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Choosing a Nursing Home 4/8/2010

Nursing homes, also known as skilled nursing facilities, can differ widely in size, location, and in the activities and services they offer. The nursing home you choose will have a profound impact on your loved one's quality of life and sense of dignity. This article will help you through the process of choosing a nursing home. If you happen to notice some condition or activity at a facility that seems questionable or wrong, you can make a report. Reports should be made to the Idaho Bureau of Facility Standards at 1-800-345-1453.

Step One: Find out what is available in your area.

Once you decide the city or region where your loved one's nursing home should be, compile a list of nursing homes in the area that meet your criteria. Next, evaluate your financial resources and future needs. Learn about public and private insurance programs and financing alternatives, such as Medicare, Medicaid and long-term care insurance.

Step Two: Visit prospective nursing homes.

The Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration), the federal agency that administers Medicare and Medicaid, annually examines nursing homes that accept either. Reading its report before your tour might alert you to possible problems or special areas of interest. To find the Centers’ latest evaluations of the facilities on your list, go to: http://www.cms.hhs.gov/CertificationandComplianc/01_Overview.asp#TopOfPage and click on "Nursing Homes."

Make an appointment for the official tour. Ask to see more than the public areas. Visit several residents' rooms. Return during off times, such as evenings and weekends, and stroll through the nursing home on your own. This will allow you to experience it without an official interpretation.

When you visit a nursing home, be ready to:
Explain the level of care needed. A nursing home should provide enough care to meet present and future needs while encouraging and allowing residents to remain as independent as possible. Visit several facilities; services and fees will vary greatly. The nursing home checklist below will help you compare facilities and organize your impressions of different homes.

Nursing Home Checklist

Does the facility accept residents who:

  • Have Alzheimer's/dementia?
  • Wander?
  • Use a wheelchair?
  • Use a walker?
  • Smoke?
  • Have pets?

Bedroom/living space

  • Is it big enough?
  • Is there a nurse's call button near each bed?
  • Is it well-lighted
  • Does it have a window?
  • Is it clean and pleasant?
  • Is there a private bathroom?
  • Is there a call button in the bathroom?
  • Are there grab bars?
  • Is it wheelchair-accessible?
  • Can residents bring furniture and personal belongings?
  • Is it a private room?

If shared:

  • How many roommates would there be?
  • How would the roommate/s get along with your loved one?
  • What's the policy if roommates have problems with each other?
  • What's the policy on choosing or switching roommates?
  • Can you and the senior meet the roommate/s in advance?
  • Is there a privacy curtain for each bed?
  • Are separate rooms available for private visits?

Location

  • Is the facility in a safe area?
  • Is it convenient to:
  • Shopping
  • Medical facilities
  • Family and friends
  • Places of worship
  • Recreational facilities

Exterior

  • Is the building well-kept? Is the exterior well-maintained?
  • Is there a nice outdoor area? Are residents encouraged to use it? Is it accessible to wheelchairs, with plenty of benches and shade?
  • Tip: Don't judge a facility based solely on its looks. However, a poorly kept nursing home may indicate inadequate care of residents.

Building safety

  • Would the senior be able to get out in an emergency?
  • Are the emergency exits clearly marked and accessible?
  • Do halls and bathrooms have grab bars?
  • Are there wheelchair ramps?
  • Are hallways wide enough to accommodate wheelchairs?
  • Is the building generally clear of clutter?
  • Are evacuation instructions posted that residents can read?
  • Does the nursing home hold fire drills?
  • Are exit doors unlocked from the inside? Locked doors prevent wanderers from leaving the building, but they also create a potential hazard.
  • Do exit doors have alarms in case a wanderer tries to leave?
  • Are stairway doors kept closed to prevent potential spread of fire?
  • Ask for paperwork showing that the home has been inspected and meets federal and state codes for fires and disasters.

Interior

If there is a smell of urine, is it mild? A mild urine odor is normal for a medical facility, but be leery if the smell is strong. Be equally concerned if a powerful room deodorizer is being used to mask an unpleasant odor. That could mean the facility is trying to obscure an unclean area rather than clean it.

  • Is the temperature comfortable?
  • Is the noise level acceptable?
  • Do you see personal, home-like touches?
  • Is it well-lighted? Does it have good natural light?

All staff, including volunteers

  • What is the staff-to-resident ratio? In general, 1-to-8 is appropriate for daytime and 1-to-15 for night. Nursing homes caring for dementia patients need a      higher ratio.
  • Is the staff visible?
  • How long are staff shifts?
  • What is the procedure for background checks? Who does it, how and when?
  • How is staff members' morale? Observe their demeanor and their interactions with each other and the residents.
  • Do staff members know residents' names? Do staff and residents greet each other in passing?
  • How does the staff respond to your questions? Trouble signs: Are they rushed, uncomfortable, angry?
  • If either the resident or staff members are not native English speakers, can they communicate effectively with one another?
  • What is the procedure for notifying families of any changes in routine or medical condition?

Reports

  • Does the facility post a valid license?
  • Does the facility have a written description of a nursing home resident's rights and responsibilities?
  • If you didn't review the latest HCFA inspection report before your tour, request a copy. If you have questions, ask a staff member to go over it with you.

Resident services

  • Note if the service is available and whether it is included in the basic fee or costs extra.
  • Assistance with bathing
  • Assistance with dressing
  • Assistance with medication
  • Arranging or providing transportation
  • Arranging medical appointments
  • Beauty parlor or barber
  • Linens
  • Laundry
  • Shopping/errands/trips

Other residents

If your senior is lucid, try hard to find a facility with similar residents. Living with residents suffering from dementia will not offer a good quality of life to a resident who is frail but mentally alert. It is also disturbing to a confused resident to be placed with primarily lucid residents.

  • Do other residents appear happy, relaxed?
  • Are they well groomed? Are their clothes clean? Are they dressed appropriately for the temperature?
  • Are they interacting with each other or just sitting around not doing much? Do they isolate themselves in their rooms?
  • Talk to residents about the facility:
  • What do they like best?
  • What do they like least?
  • What is daily life like at the facility?

Meals

  • Arrange to eat at the facility.
  • Is the food attractive and nutritious?
  • Is the dining area pleasant?
  • Are special dietary needs accommodated?
  • Are food choices available?
  • Is the meal schedule flexible?
  • Is the food culturally familiar?

Care plan

All facilities are required by law to write a care plan for each resident. Care plans begin with a comprehensive assessment of the patient, including level of function and social, emotional, mental and medical condition. The plan should focus on maximizing independence and functioning at the highest level possible. The nursing home should revise the plan every three months or whenever the resident's condition changes.

Ask to see sample care plans. Since plans are confidential, the facility might respond that they can't show you one. Explain that you'd like to see ones with all names and identifying information removed.

  • Do the plans focus on maintaining independence?
  • Are the plans individualized or generic?
  • Do the plans involve the resident and family?
  • Do they cover every aspect of the resident's life - physical, psychological, social?
  • How often does the staff consult the plans?
  • Who writes and implements the care plans?
  • Are the plans updated every three months or after every condition change?

Costs

  • What kind of payment and insurance does the nursing home accept?
  • Medicare
  • Private health insurance
  • Long-term care insurance
  • Medicaid

Ask about the basic fee, and clarify exactly what it does and does not cover. For each home, basic vs. extra costs vary. Costly extras can include laundry, room delivery of meals and incontinence supplies. Obtain a written list of what is included in the basic fee and what costs extra.