Tuesday, June 12, 2007 | Updated at 8:47 AM EDT

(Jun 12, 2007)

A crisis often prompts the need for long-term care. It can happen without warning. Emotions will be running high so it helps if plans are in place.

• Talk about it. Know how your loved one feels about long-term care. Are there homes he likes or dislikes? What qualities is he looking for in a home?
• Take your family member to visit homes. This is often impossible by the time she needs long-term care. If done in advance, she can help pick her top three choices.
• Set up power of attorney -- both financial and personal care -- so it's clear who's in charge. Know all bank accounts and investments.
• Discuss the plan with other family members and get agreement in advance. A crisis is stressful enough without in-family squabbling.
• Consider volunteering at a long-term- care facility. Most homes badly need the help and it's a good way to find out what they're really like.
• Many homes have day programs or overnight respite care. Try them out.
• Waits are up to three years, so call the Community Care Access Centre at 905-523-8600 as soon as you think you need long-term care.

How to find a good home

All homes cost the same, but they are far from equal. Make sure you do your homework to get the best care.

• Visit the homes. It's vitally important. Don't skip this no matter how busy you are or how far away you live.
• Do more than the formal tour or you'll only see the home at its best. Visit at different times of the day. Go on a weekend when there are fewer staff.
• Go off the beaten track. Ask to see the kitchen and check out stairwells to measure how clean the home is kept.
• Talk to residents and their families while visiting. Ask them if they like it there. What don't they like about it?
• Use all your senses. Start by taking a whiff. A home shouldn't smell bad. Open your eyes and look around. What are the residents doing? Do they appear well cared for? Is the home clean? Listen up. Are staff talking to the residents? What are they saying? Do they take time to say hello to you? Look for a gentle touch. How do staff handle the residents? Are they smiling? What's the mood like? Don't forget taste. Ask to sample the food.
• Go for dinner. Mealtime is an important social event that takes up a lot of the day. Check out the dining room. How long does it take to get the residents there? Does the food taste good? Do residents talk to each other during the meal? Is there a dining room you can book to have a meal as a family?
• Ask how much the home spends on food. The Ministry of Health provides $5.46 per resident per day to cover three meals plus snacks. Some homes spend more. The highest is roughly $13, but that's rare. The average is just over $6. The more a home spends, the better the variety of food. You'll get more fresh fruit and vegetables, better cuts of meat and fewer starches. Look at the menu.
• Every home must have a resident council. Ask to see the minutes of the last meeting. They should be posted in a public area. By reading the minutes, you'll know the home's issues. How long ago was the meeting? That will tell you whether the council is active.
• Family councils are not required, but are becoming common. Look for a home with one. Again, check the minutes to see what they're discussing and how often they meet.
• How long have the staff worked there? High turnover can be a red flag.
• Make sure there are social workers on staff. They're often lacking despite being more important than ever. They give the extra attention staff don't have time to provide when there's a problem. Look for a ratio of one to 100 residents.
• Ask about medical care. Is a doctor on-call 24 hours a day? How much time does your loved one get with a registered nurse? Will your family doctor still be involved? Find out about access to dentists, physiotherapists, occupational therapists and recreation staff.
• How important is privacy? If your family member likes her own space, look for homes that use walls or large furniture to separate semi-private rooms. If you think she'll get lonely, you might prefer a curtain that can be opened or shut as a divider. For a room with a view, find a home with a window for both residents in a semi-private.
• Picture making the room your own. Is there space for furniture or belongings from home? Can you have a phone, cable television or Internet?
• Ontario smoking laws have severely restricted residents of long-term care from lighting up. Many have to go off property. What's the home's policy?
• Ask about spiritual care. How often are services and for what denominations? Are there spiritual advisers on staff?
• Take a good look at the recreation calendar. Is there a lot of variety? Are there things on it your family member likes to do? How does the home make sure everyone has a chance to take part? Is it easy to go outside? How do Alzheimer's patients who wander safely get fresh air?
• What are your loved one's hobbies? Find out if there's a way to do them. A gardener might like the chance to pot plants or visit a greenhouse.
• How flexible is the home? Does your family member have to get up at a certain time in the morning or is there still breakfast available if she sleeps in? Does he have to be in bed by a certain time at night or can he stay up and watch the hockey game?
• Location, location, location. Is it close to your home so it's easy to visit? Can your loved one's friends get there?
• Look for a connection with the community. How many volunteers does the home have? Do school or community groups visit? Do community programs take place there like day care, exercise classes or swimming lessons.
• What languages are spoken at the home? This is very important if English is a second language. Seniors with dementia or Alzheimer's often revert to their first language. You want to make sure there are staff who can communicate with your family member.
• Call the home with questions. How fast you get a response and how well they answer tells you a lot. If a home doesn't have time for you while they're wooing you, they'll have less time once your loved one lives there.
• Go to the Ministry of Health's website to find out general information about the home, inspection results and complaints. health.gov.on.ca/english/public/program/ltc/26_reporting.html

Get the home of your choice

There are no guarantees and a lot of it is luck, so every little bit helps.

• Believe it or not, private rooms are the easiest to get and basic ward rooms are the hardest. Your odds of getting the home of your choice improve if you're willing to take any room.
• Pick three homes. You are allowed to pick as few as one and as many as three. Three gives you better odds of getting a bed sooner.
• Make sure you're comfortable with your top three choices. You can't hold out for number 1. Turn down a bed from any of the three and your loved one is off the list until there is a change in circumstances.
• Be realistic. If your family member is in hospital and your top three picks all have long waits, you're more likely to be put in a home you didn't choose. Take a look at homes with shorter waits to see if there are any you like. The Community Care Access Centre can tell you what homes have the shortest waits.

Be sure you get good care

Your job isn't over once your family member is in long-term care. In fact, it's just starting. Stay involved to make sure your loved one gets the best care.

• Take your family member for visits before moving in, if possible.
• Don't move in on a weekend. There aren't as many staff around to give you extra attention, and it will be harder to get answers to your questions.
• Get the name and number of at least one key contact. When you have questions or issues, go to that person. You'll develop a relationship, get better answers and have more consistency.
• Don't assume your family member's history has been passed to the home. Be prepared to brief them.
• Go to the post-admission conference. This is crucial. It's your one chance to have all of your loved one's key caregivers in the same room and have their undivided attention. Come with a list of questions or send it in advance so they know what to talk about.
• Tell the staff what you like as well as what you don't. If they know what makes you happy, they'll do it more.
• Visit regularly, but don't spend 24 hours a day there. Give your loved one enough space to adapt and get involved.
• Say no if the home makes what you consider to be an unreasonable request. Some homes ask family not to visit for the first week or even month. If you're not comfortable with that, discuss it.
• Get to know your family member's roommate or dinner companions. They're a second set of eyes who might see changes you don't or give you information about what's going on.
• Bring in old family movies or photos for staff to see. Tell them stories about your family member. Make sure they know your loved one's habits, such as did he always wear a shirt and tie or did he prefer jeans and a sweatshirt?
• Talk to your loved one about the home and if you're both happy with it.
• Join the family council or start one. It's one way you can improve the home.
• Read the residents' bill of rights at health.gov.on.ca/english/public/program/ltc/25_standards.html
• Call the ministry hotline at 1-866-434-0144 if you have complaints.
• Find a caregiver support group. Talking to other people identifies common issues and provides support.

Key numbers you should know

The basics of long-term care:

• Two-and-a-half hours of care is given to each resident a day. Personal support workers do most of it.
• Two baths a week is the norm.
• $1,513.53 a month is the price for a basic ward room. It's set by the province and all homes charge the same. A semi-private is $1,756.87 monthly and a private is $2,061.03.
• Twenty-one is how many nights a year you can be away from the home before losing your bed. That includes hospital stays.

• $53 a day allows you to keep the bed after 21 days away, but that's on top of normal fees. If you don't pay it, you're back looking at the first-available bed again when your loved one is ready to leave hospital.
• $300 a day is what Hamilton hospitals can charge patients who refuse the first available long-term-care bed.

Long-term care costs

BEST in CARE Inc. conducted a survey in 2006 that looked at the cost of various long term care options. Rates are based on averages of 23 cities (across 10 provinces).

Retirement residence:A long-term residence for independent seniors, in self-contained apartments, offering laundry, cleaning and some meals. No daily nursing care.
Accommodation: 1 bedroom or more.
Monthy/annual cost: $2,297.30/month, $27,567.60/year.

Retirement home: A long-term residential facility providing some personal services such as laundry and meals. No daily nursing care.
Accommodation: Private room.
Monthly/annual cost: $1,857.50/month, $22,290.24/year.

Nursing home*: A long-term residential facility providing both personal services and daily skilled nursing.
Accommodation: Ward Monthly/annual cost: $1,513.53/month, $18,162.36/year
Accommodation: Private room Monthly/annual cost: $2,061.04/month, $24,732.48/year
Accommodation: Semi-private Monthly/annual cost: $1,756.87/month, $21,082.44/year.

*Absolute Ontario figures
Source: BEST in CARE Inc.
Priscilla Schneidersmann/The Hamilton Spectator

(These tips were gleaned from seniors, caregivers and professionals in the field of long-term care.)

jfrketich@thespec.com

905-526-3349