The choice of a nursing home has everything to do with the needs of the person with dementia. Look closely at what the reason is for the placement. Has this person just begun behaviors that the current caregiver can no longer handle? Is this person in another nursing facility that is just not meeting their needs? Is this a very large person, and the caregiver can no longer physically handle the work involved in their care?Match the reason to the services that the nursing home offers.

If the patient is always trying to walk away, question nursing home personnel about their security measures. They should have electronic monitoring systems that assure families that patients cannot leave the nursing home unattended. There should be hourly safety checks in place on all three shifts, so that a staff member is actually seeing where this patient is and what they are doing. There should be a picture of this patient at the reception desk as well as an alarm at all doors, connected to the monitoring system. The staff should indicate to the visiting family, where the security cameras are as well as who is monitoring the cameras.

If the patient needs placement because they have become more agitated and physically aggressive. Ask detailed questions about what kinds of medications the nursing home uses for behaviors. Ask what kinds of other non-drug related ways they work with the difficult patient. What does the activity program look like, and how many activity staff does the nursing home employ. There should always be an emphasis on the use of activities and getting to know the patients likes and dislikes (person centered care). The nursing home personnel should verbalize that they only use medications for behaviors as a last resort. Those types of medications should be reviewed  on a regular basis with ongoing plans for medication reduction.

If the large size of the patient is a consideration, ask about the nursing home’s equipment. Look at the size of the beds, and types of mattresses. A very large person will tend not to re position themselves  in bed as often as a slim person. This lack of movement as well as the additional weight of the person can be a cause of skin breakdown. While asking about available mattresses is an important question for any patient, it is even more so for the very large patient.

There are as many reasons for placement in a nursing, as there are patients needing placement.  Most families tend to not relocate their loved one once a choice has been made. Finding that right place where not only the patient feels comfortable but the family as well, is all important for a sucessful placement.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing