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How to Choose A Nursing Home

Introduction

Most care givers do not want to leave their loved ones in a nursing home. However, situations may arise that make placing the patient in an institution a necessity and no longer a choice. These include:

  1. the inability to care for the patient adequately (unable to devote the time required)
  2. carer burn-out (the carer is too stressed out from caring for the patient).
  3. more specialized care is needed (eg complicated wound dressing etc).

At that point, intermediate or skilled nursing-care may be required on a short, medium term or even permanent basis.

It is a difficult decision to make, but often necessary.

Types of Facilities

In Malaysia, there are broadly 3 categories of nursing facilities

  1. Long-term or permanent
  2. Short-term, usually where the patient need a short-stay after post discharge for rehabilitation or as a short break for an over-burdened care giver
  3. Day care centers, where patients are supervised during the day but looked after at home overnight by the care givers.

These services are provided for by Government, Non-Governmental Organisations or for profit set-ups. The majority of facilities however are of the long-term or permanent type. Some of the centers are staffed by trained nurses, others by semi or non-medically qualified aids. Occasionally, there may be a visiting doctor or therapist.

There is no formal legislation concerning the set up or running of nursing home services in Malaysia, so it is quite common to see a wide degree of difference between the quality of care provided by these set-ups. Therefore, it is prudent to do some research on the centers before deciding the best one for the patient. These include:

Determine the type of care which is needed

Patients who need help for basic activities of daily living (eg. bathing, toileting, eating) would require nursing care (essentially non-medical care and can be administered by aids rather than medical personnel.) These more dependent patients (who are not expected to regain function either because of advanced disease conditions or poor potential) are usually long-term residents. Your doctor would be the best person to tell you whether the patient has good potential or not to regain his/her functions. Therefore, before deciding on the type of nursing home, it is wise to speak to the doctor beforehand for the patients prognosis.

Residents who need rehabilitative therapy and medications in addition to nursing care are candidates for intermediate care. Intermediate care is delivered by licensed therapists and registered or licensed practical nurses. They may be expected to stay for the short to medium-term only and be back to the community once he/she regains function.

Short-term care is needed when a care giver needs a short break from his/her duties either for a rest or maybe a short trip. This is known as respite care. During this time, the care givers duties are taken over by the nursing home staff and the patient goes back home once the care givers return.

Patients, who are living with their care givers but are alone when they are working for example, may benefit from a daycare center. Such centers may even have a day programme for patients focusing on various aspects eg rehabilitation, dementia etc.

Finances

Nursing-care maybe expensive, so the type of facilities and services you choose maybe limited by the funds available. The Government homes are subsidized while the NGO-run ones charge a nominal fee. For profit-groups are the most common types in Malaysia. Care givers may apply for some assistance from the Welfare Department or Jabatan Kebajikan Masyarakat. Religious bodies (eg. the respective state’s Jabatan Agama Islam) or the local Wakil Rakyat’s office may also be sources for possible assistance.

Things to Look Out For

You should look for facilities that offer the type of care needed, are geographically-convenient (so that you can visit the patient often and easily), are within your price range, and most importantly have available beds.

The next step is to arrange a personal inspection visit and enquire about:

  1. Services: Does the home provide physical, occupational, or speech therapy, social activities, television? Be sure to ask which of these are included in the monthly fee and which entail special charges. Medical services eg. a resident or on-call doctor is usually charged separately. Arrangements for emergency care eg. Hospital admissions etc also need to be determined beforehand as some places are lacking in such services. Some patients may need to go for follow-up care at the hospital or clinic. So ask if the nursing home is able to provide transport services as well.
  2. Staff: Find out how many registered nurses are the staff; how often the doctor visits; how many staff are on duty during the day and on the night shift and what is the ratio of staff to patients; and what arrangements have been made for ambulance or emergency service. Speak to some of the other relatives for opinions on the staff’s attitude and competency. As a general rule, patients needing higher levels of care (eg. rehabilitative care or wound care) would need more qualified-staff.
  3. Environment: The facility should be comfortable and not too crowded with good ventilation. Fire precautions eg sprinklers or alarms are also important. The toilets and facilities should also be elderly-friendly. The security of the place is also important.
  4. Meals and medication: The meals should be balanced and suitable for the patients (eg chewable diets for patients with no teeth) or liquid diets for those on tube feeding. Ask if there are certain medications that the home does not have (but the patients needs as these must be prepared in advance to ensure that the patients do not miss them)
  5. Contract : Ask to see the contract with the home before agreeing to sign-up for it. Read it carefully and ask questions to clear any doubt.

Always look at a few set-ups before deciding on your choice and visit the place often to see the patient to ensure that he/she is receiving the best care possible.

Last Review : 20 June 2014
Writer : Dr. George Taye Wei Chun
Reviewed : Dr. Ungku Ahmad Ameen bin Ungku Mohd Zam