What is the “promise?” “Promise me that you will never put me in a nursing home.” We hear about that promise frequently in my office. It can even be: “My kids said they would never put me in the nursing home.”

In 2001, I took over the care of my grandmother. We talked a lot about moving her to Kansas from Texas. She really wanted to stay in her home (an important lesson that I learned her), and she had this saying about a nursing home. “I know one day I am going to need to go to a nursing home. Honey, it is OK to put me in a nursing home; I just don’t want to know about it.” So, as long as she had cognitive abilities, she wanted to stay out of the nursing home.

The focus of my office and as a member of the Life Care Planning Law Firm Association, is to help individuals stay in their home as long as possible. There are multiple alternatives, including home care, independent living and assisted living.

Sometimes the nursing home might be the only alternative because of the frailty of the person.

Many times the decision to place someone in a nursing home is thrust on us with just a moment’s notice. While taking care of my grandmother, I had a couple of those close calls. On one particular occasion, she had been in the hospital and the assisted-living facility just did not feel like they could take her. Luckily, we were able to work out a compromise, but I remember driving around for two days looking at nursing homes trying to decide where in the world I would feel comfortable taking my grandmother.

Recently a family contacted us through their accountant. Their loved one’s health had really failed, and they were trying to figure out where to place that loved one. How would they choose?

Laura Buck is one of our care coordinators. She is also an RN that worked many years in a nursing home. She wrote something for the client that I consider sage advice. This is what she said about how to choose a nursing home.

Unfortunately, it is quite difficult to make recommendations regarding placement in a nursing facility. There are many factors that should be considered when choosing a facility in order to be sure that it is a good fit for your loved one and your family. First you must consider the current health status of the individual needing placement. Oftentimes, placement depends on what type of health care services the individual needs. I have found that many facilities are better in some areas than in others. For example, some provide rehabilitative services, others dementia care services, some only provide long-term care services, yet others provide for drop in care, so forth and so on.

I would like to make a couple suggestions.

• I would suggest the individual and their family research the facilities they might be interested in through the website, www.medicare.gov/nursinghomecompare/search.html?.

Now, keep in mind that most of what is found on this website link is based on paperwork, and state survey results. Unfortunately, in my experience, I have found some of the best facilities do not always have great star ratings. Likewise some of the facilities that have the best star ratings do not always have the best care.

• My second and likely most important recommendation would be for the individual or family to do a drop-in visit to the facilities they are interested in. I would not suggest a call to set up an appointment. Instead, I would encourage them to just do a drop-in. This way they are able to get a more accurate picture of what the facility looks like and operates like on a normal day-to-day basis. If an individual calls to set an appointment, it allows the facility preparation time, and the family will not always get an accurate representation.

During the visit, they will want to take something to write on and be sure to make notes so they have them to reference later. Here is a link from the Medicare.gov website on things to look for when doing a tour. This would be a great option to use: www.medicare.gov/files/nursing-home-checklist.pdf.

• While they are doing the tour, if they are able, encourage them to visit with the CNA and nursing staff members (not just administration). They will be primarily dealing with the nursing team on a day-to-day basis. Administration often provides the facility tours, but they will have limited contact with these individuals once they are living at the facility. This will give them a good sense of how they will get along with the primary care providers which is important.

• Finally, encourage the family/client to “go with your gut.” The client and family will know when they have picked the right facility. It sounds funny, but if it helps, relate this to buying a home. When you walk in a house, tour it, and it just feels good and fits they will know it is the right one for them.

Laura Buck, RN

care coordinator

Sometimes “the promise” cannot be followed. Sometimes your loved one’s care needs might be so great they cannot be addressed in any setting other than in a nursing home. I know it is a hard decision. I know it is an excruciating decision.

Let me finish with a story about my grandmother. In 2006, I made a decision to move her to assisted living. I went to Fort Worth to pick her up, drove her back to Hays and found one assisted-living facility that would take her. It was a long quiet trip, riding with my grandmother who maybe for the first time was not happy with me.

My grandmother went into the assisted-living facility, and for months, she would ask me, “Do you think I am well enough to go home?” However, by being in the assisted-living facility, we were able to reduce her medications (they had just grown out of control with multiple doctors in Texas). She started taking her medications timely. She started eating regular meals, and more importantly, she was around other people — as well as me being able to check on her on a daily basis.

About six or so months after my grandmother moved into the assisted facility, we both realized how much better she was doing and how much happier she was. She had regained her strength, she had regained social skills, and she had regained her happiness.

Sometimes we as caregivers have to step in and do the difficult thing. My heart goes out to all of you who have had to make that decision, despite “the promise.”

Randy Clinkscales founded Clinkscales Elder Law Practice in 1985. He is a 1980 graduate of Washburn Law School and has represented clients at the administrative, county, state and federal levels.