ELDER CARE: Caring for California’s Aging Population : RESOURCE GUIDE: CARING FOR THE ELDERLY : Help in Making the Tough Nursing Home Decision

Moving into a nursing home or helping a loved one do so can be a frightening and traumatic experience. For many, giving up a home for an institution can be nearly as painful as losing a friend or relative to death, according to psychologists and psychiatrists.

Fortunately, taking up residence in a nursing home is not a move most Americans will ever have to make. According to various studies, only about 5% of frail, elderly people who need assistance end up in nursing facilities. Another 5% live with their grown children or other younger members of their families. The vast majority live on their own--albeit with help.

There are situations, however, when the help that is necessary is simply not available. In some cases, it is too costly. In others, the logistics are too complicated. And in many cases, the psychological burdens are tremendous. When the disadvantages begin to outweigh the advantages, institutional care needs to be considered, experts say.

The first and perhaps the hardest step is to recognize the situation for what it is. Sometimes it takes advice from a professional whose emotions won’t get in the way of assessing what’s best for everyone involved, not only for the people who need the care but also for those giving it.

Once a decision has been made that institutional care is the least problematic of the options, the next step is to find a suitable place for the elderly person, either permanently or temporarily. That, too, is not always an easy task.

There are a variety of places to turn for help: hospital discharge offices, senior citizen centers, private care agencies, churches and synagogues. In many communities, there are also government-operated nursing home referral offices that will provide information on conditions at homes and whether they have been cited for any safety or health violations.

Mainly, however, according to people who have gone through the steps of placing a family member in a nursing home, it is a matter of asking many questions of a variety of people and doing a great deal of legwork.

The first question to ask: What level of care is needed?

Board-and-care homes typically provide meals, laundry and cleaning services but little else. Intermediate nursing-care facilities provide some medical and some personal care, as well as other basic services. Custodial-care homes provide a full range of services for people who are partly or totally incapacitated. A few institutions provide a range of services, so that residents do not necessarily need to move as their needs change.

It is important to take a close look at the facility before signing up. Is it clean? Does it smell good? Are the residents dressed? Are they sitting doing nothing or are they involved in activities?

Location and timing can also be factors. Does the family want to visit frequently? If so, having the facility nearby is important. Is it important to get a person admitted immediately, or is there time to wait? Some, though not all, of the best facilities have long waiting lists, so planing ahead can pay off.

Costs are also an important factor for most families. On average, costs run $25,000 a year in California, although some families manage on less and others spend a great deal more. It is important to find out what the daily charges are to determine if there are additional hidden charges.

It is also very important to inquire what happens if a resident runs out of money and must rely solely on Medi-Cal or Medicaid to pay the bills. Will the resident have to move to a less desirable facility where costs are lower? In some states, including California, there are laws prohibiting discrimination against low-income residents, but such laws are not always observed.

Once a nursing home has been selected, family members are urged to be vigilant in seeing that proper care is provided. If it is not, families should make their feelings known, first to the nursing home administration and then, if no action is taken, to a nursing home ombudsman who has the power to investigate and mediate problems between nursing homes and their residents.