Most of us would prefer not to live in a nursing home. But today's facilities are nothing like the nursing homes of the past. Instead of hospital-like settings, many nursing homes now have a homey look. Rooms are often clustered in small neighborhoods rather than stretched along lengthy corridors.



The approach at nursing centers is different today too. Many building administrators have adopted a philosophy known as person-centered care, where the resident is the focus. Staffers are no longer bound to strict schedules and routines. The resident is treated as a whole person who needs activities and lots of human contact.



"Nursing homes have changed dramatically," says Amy Iacch, corporate director of clinical services at Lutheran Life Communities. The Arlington Heights-based organization has five retirement campuses. "The setting is less institutional and we work to build real relationships with residents."



While nursing homes are changing their approach, the typical nursing home resident is changing too. Most nursing homes have two kinds of residents. One category of resident consists of those who are there only for a short-term stay to recuperate after a hospitalization for illness or surgery. These short-term stays can last as long as about 90 days and are usually paid for by Medicare.



Other residents actually live at the nursing facility. It is truly the elder's home. The resident is typically someone who needs round-the-clock supervision by a nurse and other medical professionals.



Susan Dudish-Poulsen had no choice but to find a nursing home for her mother who had a severe stroke and lost the use of the right side of her body and could no longer communicate. "It was a very difficult decision," says Dudish-Poulsen. "Nobody wants their mom in a nursing home." She considered other options, such as moving her mom in with her and hiring a 24-hour caretaker. But with four young children and other issues, she decided a nursing home was really the only alternative. "It's the best place for her," says Dudish-Poulsen.



Frail residents



Those with complex medical needs are more likely to be long-term residents of nursing homes nowadays, building administrators say. "Many residents have co-morbidities, such as diabetes and a heart condition," notes Beth Welch, administrator at the DuPage Convalescent Center. The building, located in Wheaton and operated by DuPage County, has 310 beds for long-term residents. "Our residents need to be medically managed."



Thirty years ago, it was more common to find healthier elders living in nursing homes than those who live there today. Back then there were few options for elders who needed only a little help. But over the last 20 years, new types of elder care buildings have emerged. Many people who would have previously been living in nursing homes are now living in assisted living buildings. Even though nursing homes have a large population of elders with dementia, there are now buildings available that provide care only for those with memory problems.



Determining care



How do you know if your relative really needs to live in a nursing home? Typically, most candidates for a nursing home must have two or more areas of activity for which they need complete assistance. It could be that the person cannot get himself into or out of bed without help. Or maybe the person cannot feed himself. "Someone with bad pressure ulcers to their skin is really not right for assisted living," notes Jeanne Heid-Grubman, health care administrator at the Holmstad, a retirement community in Batavia.



Also, an assessment is typically made of the elder's capabilities before the move to a nursing home. An outside agency usually conducts the assessment, not the nursing home or a hospital. DuPage County Senior Services handles assessments for the DuPage Convalescent Center.



Crisis mode



In many situations, it's often apparent that a senior must live in the supervised environment of a nursing home. But selecting one can still be a difficult decision, especially since it often must be made quickly during a crisis.



"We had 48 hours to find a nursing home for my mom," says Dudish-Poulsen. The hospital gave her a list of places to visit. "We didn't have much time."



Dudish-Poulsen visited three nursing homes. She says the first two she toured looked nice, but seemed short on staff. She finally settled on the DuPage Convalescent Center because it had a high ratio of aides and nurses to residents. "There were a lot of activities for residents too," notes Dudish-Poulsen. She also checked the government website Nursing Home Compare (www.medicare.gov/NHCompare). It compares nursing homes based on certain criteria. She read the evaluations regularly performed by the Department of Public Health.



Experts also suggest talking to residents and their families. "You have to visit and ask questions," says Cathy Nelson, senior director of clinical services at Life Services Network, a consortium of seniors housing and service providers based in Lisle.



A big obstacle in the search for a good nursing home is the cost. Monthly bills average about $7,000. While most seniors receive Social Security payments, it isn't enough to pay the bills at a nursing home. Seniors tap their savings to make up the difference.



But when the money runs out, or if there isn't enough money to get a spot in a nursing home in the first place, seniors turn to the Medicaid program. It pays for nursing home care as long as the senior is eligible. That means the senior cannot have a lot of assets and must need round-the-clock medical supervision.



Nursing homes usually have a mix of residents who get help from the Medicaid program and those who pay their own way. Some homes are certified only to take a certain number of Medicaid recipients. Ask the building administrator up front whether the facility accepts Medicaid, suggests Nelson at Life Services Network. If there's an immediate need for financial assistance, the building staff can help initiate the Medicaid application. Nelson says: "Many facilities will accept a person whose Medicaid application is pending."