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Elders with Special Needs: Four Questions for Your Nursing Home Search

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When a loved one has special needs or a specific handicap – from an autism spectrum disorder (ASD) to Alzheimer’s or another complex medical condition – selecting a nursing home becomes a more intricate, complex process.

From our experience navigating the long-term care system, we’ve found there are four questions you can ask to guide your decision in choosing a nursing home or long-term care facility for someone with special needs.

What Does a “Special Need” Mean?

First, a few parameters. “Special needs” broadly includes anyone with a complex condition affecting their daily life, and more and more seniors are finding themselves included in this category. Only 45% of over-65s reported their health as good or excellent in 2018, according to one study, with many afflicted by conditions like heart disease, diabetes, and arthritis. Social conditions, like poverty, can create or exacerbate health problems, and the same study suggests that just under 10% of older adults live below the federal poverty line.

For the purposes of this blog post, a special need can refer to a mental impairment, like autism or dementia, or any complex chronic disease. Older people are at a higher risk of suffering from these conditions undiagnosed, especially in the case of autism spectrum disorders (ASDs).

1. Can the facility handle your loved one’s special needs?

Often struggling simply to maintain their general operations, a typical nursing home would be hard-pressed to provide you or your loved one with the additional services they need. It’s therefore vitally important to consider how your loved one’s condition will affect their experiences in a facility.

The caregiver of a dementia patient may know they can become physically aggressive when confused or distressed. This may be predictable for the caregiver and manageable with strategies they have developed. But many nursing facilities are not able to appropriately respond. Overstressed staff are vulnerable to “compassion fatigue,” sadly frequent in these types of settings, and may reciprocate the aggression rather than de-escalating it.

Some facilities may vaguely assure you of their experience in managing conditions like that of your loved one’s, but it’s best to get as specific as possible with your questions. A good rule of thumb is to change “Have you?” questions into “How have you…” or “How would you…?” – giving a stronger sense of that facility’s experience and preparation.

2. Does the facility have sufficient staffing?

Nursing homes and long-term care facilities are required by law to keep robust and accurate staffing records, including for direct-care registered nurses, certified nursing assistants, and licensed practical nurses.

Medicare’s Nursing Home Compare tool is a great resource, allowing you to compare things like average number of residents and licensed nurse staff hours per resident to both state and national averages. The more resourced a facility is, the more time nurses can spend with residents. And more attention leads to better outcomes for the safety and wellbeing of special needs patients.

3. Is the physical environment accessible and inclusive?

It’s also important to consider whether facilities have the physical spaces required to integrate those with special needs into the residential community. Examples include small group gatherings and quiet rooms for people prone to sensory overload, or specialized units for those with Alzheimer’s/dementia. In-person tours have become less accessible since the COVID-19 pandemic, but do not hesitate to ask for a virtual facility tour wherever possible.

4. Have you asked around for referrals?

Word of mouth is often the best indicator of whether a nursing home or care facility is suited for those with special needs. Local advocacy groups, as well as caregivers, friends, and family members may be able to point you in the right direction. It is important never to settle; keep searching until you know you’ve found “the one.”

If you have questions about the legal aspects of long-term care planning, an experienced elder law attorney is an invaluable resource. Reach out to Jehl Law Group today.

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