Considerations When Seeking a Long-term Care Home

I was recently invited to speak on a radio program about changes to regulations around long-term care admissions in Ontario.

During the segment, many listeners shared their questions. While I had initially assumed these would be about the changes to legislation, most people were asking how to choose a long-term care home for their loved ones, and what types of things they should be looking for what questions they should ask when touring the home.

I was struck by the universality of these questions.

Regardless of where you are in Canada, placing a loved one in long-term care is rarely a decision to be taken lightly. Choosing a home for a friend or family member often involves care and study and ultimately may even depend on a “gut feeling” about the different homes available.

Given that many individuals moving into long-term care may be living with dementia and may not be able to make the choice themselves, those doing the placement may feel a very strong responsibility to make the “right” placement.

The following is a general overview of some key considerations when starting the process for care placement, while recognizing that some individuals may not have the luxury of choice due to their current care needs, their location (e.g., a more rural community that only has one long-term care home), or the timing of their admission.

It is also important to note that some jurisdictions in Canada offer websites that list each of the long-term care homes and any inspections made or complaints filed. Such a resource may help you in narrowing down your list of homes to consider.

Photo courtesy of Getty Images.

Culture of care

The long-term care system has traditionally been run from a very medicalized perspective. Indeed, the outdated term “nursing home” reflects this more traditional way of thinking.

While it is true that individuals living in long-term care typically require more specialized medical care (and, indeed, that is why many have moved to the home), a more person-centred, holistic model of care has been introduced over the past few decades. Many operators have been modifying their culture of care to focus on all domains of well-being: the cognitive, emotional, spiritual and social domains, in addition to providing physical care. This change reflects the fact that people cannot and should not be defined solely by their medical conditions.

Indeed, the language we use is also changing. People are no longer called “demented” or described as an “Alzheimer’s patient”; rather, we encourage the use of terms like “living with dementia” to reflect the fact that while a person may be experiencing a medical condition, they are still an individual, with likes, dislikes, motivations and moods.

• Consider the wording used on the home’s website and in promotional materials.
• Listen to the words used by staff to describe residents while you tour the space.
• Ask about each organization’s culture change journey to learn more about their overarching philosophy of care.

"A major part of living in long-term care is the availability of meaningful and purposeful activities that will serve to activate the individual, contribute to all domains of well-being and provide them with opportunities for learning, pleasure and social connection."

– Dr. Kate Dupuis

Services and recreation opportunities offered

A major part of living in long-term care is the availability of meaningful and purposeful activities that will serve to activate the individual, contribute to all domains of well-being and provide them with opportunities for learning, pleasure and social connection.

While a large part of the care plan will revolve around personal care and dietary needs, life is more than only our physical health. The availability of opportunities for stimulation and growth is crucial right across the lifespan.

• Ask to review a monthly activity/recreation calendar, inquire about “free-range” activities that may happen more organically (e.g., unit dance parties) and may not be on the calendar.
• Observe whether there are outdoor garden/walking/meditation spaces and inquire about opportunities to leave the home for recreation purposes (e.g., Swiss Chalet luncheons).

Physical space

As you move through the building on your tour, take note of the physical space offered.

Photo courtesy of Getty Images.

• Is there a lot of natural light, wide hallways with handrails to make ambulation easier, carpeting and wall panels to attenuate sounds (key to communication as the majority of older individuals are living with untreated hearing loss)?
• Does the home have visual elements that can hold attention of residents, such as pets (e.g., Baycrest Health Sciences in Toronto used to have two parrots in their main hallway), aquariums or a greenhouse with real plants?
• Are the common areas kept clean and tidy?
• Are transition points between carpets/hallways clearly marked (important as perceptual issues are common in dementia)?

Photo courtesy of Canva.

Personalization

Many homes are increasing their focus on resident inclusion, offering programs and events for individuals from different cultural and faith-based backgrounds (e.g., “Winter celebrations” rather than focusing solely on one specific religious holiday at this time of year), and hiring staff who speak a variety of languages to aid communication with residents who may be reverting to their first language learned.

Consider asking about dietary options for your loved one, and question how the home will accommodate different nutritional needs and preferences. Mealtime is an important part of every day, but some residents may prefer to simply have a cup of coffee in their room rather than come down to the dining room for a full breakfast.

• Ask the home how they accommodate individual preferences around eating and mealtimes.

Levels of care and visiting

If you are not personally currently in need of care, but wish to remain close to your loved one, you may consider an operator that offers long-term care in one building or wing, and more independent, suite-based living options in another. This may provide you with the opportunity to move closer to your loved one. Integrating into their life in long-term care will be easier (and will cut down on your commuting time!).

• If you will be driving to your visits, what is the availability and proximity of visitor parking? If you do not drive, is there transit nearby and/or does the home offer a shuttle to a local mall/shopping centre if you wanted to take a day trip out of the home with your loved one?
• If you do plan on visiting often, inquire about your ability to participate in activities (should you so choose), and whether there is a family council you could join or even meet members of during your tour.

Some homes may offer support groups or liaise with local adult day programs and outreach organizations (e.g., the local chapter of the Alzheimer Society) to provide support for loved ones either in-person or virtually. If you feel you would benefit from this type of programming, be sure to ask the home about this.