In a world full of tough decisions, one of the very toughest is whether and when to enter a nursing home.
And if you're making the decision for or helping a loved one make the decision, it's even tougher.
Payson, of course, has two nursing homes -- Manzanita Skilled Nursing and Rehabilitation Center and Payson Care Center. Both facilities are state-licensed and meet federal standards.
In addition to the basics -- meals, laundry, housekeeping, medical and nursing services -- both facilities also offer dietary, recreational and social services, plus occupational therapy, physical therapy, and speech therapy.
Manzanita Skilled Nursing
Manzanita, which has 109 beds, is particularly proud of its rehabilitation and therapy unit, which opened two years ago when a new wing was added to the facility. Tom Richey, who oversees the rehab and therapy area, explained that occupational therapy is not exactly what it sounds like.
"Occupational therapy is typically that element that does the re-training -- that takes the person who has been institutionalized for whatever reason and gets them finally ready to move back home," Richey said. "It's got washers, dryers, a kitchen sink, a bed, a shower area. You train them to do the elements you deal with at home."
Manzanita utilizes a cowboy theme with hallways named after John Wayne, Gabby Hayes and Mae West. A wing for patients who are pretty much able to take care of themselves is called the Way Station, while the long-term care and behavior unit is known as the Pony Express.
Manzanita also offers private rooms, primarily for hospice patients so families members can stay with them, and the older portion of the facility is currently being renovated and converted into a behavioral health services unit.
"It will be a secure unit, primarily for folks who tend to act out -- who don't fall within the normal geriatric populations, folks that are functioning in ways that they don't fit into a general population," Dan Belisle, interim administrator, said.
Another aspect of Manzanita's physical facility is that it is more spacious than many nursing homes, with lots of patios and lounges for patients. Manzanita even has an aviary in one hallway.
"One of the interesting things about the physical plant is that most facilities are lacking for extra space," Belisle said. "This building has lots of that. Whoever built it thought about oversizing dining rooms and activity areas, and that's not common."
But the people who work at Manzanita, which recently went through a difficult management transition, say their biggest selling point is a staff that is second to none.
"Why we stand out so much now is because of the staff we have here," Shelly McSpadden, director of nursing, said. "All the way from laundry, housekeeping, down to dietary and nursing -- everyone is just wonderful.
"This is the most caring staff I've ever come across in my nursing career. They're dedicated, they're experienced, they go beyond the norm."
Carla Carter, who has been a nurse at Manzanita for four years, returns the compliment.
"We're so close to being the best, and right now, honestly, it's the best I've ever seen it," Carter said. "This administration is wonderful."
Manzanita is one of 40 nursing homes in Missouri, Arkansas and Arizona owned by Health Facilities, including facilities in Kingman, Lake Havasu, Yuma and Prescott.
"Their niche is rural health care, and they've been in Arizona for 20 years," Belisle said.
Payson Care Center
A 163-bed facility, Payson Care Center also provides several levels of service.
"We have patients who come from the hospital for rehabilitation, and they're the shortest term," Lucinda Campbell, director of nursing, said. "Then we have long-term care residents, and they're actually the residents. Those are the people who live here and this is their final home."
Payson Care Center also has an Alzheimer's unit.
"Those are the residents who have various stages of Alzheimer's who have a potential to wander, and since we're surrounded by forest that can be a very bad thing," Campbell said.
Like Manzanita, Payson Care Center offers a full-service rehabilitation department.
"The largest service we do is actually our rehab wing, and the average stay there is 30-40 days," Campbell said.
Payson Care Center has also added some new services, including anodyne therapy.
"It's an infrared light (treatment) that is cutting edge rehabilitation therapy for neuropathic or circulatory problems of the lower limbs," Campbell said. "It's done on an outpatient basis."
Payson Care Center is also about to undergo some renovations.
"The decorator is coming out from corporate in the next two months and we're going to get a remodel, starting with the public areas -- the dining rooms and lobbies -- working our way around to the older wing," Campbell said.
Besides meeting their needs, the employees at Patient Care Center try to meet their patients' wants as well.
"I've been here a little over two years, and in that time we've added the focus of a lot of customer service, because my personal philosophy is that it's their home and it's what the residents want not what we want," Campbell said.
That's especially true when it comes to activities.
"We go to the casino, have picnics, drive to the mountains to watch the leaves change," Campbell said. "The residents drive the activities; if there's something a group of residents want to do, we'll figure out a way to make it happen."
And like Manzanita, Payson Care Center emphasizes its caring people.
"Our atmosphere is very dignified," Campbell said. "There's a lot of love here; there's a lot of caring here, They're also very attentive to your needs."
Payson Care Center is one of 216 nursing homes across the nation owned by Lifecare Centers of America, a privately-owned company.
Both Campbell and Belisle noted that nursing homes face many challenges, not the least of which is too much regulation.
"Our industry is probably one of the most regulated industries in the world," Campbell said. "We have many problems that come along with it."
The increasing number of assisted living facilities like Powell House is also posing a threat to traditional nursing homes.
"If you take a look at the nursing home industry in general, the occupancies in traditional skilled nursing facilities are lower because of the onset of the assisted living industry," Belisle said. "Home health is another (trend) that has hurt us."
Is a nursing home the answer?
Although every person and situation is different, here are the important questions to consider when deciding if your loved one needs a nursing home:
- Is the person unable to live alone?
- Does the person need 24-hour care and supervision?
- Is the person chronically ill, but not sick enough to be hospitalized?
- Does the person need help with daily activities such as eating, walking, dressing and bathing?
If you answer yes to any of these questions, your loved one may need to be in a nursing home.
-- Source: MetLife
Paying the Bill
Nursing home care is expensive. Depending upon the area in which you live and the level of care required, costs can exceed $50,000 per year. Financing options include:
- Personal Resources. Many residents or their families initially pay for nursing home care from personal resources, such as income and savings. But because the care is so expensive, they often use up their savings and must apply eventually for Medicaid assistance. Conversely, Medicaid is only for the poor, so you must use up your assets before you are eligible.
- Private Insurance. A relatively new type of insurance is private long-term care insurance. Coverage and cost vary greatly from company to company.
- Medicare. Many people are under the impression that Medicare, the federal government's health care insurance program for persons over the age of 65, includes the cost of long-term care. Actually, Medicare covers very little of long-term care costs. In some cases, Medicare insurance will pay for a fixed period of skilled nursing care in a Medicare-certified nursing home. For more information, contact your local Social Security office.
- Medicaid. A joint federal/ state program that pays for health care for people with limited income and resources. Medicaid does pay for custodial nursing home care, but it must be in a Medicare-certified facility. To find out if your loved one is eligible for Medicaid and how to apply, contact the Medicaid office orepartment of Social Servicesn your area.
-- Source: MetLife
Select with Care
Think about how much your own home means to you and how much time you spent selecting it. Choosing a nursing home should involve just as much care and consideration because, after all, it will be home to your loved one. Ask for recommendations.
- Obtain a catalog of nursing homes from your state department of health, state agency on aging or an association representing nursing homes in your area.
- Start looking well in advance if possible -- before a crisis pressures you into a hasty decision.
- Make your first visit to a nursing home without an appointment. Try to get an overall impression by looking at as many public areas as possible. Talk to the residents and their family, ask them how they like the facility. If a facility seems appealing, make several visits at different times.
- Ask your health department whether the home has ever received an Intent to Deny License because of problems.
- Ask about the M.D. who serves as medical director.
- Ask to see the results of the latest state inspection of the facility. This is public information.
- Ask friends with firsthand experience for recommendations.
-- Source: MetLife