Question from non-nurse

[Imnotanurse]

As my screen name states, I am not a nurse. I am coming here hoping to gain some clarity from professionals with inside information.

Here is the situation: As the sole caretaker for aging parents (father now deceased), I have many years experience dealing with providers in numerous settings. Many hospitals, clinics, and several long term care facilities. By and large, the nurses and physicians I have encountered have been top-notch; thorough, efficient, knowledgeable, and truly skilled professionals.

Additionally, in caring for my parents, I have worked with many social workers in hospitals, long-term care facilities, at the county level, and in private care management. Without fail, social services is always the weak link in the chain of care. Never has a social worker offered any useful guidance or knowledge in response to my questions. Standard response is always "I don't know. I can't help you." They have all been abrupt and eager to end any conversation. The very most help I have ever received from a social worker is when she thrust a list of about 60 nursing homes in my face and said, "here, pick one."

So, my question is this: From your standpoint, are all social workers like this? Or do I just have bad luck?

[Wile E Coyote, ASN, RN]

There are stiff fines and lawsuits awaiting the unlucky individual that makes a recommendation which is later brought to the attention of gov regulators or competitors to the receiver of the recommendation. Facilities are keen to avoid that, and such have policies against the practice. As already mentioned, there are better ways to decline the request.

[Anonymous865]

Examples of my interactions w/ SWs over the years:

Me:"Are there any nursing homes on this list you gave me that have better reputations than others?"

SW: "I don't know."

Me: "Are you aware of any nursing homes that care for (fill-in-the-blank-condition) better than others?"

SW: "I have no idea."

Me: "If you were in my position, how would you deal with the overwhelming responsibilities of caregiving? Are there any resources in the community that I can turn to?"

SW: "I don't know what to tell you."

Example of bad advice: Looking for a nursing home for dad. Hired a SW from a very expensive private case mgmt firm. SW's top choice was a facility that was closed six months later due to deplorable conditions and years of state and federal violations. (Dad died before we placed him in LTC.)

I could go on and on...

If you need to select a skilled nursing facility in the future, the U.S. government publishes information on the quality of care provided in Medicare and Medicaid-certified nursing homes. The tool allows you to search for nursing homes in a specific area and then compare them. It provides information on health and safety inspections, staffing, and quality measures like falls, pressure ulcers, restraint use, physical therapy, etc.

The link to the tool is

Medicare.gov Nursing Home Compare

(They provide a similar tool for comparing hospitals.)

Your state should be inspecting nursing homes. The inspection reports are available on line in my state. Google your state name and "nursing home inspections."

US News and World Reports publishes a list of "best" nursing homes like they do hospitals. You should be able to google and find the ones in your state.

I'm surprised that the social worker didn't at least point you to these resources. The reality is that for decisions this important you need to do the research yourself. What you value in a nursing home (e.g. a restraint-free environment) might be totally different from what someone else values (e.g. absolutely no falls for mom).

I'm also surprised the social worker didn't have more printed information for you. When my mother was hospitalized the hospital social worker gave us a 3 inch thick book of services available in our area for the elderly. It covered everything from organizations providing hot meals, to assistance with utility costs, to legal services, respite care for caregivers, senior daycare, help understanding your insurance, help filing taxes, home repairs, transportation services, etc. The social worker didn't arrange for any of those services, but he did give use the info on what was available and how to get those services.

[Libby1987]

I'm proactive and push for fast results and have a preconceived idea that social workers would be the same. Almost 30 yrs in and I'm still surprised when I don't see the tenaciousness of my stereotype. In my experience, their aptitude is more in listening/counseling than making things happen. I can think of a couple who are creative and persistent, and they are working in leadership roles.

[nutella, MSN, RN]

Family Caregiver Support Program

Life as a Caregiver and Dealing With Stress Caring for Aging Parents - AARP

and there are many more resources out there. Caregiver strain and the stress of caring for aging parents especially for the women who still care for their own children is well recognized. However, local resources can vary based on where you live.

Your local elder services/ council on aging agency probably has some fact sheets or other local resources information.

If you are looking to provide care for your parents at home, there are specific information available. If you are looking for a facility, I recommend you do some legwork.

The way it works in my area is that caregivers make a list of facilities that they consider and go to visit them. That is time intense but it will also give you a better idea of how the place actually looks like. Once there you can ask specific questions about their activities, staffing, surveys from DPH and so on and forth. Nursing home compare is a great resource but it does not tell you the whole story. It is based on data collection by Medicare and gives you an idea but a nursing home can have great ratings and still be not popular while a different place may have less good ratings but is well liked by residents.

Things to look for is how many LPN versus RN they staff - the best nursing homes in my area have a lot of RN and only few LPN while some of the not popular ones have mostly LPN with RN providing oversight as unit managers. A lot depends on the CNAs as they provide most of the basic care - if they have a high turn over, it is usually hard for the residents who like consistency.

Other things to consider is the need for special care - if your parent has dementia for example you can ask if they have a special unit and how they deal with dementia. Mileage varies here a lot. For example - there is a nursing home in my area that is not as popular in general because it is old and their residents have a lot of behavioral problems. But their dementia unit which is locked, is doing a better job IMO than some of the very expensive assisted living facilities with "memory care".

If you are looking into financing care you can talk to an elder lawyer or also the facilities. But bottom line is that Medicare does not pay for longterm care. If your parent qualifies for Medicaid due to low income, they will pay for longterm care but if your parent owns a house they will put a hold on that. If your parents have assets that are more than a small amount, they will have to pay with that first before they will qualify for Medicaid. Assisted living is private pay.

If you need more help at home, talk to the insurance and see what they offer. There are some Medicaid programs that offer more support at home and some managed Medicare products offer better care coordination than others.

Generally speaking, most SW are not familiar with the facilities and how they look like. They may know their reputation but will not tell you which one to prefer. Nowadays you have to be careful about that. The better places usually have a waiting list, in my area it is about 2 years for longterm care for one facility that is very popular.

If your parent is hospitalized, your go to resource is usually not the SW but the case manager who does D/C planning and can give you more information about facilities.

Another thing you need to be aware of is that as a caregiver for aging parents you should also ensure that advanced care planning is complete including POA/ HCP/ any advanced directives regarding code status and have a conversation with your parent while they are still able to do so.

The Conversation Project - Have You Had The Conversation?

This is important as it will really reduce the stress that is related to all end of life problems. It is better to talk with your parents about their wishes so when the time comes to make more decisions, you know what would be in their best interest. I often recommend this book regarding this topic:

Information For End Of Life Decision Making | End Of Life Decisions

If you look for hospice care at home, there are specific resources for that

How hospice works | Medicare.gov

and local resources are available.

If your parent qualifies for Veteran's benefits you can check that out as well. Especially for men it can be hard to find a facility that is a good fit because a lot of activities are geared to female residents. The VA has some specific programs that are geared towards men.

[LadysSolo]

As has been stated, recommendations are not permitted. Staff is also not permitted to make recommendations. What you need to do (I am in various nursing homes 5 days per week) is to go to them and casually observe interactions. Do not be "put off" by appearances, often the best care is NOT in the "prettiest" nursing homes (I would prefer them to spend money on staffing rather than "pretty", and some do.) Observe the staff interacting with residents. ASK if they have any specialty at the facility. Ask your family member's provider which several nursing homes they recommend, or ask where they have residents if you want them to follow your family member there. And MOST important, go on more than one occasion to casually observe (any facility or staff member can have a "bad day.")

[ottersloveoysters]

I'm sorry to hear you have had such poor experiences with social workers. My interactions with social workers have generally been very positive. If a question is asked that is out of their scope they will admit that and refer the patient or colleague to the appropriate person or entity. Everyone in healthcare gets asked questions they can't answer at some point. The responsible people admit they don't know and then go find someone else who can assist.

[kim0000]

Examples of my interactions w/ SWs over the years:

Me:"Are there any nursing homes on this list you gave me that have better reputations than others?"

SW: "I don't know."

Me: "Are you aware of any nursing homes that care for (fill-in-the-blank-condition) better than others?"

SW: "I have no idea."

Me: "If you were in my position, how would you deal with the overwhelming responsibilities of caregiving? Are there any resources in the community that I can turn to?"

SW: "I don't know what to tell you."

Example of bad advice: Looking for a nursing home for dad. Hired a SW from a very expensive private case mgmt firm. SW's top choice was a facility that was closed six months later due to deplorable conditions and years of state and federal violations. (Dad died before we placed him in LTC.)

I could go on and on...

I'm sorry you've had such terrible experiences. It is possible that the SWs are bound by legalities to not recommend one nursing home over another. For example, if they recommended one nursing home over another, they could get sued by the family if the facility ended up not meeting the family's expectations. They could also get sued by nursing facilities if it can be proven that they are endorsing one facility over another. I'm sure the list goes on. In this regard, they have to be impartial and allow the families to decide for themselves the facility that best suits the family's needs.

[loriangel14, RN]

Examples of my interactions w/ SWs over the years:

Me:"Are there any nursing homes on this list you gave me that have better reputations than others?"

SW: "I don't know."

Me: "Are you aware of any nursing homes that care for (fill-in-the-blank-condition) better than others?"

SW: "I have no idea."

Me: "If you were in my position, how would you deal with the overwhelming responsibilities of caregiving? Are there any resources in the community that I can turn to?"

SW: "I don't know what to tell you."

Example of bad advice: Looking for a nursing home for dad. Hired a SW from a very expensive private case mgmt firm. SW's top choice was a facility that was closed six months later due to deplorable conditions and years of state and federal violations. (Dad died before we placed him in LTC.)

I could go on and on...

Social workers are likely not allowed to promote or recommend and specific faciliies. Any opinions they have would also just be gossip and hearsay.

[softrbreeze]

Some of these responses may be what he/she was told to say to people also. Healthcare agencies do not want to be held liable for a decision that you make that turns out poorly. At my agency, for example, we provide a list of sitters for those asking, but we cannot recommend any of them even if we know them personally. The agencies put the responsibility for researching and interviewing those sitters on the person/s who will be paying them (not us). The list we provide is a courtesy only.

[artsmom, BSN, LPN]

As a home health nurse I frequently ask the SW's to see my patients/families. Some are great and try to offer up as many resources as they can, others are lackluster. What I see most often is that families can't accept the answers given. One particular family was set on finding free in home care- around the clock. This is impossible and the family did not want any help from the SW if she could not provide resources for free care. Unrealistic expectations. In terms of not answering you about which are the best care facilities- do your own research. There are websites for you to determine who you think will be the best for your loved ones, go to facilities, ask questions. I never recommend a facility because everyone has different experiences and expectations.

[JFronck]

Hello,

I have a question and am hoping someone will be able to help. Just over 2 years ago, I had a major heart attack. Although I was only 46 and in otherwise good health, I suffered a severe heart attack. Stress was a primary factor, and I am trying to make a career change to a Radiology Technician (ultimately an MRI Tech.). Does anyone know if you are permitted to work as a radiologist with a Pace Maker??? Before I go through the process of schooling and applying, I want to save some time if a Pace Maker would prevent me from performing the job. Thank you to ALL the nurses out there that helped me get through my time of illness and for giving me the inspiration to want to join the nursing field.

[BuckyBadgerRN, ASN, RN]

A radiologist is very different that a rad tech.

Hello,

I have a question and am hoping someone will be able to help. Just over 2 years ago, I had a major heart attack. Although I was only 46 and in otherwise good health, I suffered a severe heart attack. Stress was a primary factor, and I am trying to make a career change to a Radiology Technician (ultimately an MRI Tech.). Does anyone know if you are permitted to work as a radiologist with a Pace Maker??? Before I go through the process of schooling and applying, I want to save some time if a Pace Maker would prevent me from performing the job. Thank you to ALL the nurses out there that helped me get through my time of illness and for giving me the inspiration to want to join the nursing field.