Many families find themselves seeking information and help when a loved one experiences a crisis that has been brought on by acute illness, accident or disease. Often, appropriate help is found and the individual recovers after a treatment and recuperation period. At other times, however, a full recovery is not possible. The crisis event represents the last straw, the painful reality that a loved one’s physical or mental health has declined to the point that he/she can no longer take care of himself/herself and be safe. This reality is difficult to accept for both the individual and family members. Loss of ability to care for oneself represents a huge change in lifestyle and support needs, and can place a family under intense strain. As families consider care options, they need to follow a series of steps to assure that they make the best decisions possible.

1. Medical Exam
It is imperative that your loved one has a complete physical exam in order to help determine the causes of any problems being experienced. Symptoms like confusion, depression and memory loss may be the result of infection, thyroid imbalance, trauma, stroke or medications, and may not herald the onset of dementia or Alzheimer’s disease. Without a proper medical evaluation, your loved one may not be correctly diagnosed or treated.

2. Community Resources
Durham County currently offers a variety of services for aged and disabled adults; however, there is a general lack of knowledge about these services because of fragmentation in the system of service delivery. In order to make informed decisions, families must know what options are available to choose from. A good information source in Durham County is Resources for Seniors, Inc. Resources for Seniors, formerly known as Council on Aging of Durham County, is a nonprofit agency that has been in operation since 1973 providing home and community based services to aged and disabled adults. Resources for Seniors has an extensive Resource Directory that can be accessed electronically at www.resourcesforseniors.com. Additional information can be obtained by calling Resources for Seniors at 919-872-7933.

3. Long-Term Care Facilities
A. If residential placement is the option chosen for a loved one, care must be taken to choose a facility that is a good match for the individual being placed and that provides high quality care. The better informed a family is about a particular facility, the greater the likelihood that a successful placement will occur. After a physician determines the level of care that an individual needs, the family should investigate which local facilities provide this level of care, which facilities the family/individual can afford, and which facilities provide high quality care. To answer these questions, families can access the following resources:

• The NC Division of Facility Services—maintains an electronic directory of all licensed facilities grouped by licensure category and county.
• Compliance information for Durham County nursing homes can be accessed at www.medicare.gov.
• Compliance information for Durham County adult care homes can be accessed at www.Durhamcountync.gov
• Compliance information for mental health group homes (supervised living) can be obtained from calling the Licensure and Certification Section at the NC Division of Facility Services, 919-733-7461.
• Individual facilities can provide information regarding types of payment accepted and fee schedules.

• It does not matter how much a family likes a particular facility if the loved one does not. The loved one is the person who will be residing there, so he/she must “buy-in” to the placement process. Adults who have not been adjudicated incompetent in a court of law have the legal right to determine where they will live regardless of what family members think is best, and have every right to discharge themselves from a facility if they wish.
• Facilities should be chosen based on the care they provide—not on how nice they look or where they are located. Aesthetics and convenience are of little consequence if a loved one’s care needs are not met.
• Placement in a long-term care facility does not necessarily equate with aging in place. Categories of licensure define the kind of care provided by different types of facilities, and provide guidelines as to individuals appropriately served. As the care needs of an individual change, he/she may need to relocate to another type of facility in order to have needs met.
• Any policies that a facility has should be documented in writing and given to prospective families/residents. If a policy is not in writing, it does not exist. Facility policies may not conflict with state licensure rules, so check with the Division of Facility Services regarding state or federal rules if there are any questions.
• Discharge from a facility can be a stressful time if the resident/family does not want to relocate. Discharge rules governing nursing homes and adult care homes are very strict and grant the resident/guardian the right of appeal if the facility initiates the discharge. Taking time to become educated about discharge rules is time well spent.
• Facilities do not provide one-on-one care. Adults needing this level of supervision need to seek services elsewhere.

• Become educated about the continuum of services offered in the community.
• Take time to ask questions and seek help from a variety of sources.
• Put the needs of your loved one before your own.
• Do not tolerate poor quality care and services. Speak up about any concerns that you have.
• Do not patronize agencies or facilities that fail to deliver services paid for and expected.
• Advocate on behalf of your community’s senior and disabled adults