Becoming a nursing home resident can throw you for a loop.
*"It's the biggest package deal anyone ever buys. Getting a job, a house, a car in no way compares," says David Schulke, investigator with the Senate's Special Committee on Aging.
"You're buying a new existence, a new set of rules . . . It's like arriving on Earth all over again. There's little out there to teach you how to do it."
Billie Frazier is trying to do just that. A human development specialist at the University of Maryland Cooperative Extension Service, she teaches "Aging -- A Family Affair." The free, 90-minute class focuses on family responsibilities after parents or relatives become dependent.
Talk about the situation before it becomes critical and a nursing home is needed immediately, Frazier advises. Involve the physician and possibly a clergyman or social worker. "The best decision is always one that's shared with the elderly person," she says. "And don't expect it to be pain-free."
When a person is unable to do things for herself, she needs constant care, and there are no better alternatives, it's time for a nursing home (70 percent of the residents are women).
"We tell families to try and get someplace close, because then you'll visit more, and the staff will know you're watching," says Anne Hart, the District's long-term-care ombudsman.
That sounds defensive, but you're just letting the home know you're interested. "If they've got 20 people, and they know one is going to have a visit, then they know that's one who has to be clean."
To help choose a home, experts advise putting yourself in the shoes -- or the bed or wheelchair -- of the potential resident. Money is an important factor -- the cost can be as much as $3,000 a month -- but even if it is not a consideration, it can be hard to make a good choice.
Would the resident be able to ask for help from the staff or want to eat the food? Is there a caring atmosphere? Can residents decorate their own rooms? Are there grab bars, nonslip surfaces, smoke detectors and other safety features? Do residents like the place?
Find out if the patient's physician will visit the home -- some, according to Frazier, don't want to spend the time to go there. Make sure the home is certified to participate in Medicare and Medicaid.
When a parent or relative is in a home, Frazier and other professionals advise these strategies:
Make the most of your visits. Read letters from other family members. Introduce the resident to nurses and to other patients; go with her to the dining room. If possible, take her for a walk outside. Listen to her complaints, and take them seriously.
Don't feel guilty about your visiting schedule. While it's important for the resident to know you'll be coming again, don't give specific times if you may be delayed. Visit often enough to maintain the relationship, but not so frequently as to interfere with the resident's integration into the community.
Become involved in the nursing home activities. Volunteer to help take a group out or to organize bingo games. Meanwhile, try and adapt whatever activity the resident did before entering the home into something she can do there, whether it be painting, bird watching or crocheting.
Frazier has had to draw upon her own advice. Her 88-year-old mother has been in a Tyler, Tex., nursing home for seven years.
"It's expensive and time-consuming to deal with, but I've been pleased with the care she's getting," says Frazier, an only child. "It is possible to successfully monitor from a distance the care that an elderly person can get, and more and more people are going to have to be doing it."
The D.C. ombudsman's office (202-662-4933) can give advice, check out complaints, refer to other ombudsmen and arrange for you to become a volunteer. For questions about conditions elsewhere: the National Citizens' Coalition for Nursing Home Reform (202-797-0657). Billie Frazier will be teaching July 31 in Gaithersburg and Wheaton and Aug. 7 in Hyattsville. For information, call her at (301) 454-3602.