, your loved one and you will feel better about your care decision. Knowing what to expect can help you both through the first day, week and month. As you and your loved one prepare for the move, take some time to plan out the time after you leave the center on moving day. Maybe you’ll want company. Maybe you’ll want to know others can be available for a phone call. Be prepared for different options. You may want to ask family and friends to be available, just in case. If you invite family to your home and realize that you’re not up to a visit, be honest and let them know.

The First Day

As with any move, the day your loved one arrives at the Skilled Nursing Care center will likely be hectic and exhausting. Care transitions are not only physically taxing, they also take a notable emotional toll. It’s a tough day, but remember, there are brighter ones to come.

If you were providing in-home care, you may be at a loss as to what to do. It may feel odd to have time on your hands. You may feel like you’re banging around an empty house. Have a few books ready to read on the first night, including When Love Gets Tough: The Nursing Home Decision by Doug Manning. Relax with some music or turn on a movie that makes you laugh really hard or cry. When you can, sleep. And know that you’re doing your best.

The First Week

The first week may be a bit confusing for both you and your loved one. You’re getting used to a new routine, a new schedule, a new way. You may feel like you’re navigating life without a map. Staff can help you adjust. If you’re not sure whom to ask for help, ask to speak with a social worker.

Your loved one may make negative comments. Care Conversations™ can help you address any issues. Your loved one may say he or she wants to go home. Acknowledge the desire. You might say, “I know, Mom. I wish you could too. What’s hard for you today?” Then listen. If you have a suggestion, share it but don't force one. Listening often can be the most powerful solution. If your loved one begins to cry, just offer comfort and a hug.

After your loved one has had time to express feelings, say, “I appreciate you’re making the best of this. I think we make a great team.” You also may want to redirect with a suggestion, such as “Let’s take a walk down the hall” or “Let’s get a cup of coffee.”

The conversation about going home will tug on your heartstrings and nag your conscience. Just as you gave your loved one room for emotions during the decision to move, do so now. Empathize, offer comfort. Keep your feelings separate from your loved one’s. Turn to family, friends and others in your support system when you have your own tough moments.

If you struggle with how to address your loved one’s comments, ask the center's social worker for help. Also, check to see if the center has a support group or a Family Council to share solutions that work for them.

During the first week, you’ll better understand the routines of the facility: what it’s like during meals, shift change and at different times during the day. You’ll begin to recognize familiar faces. Write down any questions you may have; you can bring them to your loved one’s first care plan meeting.

During the first week, others close to you will hear news of your loved one’s move. When they call to check in on you, you may feel obligated to explain your decision. You only have to share as much information as you’d like. You can simply say, “It was just getting too tough at home. This is an adjustment for both of us. We appreciate your support.”

You may wonder if you’re calling or visiting too much. Call and visit as often as you’d like. Use your gut as a guide. You also may be so tired that you find yourself too exhausted to visit as often as you’d like. Catch up on your rest and then visit. You can call the center to check on your loved one and ask others to increase their visits in the meantime. Visits will be more enjoyable after you recover from the stress of the decision and all that led to it. See more tips for successful visits below.

The First Month

The first month will be, in some ways, a blur. And in other ways, it will seem like a year has gone by. You and your loved one will have settled into a routine and will be familiar with the staff. You’ll have attended your loved one’s first care plan meeting.

You may continue to second-guess your decision. Remember that a bad day doesn’t make a bad decision. When you have a bad day, consider the reason. What’s within your control? Can staff help you find a solution? Ask them. Are you beating yourself up for not doing more? Realize you can only do so much. Know that you will also have good days when you know the decision was right.

Take an objective look at your visiting schedule. How do you feel about how often you visit? Create a workable schedule for visits and phone calls. You also may want to include others in your scheduling efforts so that your loved one has a steady flow of visitors and conversation.

Helping Your Loved One Feel More at Home

A move into a skilled nursing care facility, also known as a nursing home, is not a moveinto a home. It’s a move into your loved one’s new home. Keeping this positive outlook will remove many of the barriers that make it tough to transition. Help your loved one make the new home as comfortable and personal as possible.

While decorative items should not interfere with the caregiving mission or facility policies, thoughtful touches can cheer both the mind and spirit. Discuss decorating ideas with staff members, and ask if they have any suggestions that you might not have considered.

Here are some tips to create an at-home atmosphere:

  • Borrow the feeling of your loved one’s former home. Capture and recreate the same mood, texture and tone.
  • Bring things that your loved one has made or collected.
  • Add comfort with favorite knick knacks.
  • Add family photos or children’s homemade crafts.
  • Change up decor for the holidays. In most cases, the brighter and more cheerful, the better.
  • Stimulate all the senses with soft fabrics, colorful artwork, or scented accents.
  • Bring the outdoors indoors, like fresh flowers, colorful leaves and other seasonal reminders to brighten the room.
  • Add magazines, books and newspapers, or tape-recorded books and/or music.

Provide a telephone or television if the room can accommodate them.

Handling Negative Comments

During the transition, your loved one may make negative comments. You may dread these because they seem to be a judgment about the decision. When your loved one expresses dissatisfaction with something, write the comment down. Keep these comments in the proper perspective: they are an opportunity for you to help make the situation better for your loved one.

Remember these tips:

  • Never hastily dismiss a negative comment. Even if the remark appears petty or provocative, ignoring your loved one’s opinions will damage morale.
  • Oftentimes, negative comments are used to voice uncertainty or fear. Your loved one may just want you to listen and offer support and comfort at a time of change.
  • Try to really listen to the emotions behind the words. Don’t prejudge the validity of your loved one’s comments. Pay particular attention to verbal cues, body language, facial expressions, posture and gestures. All can help you determine the seriousness of negative comments.
  • Dissatisfaction is not limited to verbal expression. It may take the shape of depression, anxiety, hostility, withdrawal or unresponsiveness.
  • Always respond to negative comments, whether they are legitimate or not. Use facial expressions, gestures, statements, questions and comments to show that you’re listening. Don’t get upset or be condescending or patronizing in your response. Treat your loved one as an equal in the conversation.
  • If you do feel a complaint could be warranted, bring it up to an approachable staff member. Lingering or more serious complaints should be taken up with the facility’s administration. Most facilities or centers have a specific complaint procedure. If you’re uncertain, ask.
  • Waiting and hoping problems will take care of themselves only gives problems time to get bigger. The staff will want to hear your concerns.
  • Assure your relative that the issue is being addressed. Provide status reports to illustrate progress.
  • Although you should always bring issues to the attention of the staff first, you have other avenues available to you. Each state has an ombudsman program to help family members resolve complaints about long term care centers. Residents or relatives should be encouraged to report any unresolved complaints to this or similar programs in their area.

Care Plan Meetings

Within two weeks after your loved one’s move, the nursing home, professionally known as a Skilled Nursing Care center, will host a care plan meeting. Subsequent meetings will take place quarterly. The center will contact you with scheduling information; if the meeting conflicts with your schedule, ask for a different date or time.

At a care plan meeting, you’ll interact with the staff directly involved in your loved one’s care. They’ll help you understand care treatments. Your loved one, if appropriate, might also attend. If you have out-of-town family who would like to be involved, ask the staff if they can participate via conference call.

Bring a list of questions and concerns, and take notes during the meeting. Share information about your loved one’s preferences and likes/dislikes. When the meeting is over, ask for a copy of your loved one’s care plan.

After the care plan meeting, you may want to have a meeting with family members and your loved one, if appropriate. During your family meeting, discuss the care plan, how you’ll monitor it and how you’ll keep everyone posted.

You also may want to create a system of managing concerns. It can become confusing if each family member meets with the staff about similar concerns. Instead, organize your efforts to work with staff and update one another. Who’s the point person? How do you communicate updates? Can you have regular meetings? Managing expectations and communications will prove helpful.

Remember that you are an important part of your loved one’s care team. That’s why attending care plan meetings is so important. You can offer insights that can help provide your loved one with the best care possible. In turn, care providers can assure you that they will do their best to care for your loved one.

Working Well With Staff

Care comes down to people. The more you get to know care providers, the better you’ll feel about your care decision. On the day of admission, you likely met care providers such as a charge nurse, certified nursing assistant, therapist, activities director and social worker. During subsequent visits, reintroduce yourself to those caring for your loved one.

Get to know the staff, the daily routine, and programs available. When you have questions or concerns, discuss them with the appropriate staff member right away.

Family Council

Consider joining the center’s Family Council. A family council is, in effect, a consumer advocate group. It is typically comprised of residents’ relatives and friends. Family council meetings are usually held monthly. Typically, a staff member of the Skilled Nursing Care center serves in an advisory capacity, rather than assuming a membership role. The council focuses on several established goals centered on protecting and improving quality of life, both within the facility and within the long term care system as a whole. The council works to give families a voice in decisions that affect them and their loved ones. Family councils may organize events or offer support to new residents and their families.

Tips For Successful Visits

Most nursing homes, professionally known as Skilled Nursing Care centers, offer visiting hours of up to ten hours or more. You and your loved one may like to develop a visiting schedule. Routine can be comforting. Your loved one may feel more energetic or social at certain times of the day, so try to visit at those times to make visits meaningful for everyone. You also can check with staff about times when your loved one will be involved in therapies, receiving personal care, or in need of down time. Let others know when it’s a good time to visit. If they need to make arrangements ahead of time, tell them how to do so.

When visiting, knock and announce yourself before entering the room. Show the same courtesy you would in a private home. If your loved one shares a room, be sensitive of the privacy of the other person and any guests.

To make visits enjoyable, think about the activities or hobbies your loved one enjoys. These could include listening to music, playing games, watching movies or sports, or swapping stories. Residents often like to talk about past events or milestones in their lives. Keep in mind your loved one’s energy or interest levels may change as care needs change. Look for opportunities to keep your loved one involved in family activities and events. Family photo albums or home videos can spark wonderful memories. Videotape graduation ceremonies, sports games and school plays; then share the footage with your loved one.

If you are ever at a loss for ideas, check with the center’s activity director, who may have suggestions and possibly materials to lend. Some ideas include:

  • Sharing photos or playing videos of family events.
  • Inviting residents to attend an outing.
  • Treating a female resident to a manicure or pedicure.
  • Helping a resident write letters.
  • Bringing board games or a deck of cards.
  • Taking a leisurely stroll.

Children should be encouraged to visit as well. Very young children rarely react negatively. On first or infrequent visits, older children, especially teens, may need help understanding the Skilled Nursing Care environment. If you need advice on how to make things more comfortable, discuss your concerns with the facility’s social worker.

Don’t worry about the commotion that kids can make. The activity may be a welcome change to otherwise quiet surroundings. Children offer hopeful optimism, curiosity and authentic generosity that even nonrelated residents may find refreshing. If you have more than one child and find them difficult to manage, you can allow only one child to accompany you at a time. Allow enough time for a meaningful visit.

Some kid-friendly ideas include:

  • Playing simple games like tic-tac-toe, go fish, checkers or dominoes.
  • Drawing or coloring.
  • Recreating childhood games from past generations.
  • Offering simple signs of affection, such as making eye contact, holding hands or giving hugs. Holding a baby or cuddling a toddler is often therapeutic for residents who are unable to interact well.
  • Bringing or sending a surprise for a child to open or present.
  • Celebrating special events, such as Thanksgiving or the first day of school. Costumes or uniforms help your loved one feel included in children’s lives.
  • Starting new family traditions. Special activities or shared treats can become something to look forward to.
  • Bringing history to life with personal stories. Children can ask your loved one about historic events and firsthand experiences to create a “living history.”
  • Outings

    Many residents are able to leave the facility for a meal or longer outing. These trips can mean a great deal to residents and are usually encouraged by facility staff. When planning an outing, work with staff about a week in advance to prepare medicine or any special equipment.

    You can also accompany your loved one on facility-sponsored outings to places like the mall, museum, popular fishing spot, etc. If you find yourself spending a lot of time at the facility or center, you might consider becoming a volunteer. Talk to the staff and find out how volunteering can benefit both you and your loved one.

Staying In Touch

Busy schedules or distance might prevent you or those close to your loved one from visiting as often as desired. There are many alternatives to in-person visits that can help you connect with loved ones. As the saying goes, it’s the thought that counts. Simple gestures are powerful reminders of the importance and relevance loved ones have in our lives.

To stay in touch, try:

  • Scheduling calls to share otherwise ordinary experiences like morning coffee or afternoon tea.
  • Mailing greeting cards or thank-you cards.
  • Collecting media clippings of family or community activities.
  • Mailing school photos and family portraits.
  • Surprising your loved one with cheerful flowers or live plants.
  • Packaging handmade crafts or school artwork.
  • Recording audio or video messages and sending them by mail.
  • Sending emails or chatting online.
  • Sharing digital photos.
  • Using web cams and services like Skype to chat face to face.