THOUGHT OF THE DAY: A few weeks ago Steve Moran published a three-part series in the Sacramento Bee on “the terrible state of affairs” in skilled nursing facilities in California. The response from the nursing facility industry was predicable. It’s not us, it’s the other guy. There are only a few bad apples, don’t paint everyone with the same brush.

Observations of Nursing Facilities

When I was a bedside hospice volunteer, I had the opportunity to visit patients in many nursing homes and rehab facilities throughout the Bay area. The hospice service was contracted by each of them to provide services to patients who had less than six months to live. Yes, I did see some nursing facility staff who showed little or no compassion.

The Problem

But for the most part, I witnessed warm and helpful interactions by staff who had little training and were overworked, especially in facilities with patients showing signs of dementia. I think that’s 1/2 of the problem we face in California and probably throughout the country: poor training and understaffing. That’s an economic and regulatory problem.

But the remaining problem is more endemic: we often don’t think about nursing facility placement of loved ones until we are forced to. By that time, choices are limited or may be nonexistent; you go where there’s an available bed.

And why do we wait? There’s a multitude of reasons, but it usually is cultural. We often feel obligated to care for our loved ones even when we lack the skills to do it. We don’t have the “what if” conversation with loved ones. And, at a basic level, placing a loved one in a nursing facility signals the last chapter of their life—something that may be difficult to accept.

The Solution

But what will happen if people begin the nursing facility conversation and search long before a placement is needed? There will be two benefits: 1) selections can be based on quality, not just availability; 2) loved ones are involved in placement decisions; and 3) owners of sub-adequate nursing care facilities will have a financial incentive for improving services.

If you have a loved one who may need placement in a nursing facility any time in the future, you may want to begin the conversation today.

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