Maybe your family has already been in this all too familiar situation. Your loved one, who has been healthy and self-sufficient her entire life, suddenly falls ill. You are told by the hospital that she needs to be transferred to a nursing home for rehabilitation and this needs to happen tomorrow. What do you do?
You may have adequate time to choose a nursing home or like above it may be a last-minute decision as the result of a hospital transfer. Quality nursing home care requires efficient systems, adequate staffing and updated equipment and facilities. While every nursing home will experience challenges, there are certain factors you can check to ascertain the quality of the care the nursing home will deliver. Based on my experience representing families and patients, this guide will help you to evaluate a nursing home for its ability to deliver quality senior care. This is often a very difficult time for a family, and having the right tools can make the transition easier for all involved.
1. Read the inspection reports
Check the Government’s inspection. Remember that this report is based on an inspection once every 15 months. Many nursing homes have a “code” that goes out to the staff when the inspector enters the door, which means they are on their best behavior at that time. Also remember that state violations which often happen monthly, do not appear on the inspection report.
2. Number of direct care staff to patient
This may be the single most important patient safety factor. At the Goode Law Office, the majority of abuse and neglect cases we see relate directly back to understaffing. Find out how many patients are assigned to each nursing aide. This one-on-one care is the most important factor for a successful nursing home stay. If a nursing aide is assigned to 15 patients and one requires extra care, time may not allow for them to assist all patients with bathing and toileting during each shift. This is a problem waiting to happen. Caring for seniors with a variety of medical issues presents many challenges but the number one success indicator will be adequate staff to assist the residents.
3. Staff Retention
Like any business, high employee turnover may be signs of bigger problems. How long has the current administrator been at the nursing home? How long have the nursing aides been staffed and are they assigned to specific residents when they are on duty? Are any of the nursing aides from temporary staffing agencies? If so, why does the nursing home have a staffing challenge? Ask the employees themselves and you may be surprised at their responses.
4. Quality of Daily Life
Quality of Life is a big factor in choosing the best fit. How does the nursing home help you to participate in social, recreational, religious, or cultural activities that are important to you? Is transportation provided to community activities? What kind of private spaces does the nursing home offer for when you have visitors?
Who are the doctors that will care for you? Can you still see your personal doctors? If your personal doctors don’t visit the nursing home, who will help you arrange transportation if you choose to continue to see them?
Walk around the home. Ask lots of questions and observe the other residents. As for many big decisions in life, there is no substitution for actually visiting the home, talking to people, and getting a sense of the home’s mood and routine.
Like staffing retention problems, this is almost always a sign of bigger problems. There should not be odors at the nursing home. No exceptions. A clean nursing home will not smell like urine when you walk in the door. How clean and organized are the hallways and nursing stations? Are the residents well groomed and appropriately dressed for the time of day? If there are obvious cleanliness problems, keep looking for a better fit.
Medicare only pays for post-hospital rehabilitation care and hospice care services in a nursing home for short periods of time. Medicare reimburses for some or all of the daily cost of care for these short stays. What are the daily fees after the Medicare coverage ends? If the senior were to run out of funds to pay for care privately, will the nursing home accept Medicaid as a form of payment? Find out your state’s Medicaid eligibility rules and how to apply. Don’t assume the best. Always plan for these possibilities and arm yourself with the knowledge before making a decision on a home.
7. Review Public Information
As of January, 2003, all Medicaid and Medicare certified nursing homes must publicly post the number of nursing staff they have on duty to care for residents on each daily shift. Licensed and unlicensed staff include Registered Nurses, Licensed Practical Nurses and Certified Nursing Aides. Nursing homes must also make readily available the name and contact information for all state client advocacy agencies, the state ombudsman program, the Medicaid fraud control unit along with the results of the most recent state or federal survey. If you know where to look, there is a wealth of publicly available information on the internet along with resident reviews and reports of problems. Do your homework.
8. Talk to Residents
Talk to the residents and ask them about the staff, the meals, the activities. Consider what special care needs may be required, such as care for memory loss, and if the nursing home provides these specialized services. What is the general mood? Do the residents seem social, happy, interactive?
9. Contact the Ombudsman
Contact the nursing home ombudsman to ask about any complaints or concerns at the nursing home you are considering.
10. What if more than one nursing home meets my needs?
If you find more than one nursing home you like with a bed available, use the information you gathered to compare them. Trust your senses. If you don’t like what you saw on a visit (for example, if the facility wasn’t clean or you weren’t comfortable talking with the nursing home staff), you may want to choose another nursing home. If you felt that the residents were treated well, the facility was clean, and the staff was helpful, you might feel better about choosing that nursing home.
If you’re helping someone, keep the person you’re helping involved in the decision making process as much as possible. People who are involved from the beginning are better prepared when they move into a nursing home. If the person you’re helping isn’t alert or able to communicate well, keep his or her values and preferences in mind.