Choosing home with care

December 16, 2000

Choosing home with care

By ANDREW SCHOTZ / Staff Writer

Ed Wines' nose told him he made a good choice of long-term care for his mother.

As he walked through the halls of the nursing home at Ravenwood Lutheran Village in Hagerstown, he was impressed because something was missing.

"There is no odor of a nursing home," Wines, of Boonsboro, recalled thinking to himself.

Family members and friends planning to move one of their own into a nursing home or an assisted living center have many things to consider. The level of care and the price may be the biggest concerns, but the location, the atmosphere and even the sounds and smells are important, too, say experts in the care field.

Even with all the right amenities, though, there are bound to be pangs of guilt and waves of doubt about the change.


And the person needing care probably won't relish giving up independence.

Since moving into his assisted living apartment at Ravenwood in May, Russell Keener, 85, has missed hunting and fishing more than anything. He likens his life to a baseball game in which he's been benched for the last two innings.

Keener was accustomed to starting work at his family construction business, R.B. Keener & Sons Inc., at 6 a.m. every day.

He's aware that heart surgery and glaucoma have slowed him down. Unsteady at driving, he reluctantly gave it up.

Worst of all, said his son, Keith Keener, Keener's spirit dampened when he became a widower. The senior citizen had lost his teenage soul.

"Life surrounds us with the good things," Russell Keener said. "But sometimes, it pulls the plug."

Care options

Longer life spans are causing more and more families to use professional elder care.

At one time, nursing homes were an automatic option. Now, there's an array of care available.

Nursing homes offer the greatest level of medical supervision. Some have specialty wards, such as for Alzheimer's disease.

Assisted living centers have apartments and studios where a resident can cook his own meals and be generally self-sufficient. The center provides health-care assistance, transportation and activities.

In "How to Evaluate and Select a Nursing Home," R. Barker Bausell, Michael A. Rooney and Charles B. Inlander explain some of the other options for the elderly or the infirm, such as:

HEIGHT="6" ALT="* "> Adult day care, which is social activities in a supervised setting, usually without nursing care.

HEIGHT="6" ALT="* "> Home health care, which is nursing services in the patient's home.

HEIGHT="6" ALT="* "> Adult foster care, in a home setting.

HEIGHT="6" ALT="* "> Hospice, for the terminally ill.

Some modern facilities combine several styles on one campus. Patients move along a spectrum of care as they become more dependent.

In Maryland, the state Department of Health and Mental Hygiene's Office of Health Care Quality licenses nursing homes, assisted living centers and other health programs.

A 1999 change in state law streamlined oversight of assisted living centers from three agencies into one, said Ilene Rosenthal, chief of housing services for the Maryland Department of Aging. She said the consolidation was part of a consumer protection measure.

The law requires all assisted living centers to have registered nurses to monitor the administration and accounting of medication at least every 45 days. Larger facilities had been doing this, but smaller ones weren't, she said.

Also, assisted living centers must set up care plans for prospective patients and keep the plans current, Rosenthal said.

A difficult choice

Hannah Cramer of Funkstown hadn't planned on being a care-giver for her proud, self-reliant grandmother, Maude Renner. Cramer watched as Renner deteriorated, first mentally, then physically, over about six years.

The women were next-door neighbors, which made it easier for Cramer to be there when Renner needed her.

"She called me over and said she forgot how to use her stove," Cramer said.

Other times, the washing machine or the TV were too challenging.

"She was probably having a series of mini-strokes," said Cramer, the director of Washington County's Retired and Senior Volunteer Program.

Cramer checked in on her grandmother regularly at the start. She later hired home health-care workers - first to stay at night, then full-time.

She guided her grandmother into an adult day-care program.

Worried that Renner needed more help, Cramer considered an assisted living center, but was anguished about what her grandmother would think.

"I tried to wait until she was confused enough that she wouldn't realize she's not in her own home," Cramer said, "but she did realize."

"It was like the weight of the world was lifted from my shoulders when I made the decision to put her in a center," Cramer said.

By the time Renner moved into the dementia ward at a nursing home, she had "just a flash of reality" left, her granddaughter said.

Just before Renner died in October at the age of 97, "there was total confusion," Cramer said. "But she always knew me."

Planning for care

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