How to choose a nursing home for your loved one...

Caring for a loved one at the end of their life is both privilege and responsibility. If you have been named the health care representative you will be choosing your loved one’s long term care facility. Your guiding principal should be the golden rule. Care for your loved one as you would want to be cared for. As health care representative you have been entrusted with your loved one’s life. This decision is often made quickly and with little guidance as to what to look for in a facility. I would like to offer some helpful suggestions.

1. Take some time. Know that you can request a 48 hour extension to pick a facility.

2. Look up all facilities that you are considering on the internet.
www.medicare.gov.
Go to resource locator
Then click on nursing homes

Google: (your state’s) Department of Aging and Disability.
Find the Consumer Information reports.

These two resources will help you get a general idea of what the facility care is like but it certainly does not give you the whole picture.

Quality of care should to be looked at carefully. Medication errors and actual harm dings are really bad.

3. Go visit several facilities. This will help you make a sound decision. Do not just pick the closest nursing home or the one that your neighbor said was good. Nursing care can be great one year and poor the next. If a key person leaves the job then nursing home can quickly go from good to bad. Breakfast time is a good time to visit because it is the hardest for the nursing staff. If they have their act together at breakfast they probably have their routine down pat. You should expect faces to be clean, beds made up, and patients alert by 9 or 10 a.m.

4. Find the survey. Read it carefully. Surveys have to be easily found by the public. You should not have to hunt or ask for the survey. Surveys are usually in the lobby area at the main entrance
Interpreting the survey...
Quality of care. A-D ratings are generally not a cause for concern.
G level or above are REALLY BAD.
Medication errors are BAD.
Actual harm errors are BAD.

5.Questions to ask…

How was your last survey? May I see it?
Observe the staff persons response. A well run facility will not be threatened by your questions.
What is your staff/patient ratio?
Different department should have different ratios. Departments where more care is needed should have a lower ratio.
What is your percentage of pressure sores this year?
Don’t look at the number look at the percentage. The percentage should be less than 5% unless they are specialists in healing bed sores.

6. Observations during your visit.

What is the general atmosphere?
Is the staff happy? What is the general attitude of the staff? Are they snotty and cold or warm and caring?

Is the facility dark and depressing or is it warm, cheerful, and homelike?

Is there a lot of odor? Spot odors may occur due to accidents but in general the whole place should smell clean and fresh.

Is the staff checked out? Someone should stop you and kindly inquire as to whom you would like to visit.

Is the staff working? or are they down the hall talking?

Are the patients being fed? Patients should not be staring at a plate of food. Meals should be brought when someone is available to feed them.
Are patients being encouraged to eat?

Are patients alert? Patients should be alert and not drugged or tied into a wheelchair.

Is the facility restraint free?
Bolsters, scoop mattress, and M bars are all good.

Beds should not have side rails.
Side rails are dangerous as people can become trapped in them.

Talk to a resident… what do they say?

7. Listen for these buzz words.
Eden Alternative
Person-centered care
Culture change

Research each of these philosophies.

While these things do not indicate the quality of care they do indicate that the nursing home is focused on patient choices. These will also give you some sense as to the nursing homes underlying philosophy of care.

Two more things you can do…
Ask for daily skilled service. (this will ensure that an R.N. will check on your loved one on a daily basis)
Ask for a lawyer name that specializes in Medicaid.

Remember to look at the big picture…
Any short term disruptions or inconveniences that you experience will be rewarded by the satisfaction that you did right by your loved one. You are their friend and advocate.