Transitioning from Home to Long-Term Care

Admitting a loved one to long-term care is often a difficult decision. The past few months or years have been a struggle. There have been numerous trips and admissions to the hospital. The aging adult, family, and healthcare team have made the decision that the time has come to consider placement into a long-term care (LTC) facility.

Wait times for admission to a personal care home (PCH) vary from weeks to months to years. Although there is usually a long wait prior to admission, it then happens quite suddenly. Once a bed becomes available, the expectation is to move in within a day or two. This is where panic can strike. So many decisions to make, typically in a noticeably brief period. Therefore, having conversations early in the aging trajectory is helpful in alleviating some of the stress immediately prior to admission to LTC.

It is highly beneficial for all older adults to be having these discussions and making decisions long before they are on the doorstep of needing to, but often it just does not happen. It would be helpful if healthcare providers were prepared to guide and often initiate discussions and provide information.

When an older adult is admitted into the hospital, nurses should take this as a prime opportunity to have conversations with the patient and family regarding what lies ahead. It is imperative that healthcare personnel take this seriously, as many patients and families have no idea what the process is. This lack of information causes needless anxiety. So, be kind and share the information and guidance that will make their journey easier.

Let’s Talk About It Sooner Rather Than Later

1- Discussion Topics

• Who will care for me if I become seriously ill and can no longer care for myself in my home?
• Is my will prepared?
• Who will be my Power of Attorney, and have I given them access to all my important documents and accounts?
• Do I want a different person to make my health care decisions if I am unable?
• Do the people who may make decisions for me, if I am unable, know what I want?
• Am I up to date with my income tax filing? (This will determine your pay rate in the home).
• What type of medical intervention do I want? Advanced Care Plan (ACP).
• Would I consider Medical Assistance in Dying (MAID)

2- The Process of Admission to PCH

It is often the family that initiates the process by recognizing it is no longer safe for the older adult to remain at home and/or the family is unable to care for them any longer. Admission to long-term care is typically a last resort. Before this time, there has usually been maximum support placed in the home through community services/Home Care. The Home Care Coordinator will consult the long-term care access center (this will differ depending on your location) to begin the process of panelling. The coordinating center will assign a case coordinator who will complete the application along with the family, the physician, and members of the health care team.

Once the panelling assessment is complete and approved, the person is placed on a waitlist for their preferred site. At times, the client may end up in a facility, not of their choice, for an interim placement until a bed is available in their home of choice.

3- Take Tours and Ask Questions

Once it is evident that the older adult can no longer cope in their home, it is time to consider where they want to live. If time is not a deterrent, tour all the homes of interest and get a feel for what you like or do not like. Touring the facility before admission presents the opportunity to have questions answered that may alleviate some of the anxiety. The person being admitted may also benefit from attending the tour if possible. Getting a visual of the future room will assist in making decisions of furnishing or decorating the room.

Here are a few questions to ask

• What furniture/décor can and cannot be brought into the room?
• What services are offered, and is there a cost? -occupational therapy, physical therapy, dental, podiatry, dietary, recreation, spiritual care, physician coverage, medication provision, taking their loved one out, etc.
• What are the visiting policies?
• What happens if there is an infectious outbreak?

4- Decide what to Take to the PCH

Most rooms in a PCH have limited space, and therefore limited items can be brought in. Too many possessions in a room make for an unsafe environment, thereby increasing the risk of falls for residents and staff. Thus, being selective in what is brought into the room is important. Go through possessions with the older adult and decide what is truly meaningful to them. This can be an arduous process. Photos and albums are often a wonderful addition to a room as they do not take up a lot of space, and they often bring joy to the resident. This can be a time-consuming process, so again another reason to begin sooner rather than later.

5- Complete a “Get to Know You” Record

Having pertinent and interesting information about the aging adult will assist the PCH team in getting to know the family member better and thereby making an individualized care plan that is suited to them. When preparing this information, be sure to Include likes, dislikes, careers, jobs, special memories, important accomplishments, hobbies, favorite books, etc.

6- Admission Day

Arrive at the agreed-upon time and accompany your loved one if possible. Seeing a familiar face amongst all the new ones is comforting. Bring their personal items and help to set up their room according to their preferences. Items of clothing and bedding will usually be brought to the laundry department, laundered, and labeled with the resident’s name. Time will also be required to complete admission forms.

7- Lastly, Give It Time

There is a substantial amount of loss when a person enters a PCH: personal home, most possessions, freedoms, personal space, choices, etc. These losses may result in a period of grieving, causing residents not to be thrilled with their new homes. There may be complaints. The support and encouragement of family and friends are especially important at this time. Give it time; things will get better. Friends will be made, staff will become familiar, and routines will be embraced. In a few months, usually, everything will be settled, and life will hopefully be enjoyable.

There is relief found in 24/7 care, having nourishing meals and snacks provided at regular intervals, having a nice hot bath in safety, and having all the basic needs met in a safe and caring environment. There is also the benefit of socializing with others of a similar age and ability and engaging in age-appropriate recreation.

Admission to a PCH will never be without challenges although many of the issues can be alleviated with discussion and education prior to admission resulting in a smoother transition from home to a personal care home.

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References/Resources

Advocacy Centre for the Elderly: Powers of Attorney

Dying With Dignity Canada, Inc.: Get the facts: Canada’s medical assistance in dying (MAID) law

Alzheimer Society of Canada: Long-Term Care: Preparing for a Move

Island Health: Long-Term Care Access Guide

National Institute on Aging: What Is Long-Term Care?

Winnipeg Regional Health Authority: What you need to know about personal care home eligibility