NURSING HOME SITE - ADULT RETIREMENT COMMUNITIES SITE

Active Baby Boomers

How to Choose a Nursing Home

It is vital for your family member that you spend a considerable amount of time researching the nursing home before you send them to the home. It is much easier to pick a good home in the beginning than it is to choose a poor home and have to go through the many obstacles to improve the care or try to transfer your family member to another facility. It is important not to judge the nursing home on the basis of a guided tour or the nice furniture and wallpaper in the lobby. You must remember that, especially in a for-profit nursing home, they put a lot of effort in marketing to convince you to bring your family member to their home. The pictures of happy grandmas in their brochures, nice dining rooms and landscaped entrances do not give you an idea of the quality of the basic care that your family member will receive.

 

Here are some suggestions on getting past the marketing efforts to see what type of care that your family member will receive at a nursing home:

Try to find at least one resident that you can visit in the facility. This will help you in evaluating the facility without a guided tour. Once you visit that resident, walk up and down the halls and talk to bedridden residents and residents who are wheelchair bound. As you talk to them, check out their grooming, skin quality, nail care, and oral care. See if their clothes are clean or if they have remnants of the last meal down the front of them. See if the residents appear to be upbeat or if they are depressed or dopey from drugs. If almost everyone you talk to is confused and unable to have a normal conversation, there could be a malnutrition or dehydration problem underlying that confusion or the facility may be overusing drugs to keep everyone in place and quiet. Even the incoherent residents who may be muttering to themselves can give you an indication of their comfort and care level. Are these residents babbling happily or are they constantly shouting for help and are angry? Stay away from facilities that try to restrict your access to the facility and talking to residents who are willing to talk to you.

 

Trust your nose. The halls, rooms and residents should not smell of urine or feces. If they do, the diapers may not be changed often enough and this can lead to life threatening illnesses such as urinary tract infections or decubitus ulcers (bedsores). If you smell a sweet rotting smell, that may be an indication of unclean or untreated decubitus ulcers. If anyone has decubitus ulcers, they should not smell.
Visit the facility at different times of the day. Sometimes a facility can look adequate in the morning when the staffing level is usually at the highest. Try going in the evenings or weekend afternoons. Nursing homes usually are the worst on the weekends or between four and eight pm on the weekdays.
Visit during mealtimes and find the dining room where the residents need assistance eating, especially the evening. This dining room is usually not the dining room in the front of the facility with the linen table clothes. Look for an assisted eating dining room that is usually located in the back of the facility. Look at the residents who are being fed and see how much time the aide spends with each resident and how much of the food is finally eaten. At least half of the food should be consumed. Also check the residents in the dining room and see how many of them appear to be thin when compared to a general population of seniors. Be concerned if there appears to be more than a few thin residents.
Check to see if the residents are rushed or if they are given enough time to eat. Often, the aides are so rushed that they feed residents too quickly and the resident does not have time to swallow and is reluctant to eat more. Try to smell the food and see if it smells palatable. Also check to see if milk and juice are served and if there are any fresh fruit and vegetables or if everything is canned.
Walk around the facility and check on the residents that are fed in their beds. Are there trays sitting in front of residents without anyone assisting them with eating? Are the aides running from room to room trying to feed bedridden residents? Is the food cold? How much of the food is eaten? Once again, at least fifty percent of the food needs to be eaten.
Are there water pitchers filled with fresh ice water within reach of the residents in their rooms? Look to see if any of the aides ever offer water to those residents who cannot get it themselves.
Ask about the level of staffing for each shift, morning, evening and overnight. Ask how may nurses are on duty and how may Certified Nursing Assistants (CNAs) are on duty. Compare that to the number of residents. If there are less that one CNA for each 5-8 residents for the morning shift, there may be a serious quality of care problem. Also note how may residents are bedridden or in wheelchairs who require total care in the daily activities such as toileting, grooming, drinking and eating. If there are a large number of these types of residents, the CNA ratio to residents should be smaller.
Most states require that the facility have the latest state survey of the facility for review at the facility. Read it and see if there are concerns that deal with basic nursing care and basic medical care. Go down to the State Licensing and Certification office and look through at least several years of the surveys. These surveys should be available for public viewing. When you visit the facility and it appears to be clean, well staffed and functioning well, make sure that you did not visit within several weeks before a state survey. Nursing homes are usually surveyed the same time every year and they can really clean up their act before the state surveyors appear only to have the poor care return within a month after a survey.
If your funds are limited, look for a facility where all the beds are approved for Medicaid. A facility that has only a few beds that are Medicaid approved may try to evict your family member when your funds run out. The facility is required by law to inform you of this policy in writing at the time of admission and contract renewal time. Do not sign any document agreeing to move when private funds end. Make sure that you keep your family member's doctor when you move into the facility. Any doctor that the facility would suggest is usually on contract with that facility. Use your doctor to make it clear to the facility that adequate care is expected and make sure that your doctor is willing to make personal visits to that facility.

Looking for a good nursing home can be a difficult task. It is good to get references from others who have had loved ones in the facility, but trust your own instincts. If there appears to be inadequate care given when you visit, it is unlikely that it will improve.