Many myths exist about nursing facility life. In the past decade, nursing facilities, like all areas of health care, have changed dramatically in terms of staffing, policies, procedures, and general approach. Our goals as long term care professionals are to provide both quality care and a quality way of life for our residents.

Understandably, many people fear the move from their own facilities to a nursing facility. People don't know what to expect and worry about relinquishing control over their lives. Long term care providers understand these concerns, and we want residents and their families to know the difference between the myths and the realities of life in a nursing facility.

Myth: A nursing facility is like a hospital.

  Reality: A nursing facility is not a hospital. Many people enter a nursing facility after a hospital stay and tend to think of the nursing facility as an extension of hospital care. A nursing facility is different, however. Medical, rehabilitative and nursing care are provided as needed by qualified personnel. Yet at the same time, nursing facilities try to be facilities where people can feel comfortable, find familiar faces, and build a life.

Nursing facilities do not have restrictive visiting hours like hospitals. Whenever possible, residents eat in communal dining rooms rather than in their rooms. And various activities are offered each day to stimulate residents mentally, physically, and socially.

Myth: All nursing facility residents are confused.

  Reality: Most people slow down physically as they age. For some, this may be true of their mental processes as well. In fact, many people enter a nursing facility, in part, because poor memory makes caring for themselves difficult or impossible. Often, memory problems can be reversed with adequate nutrition, exercise, social stimulation and properly controlled medication.

It is true that a large portion of nursing facility residents suffers from Alzheimer's disease, an irreversible neurologic disorder that causes severe and progressive mental difficulties. In many cases, Alzheimer's residents live together in special wings where they can receive the specialized care they require.

Myth: I will have no privacy in a nursing facility.

Reality: Nursing facilities must strike a difficult balance between the provision of adequate supervision and much needed privacy. Common areas in nursing facilities tend to be open, while resident rooms are considered private. Staff members respect resident privacy by being courteous and by knocking before entering a resident's room.

Myth: If I enter a nursing facility, I will never go home.

  Reality: The primary goal of the nursing facility is to rehabilitate residents so that they can return to the community. In fact, many residents are discharged to facility-like living arrangements. Those who cannot return to their homes permanently can make short visits, health permitting. In most states, Medicaid-certified nursing facilities will hold beds for residents while they make what are termed therapeutic facility visits.

Myth: If I enter a nursing facility, I will surrender my right to make decisions.

  Reality: Nursing facility staff strive to maximize resident independence and honor resident preferences. It is a resident's legal right to make choices about activities, schedules, health care and other aspects of facility life. Yet it is important to recognize that the facility must have some rules to secure an environment where residents can live together safely and harmoniously.

Resident councils, which are made up of residents and sometimes family members, provide an opportunity for residents to address their concerns to staff and to one another. When it comes to treatment decisions, some residents choose to shift decisionmaking responsibilities to their children or other loved ones. Some residents may choose to prepare an advance directive, a legal document designed to express the resident's wishes for treatment should the resident be unable to communicate his/her desires.

Myth: Nursing facilities have an unpleasant odor.

  Reality: Today's nursing facilities should have no lingering unpleasant odors. In fact, with the effective cleaning products available, a properly cleaned nursing facility should smell pleasant. However, because many elderly nursing facility residents are incontinent, an occasional odor may be noticeable. If incontinent residents are changed and cleaned promptly, there should be no lingering smell.

Myth: Nursing facility residents do not receive adequate care.

  Reality: Stories about inadequate care in nursing facilities make news precisely because they are not typical. More common are aggressive internal quality assurance programs that constantly monitor the delivery of high quality care.

Keep in mind that inspections are made frequently by each state to ensure that government quality standards are being met. Problems are cited and plans for correcting them are put into action immediately.

Family and friends can serve as an important safety net. If you feel that proper attention or care is not being given to a specific problem, ask questions. Speak with the director of nursing and the administrator. If you are not satisfied with their responses, it may be time to find a more appropriate facility.

Myth: Husbands and wives must live apart from one another in a nursing facility.

  Reality: This is simply not true. Many married couples enter nursing facilities together and may share rooms. In fact, the patient's bill of rights mandates that this be permitted in facilities certified to receive Medicare and Medicaid funding. Furthermore, staff members respect the privacy of couples living in nursing facilities.

Myth: Nursing facility residents aren't visited regularly by family and friends.

  Reality: When an elderly person needs more physical care than the family can give, professionally trained staff take over a portion of the care. However, hard as they try, the staff can never offer the same sort of social and psychological support friends and family bring to a resident. Staff members recognize this and try to encourage visits and make visitors feel welcome.

Myth: The food is terrible in nursing facilities.

  Reality: Good food is a matter of individual taste. Everyone has certain customary dishes and styles of preparation that no one else can duplicate. In the nursing facility, some residents are placed on restrictive diets that may limit salt, fat, cholesterol, or sugar. But dietary staff make every effort to ensure that these diets are varied and appealing.

Because proper nutrition is so important to the health of residents, dietary managers should be available to discuss problems concerning food.

Myth: I will be given medications that will cause me to lose control of my thoughts and actions.

  Reality: Every person has the right to know what medication he or she is taking and has the right to refuse any or all treatment. Tranquilizers, pain relieving medications, sleeping pills, and mood changers are all powerful drugs and do have a profound effect on how alert an individual remains.

Properly prescribed, these medications help rather than harm individuals. Government regulations require that residents' medications be reviewed by a consultant pharmacist and state inspectors. Staff include the residents and family in care planning. Residents and family members should ask questions about prescription medications, especially if it is felt they are being used improperly or are having a negative impact on the resident.

Myth: I will be physically restrained in the nursing facility.

  Reality: Nursing facilities have made great strides toward reducing the use of physical restraints. Over the last few years, physical restraint use has declined significantly. As more alternatives to restraints are developed and restraint reduction programs are enhanced, restraint reduction efforts will continue to improve.

Residents and family members should know that the use of restraining devices may be used only under a physician's prescription. For example, if a person who has had a stroke has difficulty balancing while sitting, a restraint may be prescribed to facilitate sitting, positioning for eating or participation in activities or therapy. Facilities strive to give residents maximum freedom of movement while also achieving improved functions and safety.

As with prescribed medications, if you feel restraints are being used improperly, speak with a doctor, nurse, or administrator.

Myth: Nursing facility care should be like hotel service.

  Reality: At first glance, nursing facility costs may appear high, and a newcomer might expect hotel-type accommodations. However, nursing facility care is costly, not because the per day charge is high, but because many nursing facility residents remain in the facility for lengthy stays. The average daily fee for a nursing facility stay is $112. This daily fee covers a complete set of services, including room, board, medical care, and a full range of activity programming. Once the range of services is taken into consideration, it becomes clear that daily charges are really quite reasonable.

It's also important to note that the primary goal of nursing facilities is to rehabilitate residents and to maintain good health. Staff members try to encourage residents to do for themselves as much as possible so that they can maintain a sense of independence.

Myth: Medicare or my health insurance will cover a lengthy stay in a nursing facility.

  Reality: Because many people mistakenly believe that Medicare or health insurance will cover their long term care costs, they are forced to drain their savings to cover the cost of care.

Consumers should be aware that the government provides little financial assistance for nursing facility care unless a resident is impoverished and qualifies for Medicaid. Under certain conditions, Medicare, the health insurance program for the elderly, covers the first 20 days of care in a skilled nursing facility. For the 21st through the 100th days, the beneficiary must share the cost of care by paying a nationally set rate of $92 a day. Medicare does not cover stays in an intermediate care facility. Most health insurance policies do not cover long term care costs.

Long term care insurance offers a more viable solution to paying for long term care costs while preserving personal savings. However, due to lack of public awareness about long term care and who pays for it, long term care insurance currently pays only two percent of national nursing facility costs.

Financing nursing facility care should be approached with as much thought and preparation as any major investment. Obtain in writing what your basic charge will be and understand clearly all financial arrangements before signing a contract.