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Nursing Homes
Fact Sheets
A Consumer Guide to
Choosing a Nursing Home
Each nursing home in your area will have unique
strengths and weaknesses. Before you begin looking, be sure your
loved one's medical condition has been thoroughly evaluated. For
example, some treatable conditions such as depression or
delirium may be mistaken for dementia.
Since most people prefer to stay in their own home, it is also
important to investigate possible alternatives to nursing home
care. One source of information about available services is the
Eldercare Locator, 1-800-677-1116. Once it is certain that
nursing home care is necessary, determine which qualities of a
nursing home are most important for meeting the needs and
expectations of the resident.
If at all possible, take the resident to visit potential nursing
homes before a decision is made. This visit can give you insight
into the resident's wishes and may ease your loved one's fears.
Visit as many nursing homes as possible. You can learn a great
deal about a nursing home by taking time to sit and observe how
staff interacts with residents. Also, speak with residents to
get a full understanding of life in the home. Gather information
on both quality and payment issues.
It is very important to visit homes a second time during the
weekend or evening -- times when many nursing homes reduce their
staff and services.
Quality Issues
Some quality issues are subject to personal preferences while
others are critical to any resident's health and well being. Ask
nursing home residents, resident's families, community advocacy
groups, your physician, and clergy members what they think about
various facilities. Also, contact the long-term care ombudsman
in your community. The ombudsman program serves to advocate for
nursing home residents. The ombudsman may have a directory of
facilities in your area and information about problems
particular facilities may be having. The following questions may
help in your evaluation:
Using your senses -- sight, hearing, smell, touch:
- Is there cheerful, respectful, pleasant, and warm
interaction among staff and residents?
- Does the administrator seem to know the residents and
enjoy being with them?
- Do staff and administration seem comfortable and peaceful
with each other?
- Do the rooms of the residents appear to reflect the
individuality of their occupants?
- Are rooms, hallways, and meal tables clean?
- Do residents look clean, well-groomed, well-fed, and free
from bruises?
- Do many residents seem alert? happy? peaceful?
- Are residents seated comfortably?
- Is the home free from any unpleasant smells?
- Do you notice a quick response to call lights?
- Are there residents calling out? If so, do they get an
appropriate response from staff?
- Do the meals look appetizing? Are residents eating most of
their food? Are staff patiently feeding residents who need
it?
- Are there residents in physical restraints (formal or
informal devices that tie residents to beds, chairs, and
wheelchairs)? Why?
- Are residents engaged in meaningful and pleasant
activities by themselves or with others?
Things you can ask of staff:
- Does each shift have enough help to be able to care for
residents as they'd like?
- Do they enjoy their work? Are their ideas and information
solicited and valued by supervisors?
- What activities are residents involved in?
- Are staff permanently assigned to residents?
- How are the nursing assistants involved in the care
planning process?
- How much training is given to staff? Is it enough?
- How often are residents who need it assisted with
toileting or have their disposable briefs changed?
- What approaches does the facility use to prevent use of
physical or chemical restraints?
- How does the staff assure family and resident
participation in care planning meetings?
- What does the facility do to encourage employee retention
and continuity?
- How long has the current administrator been at the
facility?
- Has the facility undergone any recent changes in ownership
or management?
- Does the facility provide transportation to community
activities?
- What kind of therapy is available to residents?
- Can you give me an example of how individualized care is
give to the residents?
- Is there a resident and/or a family council? Can you talk
to members of these councils?
- What happens if someone has a complaint or problem? Are
family/staff conferences available to work out a solution?
- Are residents involved in roommate selection?
- Who decides where residents sit for meals?
- Under what circumstances might a resident be transferred
to another room or unit or discharged? Is the
family/resident able to refuse?
- Does the facility employ a professionally qualified social
worker?
Things you can learn from talking with other residents and
their families:
- Does the facility respect the resident's wishes about
their schedule (bedtime, baths, meals)?
- Is attention given to residents at night if awake?
- Does the resident have the same nursing assistant most
days?
- Are staff responsive to resident requests? Do they assist
the resident with toileting?
- Are snacks available to residents? Fresh fruit?
- Do residents participate in care planning conferences? Are
his or her opinions valued?
- Has the resident had missing possessions?
- Who handles resident or family member concerns? Is that
person responsive?
- Does the resident get outside for fresh air or activities
as much as he or she wants?
- What is best/worst about living in the home?
Information you can obtain outside the home:
- Copies of state inspection reports from the licensing and
certification agency which are available from the facility
itself, from the ombudsman, or on the world wide web at www.medicare.gov,
click on "Nursing Home Compare."
- Information about the facility from the local or state
ombudsman or citizens' advocacy group.
Payment Issues
Most nursing home residents, even if they pay privately when
they enter a home, run out of money because of the high costs.
They then convert to Medicaid payment. Unless you are certain
the resident can pay indefinitely (i.e. 2 years or more) with
private funds, choose a facility that accepts Medicaid payment.
Find out what your state's Medicaid eligibility rules are and
what resident's rights are for Medicaid recipients.
Nursing homes that accept Medicaid cannot transfer the resident
once he/she exhausts private funds. Federal law prohibits
nursing homes from charging Medicaid residents or their families
for items and services covered by Medicaid. It also prohibits
homes from asking Medicaid beneficiaries for contributions as a
condition of admission, or charging fees to supplement the
Medicaid rate. Facilities must provide you with a list of items
and services that are included in the basic Medicaid or private
rate and any services that require extra charges. Also, the
Nursing Home Resident Protection Act of 1999 requires that
facilities continue to care for Medicaid residents already
living in the facility even if the nursing home chooses to cease
participation in Medicaid.
Family Involvement
A key to quality care for your loved one is your continued care,
support, love, and involvement in their lives. Make sure you:
- Speak up to raise concerns and compliments;
- Participate in family council meetings if a
family council exists, or seek out other family members to
organize one;
- Attend quarterly care plan conferences and
advocate for individualized care;
- Get to know the staff and help them get to
know the resident. Share details about the resident's likes,
dislikes, and daily routines;
- Follow up on the agreed upon care plan. Make
sure the resident's doctor knows what is in the plan. Notice
if the plan is not being followed and request another
meeting if necessary;
- Make contact with your community's long term
care ombudsman and become familiar with the state and
federal laws and regulations that apply to nursing homes,
and;
- Document (date, time, persons involved) any
problems you might observe so that managers or the ombudsman
can investigate.
This Fact Sheet is provided by The
National Citizen's Coalition for Nursing Home Reform.
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