When the health or capacity of a loved one deteriorates and the family decides that a nursing home is the best care option, it can be a very traumatic time for both the caregivers and the patient. You want to ensure your parent or friend is placed in a facility where they will get the best possible care in a safe, nurturing environment.

However, depending on the length of waiting lists and where you live, your choices may be very limited. For example, this directory of long-term care providers in Saskatchewan illustrates that in many smaller communities there is only one government-subsidized nursing home. And if a bed becomes available you will likely have to decide whether or not to accept it on very short notice.

Last week we wrote about “What you need to know about residential care for seniors in Saskatchewan” and discussed the difference between retirement homes and nursing homes (special care homes). This week we offer a checklist of things to look for when you are evaluating the suitability of a special care home for your family member.

The Canadian Association of Retired People (CARP) has developed an extensive catalogue of things to look for. Here (in no particular order) are some of my favourites, including questions we asked when my mother recently moved into long-term care.

1. What is covered in the regular monthly fee and what additional charges can be expected?
2. Are residents clean, well-groomed and appropriately dressed?
3. Do they seem happy?
4. How do family members of current and past residents rate the facility?
5. What activities are available for residents?
6. How long have senior staff worked for the residence?
7. Do staff appear to be happy?
8. What is the staff-to-patient ratio of PSWs, RPNs and RNs to residents on each shift?
9. Does the home rotate all staff members or try to keep the person(s) caring for each resident?
10. Are there any limitations on visiting hours?
11. How do family members participate in the care plan?
12. How are care complaints handled and by whom?
13. Do doctors, physiotherapists, denturists, podiatrists regularly come to the residence for patient care?
14. Does a hairdresser and manicurist regularly attend to provide personal care?
15. What resources are available for the care and safety of residents with cognitive impairment?
16. Are religious holidays and birthdays celebrated? How?
17. What are the policies and procedures for ensuring that personal clothes and belongings are not lost or stolen?
18. What is the home’s fall prevention program?
19. Can the resident bring personal furniture, pictures and other knick knacks?
20. What are the policies and procedures for handling a resident who is harmful to himself/herself or other residents?
21. Does the home have a palliative care program?
22. Will the food appeal to your loved one?
23. Can a family member have a meal with their loved one? If so, is there a fee?
24. Are special menus available for people who require soft food or other special diets?
25. Does the menu suit your loved one’s cultural or religious regulations?

Regardless of the answers you get to these and other preliminary questions, once your loved one moves in, it is important for family and friends to visit as often as possible at various times of the day and in the evening both to keep his/her spirits up and monitor the actual care he/she is receiving. In many cases elderly or infirm patients are incapable of advocating for themselves.

Generally we are very happy with the facility we chose for Mom, but we have to stay on top of things. For example:

• When she returned to the residence after she broke her hip we had to encourage staff to get her up and walking so she didn’t totally lose her mobility.
• She is supposed to get her hair done every week and a manicure every two weeks but inexplicably, her name sometimes doesn’t make it onto the list.
• There is lots of staff, but they are rotated and often it seems like the right hand doesn’t know what the left hand is doing!

By understanding the rules and limitations of the special care home where your loved one resides, you can monitor care more effectively and provide additional support as needed.

Written by Sheryl Smolkin
	Sheryl Smolkin LLB., LLM is a retired pension lawyer and President of Sheryl Smolkin & Associates Ltd. For over a decade, she has enjoyed a successful encore career as a freelance writer specializing in retirement, employee benefits and workplace issues. Sheryl and her husband Joel are empty-nesters, residing in Toronto with their cockapoo Rufus.

By Sheryl Smolkin

I’ve been thinking about the cost of health and long term care a lot lately because my 88- year old Mom recently had a bad fall and cracked five ribs. She is recovering at home but she is in a lot of pain, and requires 24/7 care for the foreseeable future.

The plan has always been to keep her in her own apartment as long as possible. Fortunately her wonderful, privately-paid caregiver (a registered practical nurse) who normally works 40 hours/week has virtually moved in and is helping us to take excellent care of her. But as costs mount up over the short run, we are beginning to wonder if this will be a luxury she soon can’t afford.

Access to public resources varies across the country, but in Thornhill, Ontario where she lives , I’ve been told that a maximum of one hour a day (and most probably only two hours a week) will be offered to her on the government dime. But I’m grateful that 22 in-house physiotherapy sessions to get her up and moving better and train her to avoid future falls have been approved.

So if health and long-term care are not in your retirement planning radar yet, I have put together a few recent articles that may get you thinking about what you can expect.

On Retire Happy, Donna McCaw writes about Your Health in Retirement: Asking for Help. She cites staggering statistics from the Vancouver based Canadian Men’s Health Foundation about men and heart disease, cancer, diabetes, obesity, alcohol-related deaths as well as suicide. She interviewed recently-retired men who made it their first priority to get healthy and get rid of their “ring around the waist” by embracing fitness and learning to eat healthy.

Life after retirement: Health care costs require careful planning in the Financial Post is by Audrey Miller, the Managing Director of  http://www.eldercaring.ca/. She cites home care costs by the week and by the year (albeit in Ontario) and says as family members and professionals, we need to be better prepared. The cost of care is only going to become more expensive, especially as our public and private resources are reduced. Not only will we soon have more seniors than young people under 15, but our pool of those who are willing to be paid to do this work will also become smaller.

The coming health benefits shock for retirees by Adam Mayers at the Toronto Star reminds us that contrary to what many people believe, glasses, drugs and nursing homes will not in most cases be paid for by our universal health care. He quotes Kevin Dougherty, president of Sun Life Financial Canada who says one reason for the disconnect may be that we form an opinion of the health system through our use of it. Most of us are covered by workplace health plans and we don’t need much from these plans during our earlier years, and into middle age what we do need is covered.

Navigating Retirement healthcare is a comprehensive report from CIBC Wood Gundy discussing health care cost considerations in retirement. The study notes that long-term care is classified as an extended healthcare service under the Canada Health Act but the role of publicly-funded LTC facilities is changing as provincial governments limit the expansion of these facilities by reducing the number of registered nurses, maintaining or decreasing the number of available beds, and tightening the qualifications for acceptance into a facility.

Even if these policies were reversed, an individual’s current wait time of one year will likely increase unless significant expansion of the LTC provision occurs. The result is that a greater number of seniors are paying to enter more expensive for-profit private or semi-private facilities that can cost up to $7,000 or more a month.

Finally, Long-term care costs in Saskatchewan 2014 by Sun Life discusses how residential facilities, retirement homes/residences, government-subsidized home care, adult day care and private home care operate. Government subsidized options including home care are administered by the Regional Health Authority (RHA). As RHA resources are limited, many seniors don’t get the care they need from RHA services and have to rely on private home care services. The provincial tariff for skilled nursing ranges from $42-$70/hour while 24 hour live-in care can cost from $21-30/hr.

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