Thursday, August 18, 2011

How to Find the Right Nursing Home

As an elder law attorney for more than 25 years, I have counseled many families whose loved ones were in a nursing home.  Many of these families had devoted a lot of effort to finding the "right" nursing home, but others had made the choice without much if any forethought.   

Finding the right nursing home is a difficult task. How do you choose? After you do choose, how do you evaluate your choice? If you've never done this before, you might want to talk with a medical social worker, a geriatric care planner, an elder law attorney, or other professional who is more experienced with the facilities in the area, and the types of services each offers.

Here are some general tips:

    1. It is unwise to think that the appearance of the facility alone is an indicator of the quality of the care. A facility may spend thousands of dollars to "pretty" up the physical environment, but spend no more on, or even cut back on, staffing in the facility. The quality of the care that a nursing facility provides comes from the people who work there!

    2. Let your senses be your guide! For instance, overall, the smell of the facility should not be unpleasant. The noise level should be comfortable. The hallways, rooms and nurses stations should be organized and relatively clear of clutter. Is it too warm or too cold? Does the staff greet you with a smile? Is there cheerful, respectful, pleasant interaction between the staff, the residents, and administration. Does the nursing home have a "homey" atmosphere or is it cold and business like? Does the food look and taste appetizing? Are the residents wearing appropriate clothing, jewelry, makeup, and are the men clean shaven? Are residents involved in activities and using the common rooms such as the lounge? Observe the facial expressions and body language of the residents. Do they appear relaxed and how do they respond when approached? Visit during different times of day and visit unannounced; however, for your safety as well as the safety of the residents, you should not tour the facility unattended.

    3. Inspection Reports. Although inspection reports are not necessarily the best reflection of the quality of care that a facility provides, you should ask to see the most recent one. The administrator should be more than willing to share it with you or show you where it is posted within the facility. If it is not made available to you, the most recent inspection report is available on the Internet. In Pennsylvania, go to the Department of Health's Nursing care facility locator. Go to http://app2.health.state.pa.us/commonpoc/nhlocatorie.asp and click on the county in which you wish to search.  Then click on "view patient care surveys" for the particular facility.  

    4. Talk with residents and their families. If you know someone in the facility, or a family member, ask them to share with you how they feel about the overall care and about the facility administration. If possible, talk with a few of the residents to get an average view of how they feel about the important things like the hands on care, the food, and the overall atmosphere. If time allows, attend a family counsel meeting where you can talk with a number of family members who meet to support each other. Don't forget to ask your physician frank questions about nursing homes in the area, and which facilities she/he might favor. Note, however, that few private physicians will actually visit their patients if they reside in a nursing facility. 

    5. The staff!! The importance of quality staff can't be overestimated. Spend time talking with some of the nurses and nursing assistants throughout the facility. Do they speak warmly of the residents and their co-workers? Do they smile when approached by a resident? When a call bell rings, do they try to respond quickly? Do the nursing assistants and nurses seem to work well together? Ask how long they have worked there. It's not a good sign if a large percentage of the assistants are new employees. Does the facility have an active volunteer contingent? A strong volunteer program can add much to the overall feeling of community.

    6. The facility tour! Take your time and consider touring the facility at different times. Does the admissions coordinator take time to answer your questions and address your worries and concerns? The following is a list of questions you may want to ask the admissions director or other staff members while touring the facility:

  •         Resident rooms should reflect the individuality of their occupants. What types of things are the residents permitted to bring from home? How much storage is available for the resident's personal belongings?
  •         How quickly are call lights answered? Does the facility have a policy on answering call lights? Are all staff members, including management, required to answer call lights?
  •         Are there rooms that residents and their families can use for private visits?
  •         What is the policy on physical restraints? What alternatives to physical restraints are used to ensure a resident's safety?
  •         What kinds of activities are residents involved in? What kinds of activities are there for residents with dementia? Does the facility have a wheelchair accessible van for community activities?
  •         How many residents are assigned to each nursing assistant? Is there permanent assignment of staff to residents? Does the nursing facility try to accommodate individual schedules and preferences? Is the patient's privacy protected when dressing and bathing?
  •         Are the nursing assistants involved in the care plan meeting? They should attend and contribute ideas as they have the most contact with your family member.
  •         What is the facility policy for missing clothing and other possessions?
  •         What kinds of therapies are provided and who pays for these services?
  •         Who should you talk to when you have a concern or complaint? How are my concerns resolved? Are there family council and resident's council meetings?
  •         What is your daily rate and what is included in that fee? How often do your private pay rates increase? Are there charges for extra care, special diets, and ancillary supplies?
  •         Does the nursing home accept Medicare and Medicaid?
  •         What is the policy on roommates and room changes? What happens if your family member does not get along with his or her roommate?
  •         Does the facility have a policy regarding smoking? Are there designated areas for smokers?
  •         How is the outside environment? Are there places to walk or sit outside? Is there a secured place outside for residents with dementia to enjoy?
  •         Do residents participate in patient care conferences? If the resident is not able to participate, are conferences held at a time that family members can attend. Is adequate time allotted to allow all of your concerns to be addressed?
  •         Does the dietician work with the resident and/or family members regarding food likes and dislikes? Is there a second choice available at meals? Can you have meals with your family member? Are snacks provided? Is there a place to store snacks and food brought from home?
  •         How are outside doctor's appointments handled? Does the facility provided transportation to these appointments?
Choosing a nursing home for a loved one is not an easy process. Spend some time touring different facilities, talking to the staff, and becoming informed. It is extremely important to gather as much information about a nursing home as possible before making a decision.

Here are some links to further information:
Marshall, Parker and Associates Nursing Home Guide
Medicare Nursing Home Compare (detailed information on every Medicare and Medicaid facility in the country)

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