Choosing A Nursing Home

Many Caregivers have grown up thinking that they would never want to place their loved one into a nursing home. The decision is probably one of the hardest ones you will ever have to face in your lifetime. Unfortunately life doesn’t always go the way you would like it to. You may have promised your loved one that you would not place them in a nursing home and you and you may even feel like a failure for no longer being able to care for them. However, when you are no longer able to care 24/7 because you may be burned out, your loved one has a chronic illness that does not require hospitalization but needs supervisioin and care, reality kicks in and the need may be upon you to make a choice. For some of you, there may not be a choice. Your loved one may be transferred from the hospital directly into a nursing home following an operation, sudden illness or an accident to convalesce.

As people age, their needs are constantly undergoing change. The purpose of a nursing home is to help people care for themselves and to assist them until their final days. Skilled 24 hour nursing care and medical supervision is required usually when a patient is taken directly from a hospital because they are recovering from a surgery or major treatment. Custodial care means they are in need of care because they cannot live independently due to a serious chronic illness or a disability. They might not require skilled nursing and medical attention but they do need full time care and supervision.

It is best to retrieve information on nursing home facilities by referrals or recommendations from physicians, home care professionals, geriatric care managers, social workers, hospital staff, friends, and clergy. You can also check through the Eldercare Locator, professional and consumer service organizations, your state or local health department and the department of aging.

Nursing Homes Provide:

• Room and board
• Skilled nursing
• Medical services (nurses and doctors)
• Rehabilitation (therapies and counseling, such as speech, psychological and physical)
• General supervision.
• Opportunities for recreation and socialization

Some questions you may ask yourself, your loved one and also family members who may be involved in this decision are as follows:

• Can I continue to provide the needs for our loved one on a 24-hour basis? Am I able to provide the quality of care they need? Am I jeopardizing my own health and/or the needs of my own family?
• In your current living arrangement does your loved one miss or want more social interaction?
• Does your loved one have a pet?
• Are they chronically ill where they require intensive care but not hospitalization?
• Do they require help with their daily living activities such as bathing, dressing, eating and using the toilet?
• What do your finances permit for? What does Medicare and their health insurance provide? What does their long term care (LTC) insurance provide?
• Would my relationship with my loved one improve if they are placed in a facility?
• Have the patient’s doctors and homecare professionals recommended that your loved one be placed into a nursing home?

The more you research, the more you will be able to make a better, more informed decision.

Considerations to look for when choosing a nursing home:

• Location- is the home a reasonable distance from your home? By being close, visiting will be easier. Do you have accessible transportation to the home?
• What are the visiting hours? How do they fit into your schedule?
• What kinds of activities are provided for the residents? What types of activity rooms are available for recreation?
• Are there safe areas and gardens for walking and sitting outside?
• What is the physical layout of the facility like?

1. 1. Is it attractive?
   2. Is it well organized?
   3. Is it designed for the privacy needs of the patient?

• What are the ratios of patients to staff?
• Is the staff welcoming and responsive?
• Is the level of hygiene maintained – the cleanliness of rooms and hallways.
• What is the quality of food like?

1. 1. Are the foods nutritious, and geared towards the patient’s individual needs?
   2. Is assistance available if the patient needs to be fed?
   3. Are snacks and proper foods available in between meals?
   4. Can residents choose their own menu?
   5. Is the kitchen clean?
   6. Are dishes, pots and pans clean?
   7. Are there bugs?

• What are the resident’s rooms like?

1. 1. How are they furnished?
   2. Are they warm and comforting?
   3. Can you bring in your own bed and furnishings?
   4. Is there storage for the patient’s belongings?
   5. Can personal items be brought in to create an environment that is comfortable for them?
   6. Are these personal items safe? How is the theft of personal possessions handled?
   7. Does the room have an emergency system to call for help? Are they working properly?
   8. Does each room have it’s own bathroom and is it clean?
   9. Does it have the proper hand rails, grab bars and accessories your loved one will need?
   10. If patients share rooms with another resident, how are problems handled?

• How accessible are bathrooms outside the patient’s own room?
• Is their a phone in the patient’s room or nearby for personal use? Can those with wheelchairs reach the phone?
• Is there a television and radio in the room if the patient is bedridden? What if the patient prefers to just watch TV or listen to the radio on their own in the comfort of their room?
• Are personal services available i.e., hair cutting, washing and tailoring?
• How are ingoing and outgoing personal mail services delivered? Are postage services for mailing available?
• Who is responsible for shopping for the personal needs of the resident?
• Are pets allowed and how is this handled if they are?
• How is cash handled for the resident’s incidental needs?
• Are all entrances, exits, rooms, and hallways and elevators wheelchair accessible, and walker accessible and does the width meets the needs of the patient’s means for getting around?
• Is smoking regulated?
• Are exits marked and not blocked?
• Are the floors slippery?
• Are heating and cooling systems adequate and working properly? Does the resident have individual control of the heating and cooling systems in their room?
• Are floors, sidewalks and ramps smooth to prevent tripping and falling?
• How frequent are linens changed?
• How are resident’s personal laundry needs handled?
• How does the facility involve the family?
• Is there professional support one on one or are there support groups?
• How are the resident’s spiritual and religious needs met?
• Are there periodic meetings scheduled between the care team and the family members? How often are they?
• How are family members informed of their loved one’s status and how often?
• If your loved one has Alzheimer’s observe and check out the following:

1. 1. (In terms of Alzheimer’s patients, the need for placement will require that special needs be met daily by the facility. Many homes now have separate Alzheimer’s units with specialized care. Some may even offer therapeutic programs for the family members as well).
   2. You will want to check out how the staff interacts with these patients.
   3. How knowledgeable and trained are the physicians with Alzheimer’s, the current medical technology etc?
   4. Is the staff trained with the specific dietary, activities and other problems and needs arising with the patient?
   5. What safety precautions in case they wander and hurt themselves? How are they monitored?
   6. Is there confusion and lots of noise in the unit, possibly indicating a lack of control and supervision on the part of the staff?
   7. How are medications and physical restraints used in behavioral management? (Remember there are laws governing these restraints. The family must give permission and certain forms are illegal. No one can be restrained 24 hours a day.)

• Speak with other residents and their families if possible, to view things at the nursing home from their perspective.

1. 1. Observe other residents?
   2. Do they have bruises on their faces, arms or legs?
   3. Are they dressed properly?
   4. Are they occupied or are they wandering aimlessly in the halls or left sitting all alone?

• Are there odors in the hallways and communal areas?
• Are smoke detectors and fire extinguishers working and visible?
• Are calls for assitance promptly answered both day and night?
• Is there a physician available for emergencies at all times?
• Where and what is the nearest hospital?

1. 1. Will the home take the patient to the hospital from the facility if needed?
   2. Will the hospital be able to provide the care that your loved one might need?

• Visit all facilities unannounced. Try to do this when there aren’t visiting hours.
• Is there a family council that meets to handle complaints?
• What types of admission plans are available? Single rooms? Shared rooms?
• Is there a waiting list?
• Do a complete background check on the facility: i.e., ownership, management, financial stability, and staff qualifications. You can check with the Chamber of Commerce, the Better Business Bureau and your state’s department of health.
• Use the services of an ombudsman. (An ombudsman is an advocate for the residents). They can find out about past complaints and lawsuits against the nursing home.
• Make sure the facility has complied with all state licensing and accreditation requirements.
• Is there an admissions fee in addition to the regular monthly charges?
• Get a copy of the last inspection report for the facility.
• Get written copies of all oral agreements or promises.
• Request a copy of the resident’s bill of rights. Under the Federal law, all nursing homes must have a written description of the rights of the residents and it must be made available to the resident or family member who requests it.
• Does the facility accept benefits from Medicare, Medicaid and the Veterans Administration?
• What are all the financial costs involved?

1. 1. Is the fee daily or monthly and how much is it? How are extra needs met?
   2. What payment options are available?
   3. What is and what is not included in the monthly costs?
   4. What services are available for extra charges?
   5. What is the policy regarding daily or monthly rate increases? When was the last one done? What was the last increase?
   6. How much notice is given regarding an increase and how are they informed?
   7. Under what conditions are refunds made available to the resident? How much notice is needed?
   8. How long does the home hold a room if a resident needs hospitalization?

• How often are the families informed of the status of the resident?
• Will our loved one need their own aid or nurse 24 hrs within the facility in addition to the home’s staff?
• Meet with the administrator to ask important questions you may have.
• What grounds are cause for the contract to be canceled?

Before signing any agreements, have an attorney review the contract, the small printed matter and the rules and regulations of the facility.

With proper research and preparedness, you can be reassured that you will find the proper home that meets the need of your loved one and their family. It is important to stay involved and oversee that the home is maintaining the quality of life for the patient. Many times it is important for the patient to see familiar faces as they can become disoriented when the transition is made into a home. Close monitoring on your part will assure your loved one receiving the best care.

Richest Blessings,

Gail Mitchell