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In my experience, caregivers have begun to consider long-term care placement when their loved one begins to get out and wander and when they become incontinent and need to begin wearing briefs.

Centers for Medicare and Medicaid Services:  Your Guide to Choosing a Nursing Home

Click on the link below to be taken to the guide to choosing a nursing home:

Choosing a Nursing Home: A Caregiver’s Guide

It seems virtually no one wants to go to a nursing home, and most caregivers do not want to institutionalize a loved one. But
even though you may be committed to home care and have no intention of utilizing the
services of a nursing home, circumstances may arise that make institutionalizing your loved one a necessity, not a choice

It is possible that after a stay in the hospital your loved one may need a period of specialized care of the sort you can’t provide
at home, Or you yourself may become ill
and need to find a nursing home that can care for your loved one while you recuperate.

Perhaps your loved one's condition will
progress to a point where you can no longer provide the level of care needed. At that point intermediate or skilled nursing care
may be required on a long term or even permanent basis.

If any of these things occur, you will find yourself, perhaps very unexpectedly, in the position of needing to evaluate and choose a
nursing home.

A Decision with Heavy Emotional Components

Like so many issues in caregiving, the decisions surrounding this process involve very practical considerations overlaid with
an emotional component. Feelings of sadness, relief, guilt, and a sense of having
failed may all be experienced when the time comes to put a loved one in a nursing home.

As time goes on, and the raw emotions of the moment subside, one of the most important areas of comfort will be knowing that you have chosen the right home for your loved one.
 Types of Care

It is impossible to choose a nursing home without first determining the type of care your loved one needs. Not only will that
information assist you in finding a home that provides the proper level of care, it will also
be a major factor in determining what, if any, government aid (Medicare or Medicaid)your
loved one will be eligible for.

The three most common types of care are personal care, often referred to as custodial, intermediate, and skilled nursing.

Custodial care means that residents need help with personal activities such as dressing,bathing, and eating. This type of care is essentially non-medical and is administered by aides rather than trained medical personnel.

Residents who need rehabilitative therapy and medications in addition to personal custodial care are candidates for intermediate care. Intermediate care is
delivered by licensed therapists and registered or licensed practical nurses.
When the level of disability is such that the resident is not able to care for him-or herself
and may even be bedridden, skilled nursing care is needed. It is administered on the orders of an attending physician by licensed
medical personnel.

Taking Stock: What Kind of Care Is Needed?

A good starting point for evaluating your love one' health status is the list of activities
of daily living (ADLs), which include bathing, dressing, eating, going to the toilet, mobility,
and getting in or out of bed and other transferring situations.  An additional list, the instrumental activities of daily living (IADLs),
which include cooking, cleaning, shopping, taking medicine, and paying bills can also
help give you an overall picture of your loved one’s abilities.

And of course, consultation with the doctor, who will most likely have had considerable
experience in nursing home placements, can prove invaluable.

Finances: What Can We Afford? What Do We Need to Know About Basic and Supplemental Costs?

Nursing homes are expensive; $50,000 on average and so your choices may well be dictated by what financial resources are available. First, it is important to realize that
Medicare only covers very specific types or combinations of care.

Personal care without other necessary prescribed care is never covered. Medicare
covers only 100 days in a skilled nursing facility; the first 20 are fully paid but you must contribute a co-payment for the remaining 80 days.

If your love one's stay is covered by Medicare, the facility you choose must be
Medicare approved.

Medicaid does cover nursing home costs but you must meet strict financial guidelines to
qualify. If you think your loved one might be a candidate for Medicaid coverage, it is wise to contact an elder care attorney, or other
professional that can help you work out the details and apply for Medicaid-eligible

Make sure you understand the home’s daily or monthly rate; which basic services are covered in this rate; which cost extra; what
your payment plan will be, and whether or not a deposit is required.

Choosing the Nursing Home: What to Look for

Your initial screening should provide you with a list of facilities that offer the type of care needed, are geographically convenient,
are within your price range, and have available beds.

The next step is to arrange a personal inspection visit. Areas that you should inquire about (some of these can be handled over the phone to save time during your on-
site visit) include:


Does the home provide physical, occupational, or speech therapy; religious services; social activities; laundry service;
television? Be sure to ask which of these are included in the monthly fee and which entail
special charges. Surcharges can add several
hundred dollars to your monthly bill, and you need to factor these costs into your financial


Find out how many registered nurses are on the staff; how often the doctor visits;
how many staff are on duty during the day and on the night shift and what is the ratio of
staff to patients; whether dental care is provided in-house; whether a pharmacist or other trained person maintains and reviews
medication records on patients; how much turn-over there is among the staff, and what
arrangements have been made for ambulance service.


If your loved one qualifies (or may qualify in the future) for Medicare or Medicaid, make certain that the institution is certified by
these programs. It should also be licensed by
the state. Other accreditations, such as those from the Joint Commission of the
Accreditation of Hospitals (JCAH) may provide further assurance, but the first two are absolute necessities.

Examine the survey reports that are mandated for each nursing home by federal law. The state health department must inspect each facility to see that it meets certain minimum standards and it issues
deficiency report detailing problems found. This report should be displayed at the home.
If it is not, ask to see it. If the facility can’t seem to find the report while you are there,
you will want to note that fact. However, don’t be swayed solely by the number of
deficiencies. A home that has numerous small, easily correctable deficiencies may be
much more desirable than one which has fewer, but far more serious ones.

As You Tour the Facility Consider These Areas:


Are there sufficient smoke detectors; emergency exits; wheelchair ramps; call buttons; hand and guardrails
in bathrooms and bedrooms?


Do the current residents look clean and cared for; are they engaged in varied activities, or are they simply sitting and staring?
Are there opportunities to sit or recreate outdoors? Are physical restraints excessively used? Are the rooms of a decent size, with space for the residents’ belongings? Are they
bright and cheerful? Can the residents decorate their rooms to some degree?
Is there adequate privacy? Are the common rooms clean and welcoming or is there a pervasive, unpleasant odor? Does the staff treat residents respectfully and kindly? Does the staff radiate a generally pleasant and cheerful demeanor?


Is the food nutritious and appealing? Are fresh fruits and vegetables available?
Are snacks served? Is the menu varied; are special (low salt or low cholesterol) diets available? Does the staff feed those who
can’t feed themselves? Do the current residents say they like the food?

Tips from Those Who Have Been There:

• If you can afford it, try using a nursing home for short term stays to determine how well they meet your family’s needs.

• The nursing home decision is a very emotional and stressful one. Seek out counseling either during the decision-
making process or immediately after.

• If your loved one is mentally fit and younger than typical nursing home residents, try to find an institution that is, if not geared to a younger population, at least a place where there is some interaction with people of a similar age and activities that are planned with younger people in mind. Check
out the facility’s bulletin board. It can give you a good idea of what activities are actually being offered.
• Plan ahead. As difficult as it is, if you know
your care recipient may be a future candidate for a nursing home, do some of the research
ahead of time, when you are not feeling stressed about a time limit. This can increase
your chances of finding the best possible facility.

The Subtle Component:

You do need to have a list of practical considerations when you’re looking at a nursing home, just as you do when you are
considering any other type of housing decision. But the answers on a checklist aren’t necessarily the whole story.

Sometimes you find a place that’s not as
beautiful or as good on paper as some of the others, but you can just tell it has heart.


The Eden Alternative


A Harvard-educated physician and Board Certified Geriatrician, Dr. Thomas searched his medical texts and found nothing to heal
loneliness. This inspired him to watch and
listen to life in the nursing home where he worked. Over time, he witnessed that the
institutional model of care breeds three deadly plagues of the human spirit: Loneliness, Helplessness, and Boredom.
And so he began to think about a different kind of world. He envisioned a care environment where people could live
and thrive, not just wait to die.

Working together, with his wife, Judith Meyers-Thomas, this vision of a Human
Habitat began to unfold and change the lives of Elders and their care partners across the
country and beyond.

Click on the link below to be taken to an interview with the founder of the Eden Alternative, Dr. William Thomas:



The philosophy and work of The Eden
Alternative is guided by The Ten Principles:

Principle #1

The three plagues of loneliness,
helplessness, and boredom
account for the bulk of suffering
among our Elders.

Principle #2

An Elder-centered community commits to
creating a Human Habitat where life
revolves around close and continuing
contact with plants, animals, and children. It is these relationships that provide the young and old alike with a pathway to a life worth living.

Principle #3

Loving companionship is the antidote to loneliness. Elders deserve easy access to human and animal companionship.

Principle #4

An Elder-centered community creates opportunity to give as well as receive care.
This is the antidote to helplessness.
Principle #5

An Elder-centered community imbues daily life with variety and spontaneity by creating
an environment in which unexpected and
unpredictable interactions and happenings
can take place. This is the antidote to boredom.

Principle #6

Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health.

Principle #7

Medical treatment should be the servant of
genuine human caring, never its master.

Principle #8

An Elder-centered community honors its Elders by de-emphasizing top-down bureaucratic authority, seeking instead to
place the maximum possible decision-making
authority into the hands of the Elders or into
the hands of those closest to them.

Principle #9

Creating an Elder-centered community
is a never-ending process. Human growth
must never be separated from human life.

Principle #10

Wise leadership is the lifeblood of any struggle against the three plagues. For it, there can be no substitute.

A Day in an Eden Alternative Home

You notice something different about an Eden home before you enter the door. It might be a winding garden path, an attractive landscape, or playground equipment in the front yard. You may see birds at a feeder or hear a donkey braying, even in an urban neighborhood!

When you enter the building, something else catches your senses-the tantalizing aroma of a good meal. You may hear the conversation of children, watch the flight of finches in an aviary, or revel in the richness of lush house plants, paintings, pictures, photographs and schoolwork on the walls. Everything reminds you of home.

Many residents awaken to the sound of birdsong, because there are parakeets in nearly every room. Every day, the "birdmobile" (a converted medication cart) makes the rounds of rooms, with food and supplies. At Chase Memorial, the birdmobile is manned by volunteers from a local middle school. The kids enjoy interacting with the birds and their owners.

Children and pets are naturals in an Eden Home. Once awake, a person might choose to have a cup of coffee, or tea. Or they might decide to have breakfast in the dining room.

Many Eden Alternative homes have open hours for dining. The homes may offer a buffet, so residents have a choice of when and what they eat.In the Eden Alternative home, the activities schedule has been altered to reflect the natural rhythms of home life.

Rather than hunting for residents for the programmed activities, the activity department staff are helping residents care for the tame rabbits and hedgehogs, the cats and guinea pigs. You can imagine the excitement when the hamster has babies.
Residents may decide to walk or pet the dogs, or to visit with the children in the on-site child care center.

At lunch, they sit with their friends. They may enjoy tomatoes harvested from the nursing home's gardens. They may decide to take a nap, join a group of friends for a game of cards, or work in the garden for a while.

The Garden of Eden

The gardens are designed for accessibility. As Dr. Thomas writes, "Elderly residents cannot and should not have to climb over misplaced obstacles or reach into a flower or vegetable bed that's too wide." Walks are paved for wheelchairs. Raised beds, benches and shade are all important components of the garden.

The most crucial aspect of the Eden Alternative garden, however, should never be overlooked: it must be inviting and available-not a showplace, not a well-trimmed yard, but a natural retreat for everyone at the nursing home. It should never be "off limits." Many Eden homes combine gardens and playgrounds, so that residents may watch the children at play. A well-equipped playground encourages visitors. Before you know it, families are bringing their young ones to see grandma.

Getting There 

How does a nursing home become an Eden Alternative home? Today, certification assures that the residents, owners, administrators, families and staff are committed to the Eden Alternative. The administrator and other staff members are trained as Eden Associates, and receive ongoing advice. Each step of the process-and it is a process, not a marketing ploy-is acknowledged. In an Eden Alternative home, "change is good." The Eden community supports every effort by forming regional coalitions, and stays in close contact through discussion groups on the Eden web site.

In Indiana we only have 3 Registered Eden Alternative Nursing Facilities:

Fairmont Rehabilitation Center
3518 South Lafountain St.
Kokomo, IN. 46902

Parkview Care Center
2819 N. St. Joseph Ave
Evansville, IN 47720

Provena Sacred Heart Home
515 N. Main St.
Avilla, IN. 46701

There are some nursing facilities that have adopted some of the Eden Alternative elements, but are not registered as an Eden Alternative facility. 

If you are searching for a facility that has some of those elements, make sure to ask the Executive Director or Admissions Director when you take the tour of the nursing facility you are considering.


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