Making the decision to enter a nursing home and choosing the most appropriate one are problems faced by many senior citizens and their families.
Many people wait too long - until a crisis is upon them - before investigating options, said Patricia Lusk of the geriatric and institutional care division of the Prince George's County Health Department. This could be unwise because waiting lists are common and because nursing homes differ in servies provided, she said.
More than 40 licensed nursing homes are located in Montgomery and Prince George's counties combined. Any citizen can obtain a list giving addresses and useful information about the facilities provided in each of the area homes. In Montomgery County the list ia available from the institutional and medical care section of the County Health Department, 5640 Fishers Lane, Rockville, Md, 20852, telephone 770-2020. In Prince George's County lists are available from the geriatric and institutional care section, Health Department, Cheverly, Md., 20785, telephone 773-0900.
Interested persons are invited to visit those offices. While the local health departments do not recommend specific nursing homes, they can provide information such as which homes have particular therapy programs and what kinds of activity programs exist in varous hoems.
Inquiries about nursing homes can sometimes lead to alternative solutions, such as enrollment in a day care program or use of available services in one's own home. When Medicaid funds are involved, a conference with a health department representative is required as part of the nursing home application procedure.
Additional information ia available from the U.S Department of Health Education and Welfare. Write then at Health Care Financing Administration, Medicaid Bureau, 330 C St. SW, Washington, D.C. 20201, a publication called "Nursing Home Care" which answers such questions as: What are the alternatives to nursing home care? When does a person need a nursing home? What is the first step in finding the right nursing home? The publication includes a checklist for use in exploratory visits to homes.
Nursing home care occasionally has been subjected to considerable criticism. The most recent example is Robert N. Butler's review of the book, "Too Old, Too Sick, Too Bad" by Frank E. Moss, former chairman of the U.S Senate Special Committee's counsel. The review appeared Sept. 4 in The Washington Post.
On the other hand there was a supportive letter to the editor in The Post on Aug. 25 by Roselyn M. Matako, a registered nurse who has worked in an advisory capacity in more than 50 nursing homes across the U.S. She deplored the image of nursing homes as "local horror chambers." While admitting that there are some poor ones, she pointed out that "there are many well-managed nursing homes" with "dedicated staffs" serving the needs of the elderly.
Seniors who are considering nursing home application may get some reassurance from the licensing and inspection service provided by state and local governments. In Maryland licensing is done by the state, but there are a few local jurisdictions, including Montgomery County, that have local licensing and inspection as well.
According to Virginia Maxwell of the Montgomery County Office of Adult Health, there are distinct advantages in local licensing. On is more cooperation between local institutions and local licensing agencies in the development of standards of nursing home operations. Another benefit is a more immediate response to complaints.
Montgomery County does an annual in-depth evaluation which includes face-to-face visits with personnel, examination of facilities and review of therapy and activity programs. In addition, there are quarterly interim reviews, conducted day or night, which are generally unannounce.Follow-up of complaints received is immediate.
Prince George's County does not have local licensing or inspection for nursing home patient care. The local health department, according to Patricia Lusk, is required to confine its inspection to environmental survey work such as examining the structural adequacy of a building, hallway clearance and food handling facilities. Complaints about patient care must be sent in writing to the state office.
Concerned citizens of Prince George's County, particularly a group known a BUS (Betterment for United Seniors) advocated local licensing and inspection. Faith Loveless, president of BUS, said that obtaining local licensing authority is the group's major project now. She feels that local licensing and inspection is essential for upgrading nursing homes in the county. This opinion is based upon on-site, informal inspection of institutions in Prince George's and other countles undertaken recently by a BUS ad hoc committee.
This group, in conjunction with the Nursing Home Action Coalition (NHAC) was well represented at a public hearing before the council's human resources committee recently in Upper Marlboro. The bill, CB 110, proposed and presented by councilman Frank Casula, would establish local licensing and inpection. BUS also advocated and amendment to create a senior board of review that would give a monitoring role to senior citizens.
Arguments against the bill, primarily from nursing home representatives but including the state licensing office, centered on what was termed "unnecessary bureaucratic duplication and expense." Arguments for the bill, primarily by NHAC-BUS representatives but including local health officials, removed from the scene, to respond adequately and expeditously to the requirements of the local situation.
Florence Culver, on the BUS delegation, expressed some anxiety at the end of the day's hearing but continued to hope that the bill would pass and the appropriation made to carry it out. "Prince George's County residents," she said, "deserve the benefits of local licensing and inspection. It would assure needed upgrading of nursing home care."