Choosing a nursing home is a challenging decision to make for you and your loved one. Here’s a look at a few things to keep in mind as you navigate this:
1. You need to know what your family can actually afford
To consider: Before choosing a nursing home it is important to determine what your family can afford. “I do know that sounds crass, but it’s a really important point,” said medical malpractice attorney, Charles Brown. Brown said determining cost will help focus your field of choices. AARP Associate State Director for Advocacy and Outreach, Amanda Fredriksen said a family also has to decide what level of care a loved one needs.
Advice: “For a nursing home, you have to have a medical need, because nursing homes are the only arrangements that are actually required to have a certified nurse on staff” Fredriksen said. “Assisted living, you might need help with bathing and dressing, you might need medication reminders but you don’t actually have a specific medical need.” Fredriksen said if a person is suffering from Alzheimer’s or dementia, then families need to make sure a facility is equipped to handle those specific needs.
2. These are online resources you should use in your search
A tip: If a family is considering a facility that accepts Medicare or Medicaid then Brown and Fredriksen strongly suggest going to Medicare’s Nursing Home Compare. You can search for facilities by name, state or zip code.
Advice: “They have data on staffing, they have data on incidents, they can tell you the number of residents that get a bedsore,” said Brown.
Also do this: The site also recently started including an icon of a red hand next to a facility’s name to indicate the business has been cited for abuse. You also need to check your state’s long-term care ombudsman office. This will have information on both nursing homes and assisted living facilities. Click here for Texas’ office.
3. Assisted living facilities are different than nursing homes
It’s in the regulations: Fredriksen cautions families that assisted living facilities do not have the same strenuous regulations as nursing homes. “(Regulations are) much more about the building, and the safety of the building, and the safety of the food and the services provided. A lot less about hands-on care,” said Fredriksen.
You have to visit: While some information on assisted living facilities is available through the state agency overseeing long term care, a site visit is a must. Brown and Fredriksen suggest also searching for online reviews. Brown said many people aren’t sure where to report problems, but they will voice their concerns online.
Advice: “If you see two or three reviews that all have the same problem, maybe you don’t say, ‘I’m never going here,’ but you at least know to say to the director of nursing, ‘hey, I saw you’ve had this problem in the past, how did you resolve it?’” said Brown in reference to reviews about nursing homes. “I think people should really take (reviews) to heart.” Fredriksen also caution consumer to make sure online reviews aren’t coming from ‘pay for’ sites. She said facilities will pay to have their names placed on lists that cast the business in a positive light.
4. Visit the facility and make sure you are talking to the staff
A tip: Part of the process of choosing a nursing home should include visits to the facility. Brown said it is important for families to meet with more than just the facility’s administrator. “I think one of the mistakes that sometimes people make is they forget who is actually going to be caring for the residents,” said Brown.
This is who to visit with: Brown said you need to meet with the facility’s director of nursing and the certified nursing assistants. “The person who is going to have hands-on care is going to be the CNA,” said Brown. “These nursing assistants are the ones who are really going to be in the room most often.”
How to avoid issues: Brown said meeting with the CNAs can reveal potential red flags. “You should be able to feel their compassion and concern for elderly people,” said Brown. “If they come across as mean to you, or gruff with you, imagine how they’re going to be at the end of a 12-hour shift and someone has thrown water on them.”
5. Do more than going on a guided tour
A tip: Brown said also make sure to visit the specific area of the facility where a loved one will be living, don’t just accept the guided tour. Smells are also important. “There are two smells you really want to look for; one is urine, the smell of urine obviously means it’s not clean,” said Brown. “The flip side of that is the very strong smell of cleaning fluids. That tells you that they’ve cleaned recently and they’ve cleaned often.”
Look around: Fredriksen suggests also paying close attention to other residents. “Are their fingernails clean, is their hair groomed,” said Fredriksen. “If I’m seeing folks that don’t look too well put together and too well cared for and it doesn’t smell great, I’m thinking there’s a staffing problem."
Even see the food: Fredriksen also said ask to see the food being served to residents. She said discussing staff consistency is also a must. “If you have the same aid coming in every morning to check on mom, they’re going to know when mom doesn’t seem quite right,” said Fredriksen. “If you have a different person coming in every day because you have a hard time keeping staff or your staff haven’t been there very long, some of those little things get missed.”
6. Know this about your family member’s medical records
A tip: Brown and Fredriksen said once you’ve settled on a facility, there are still several considerations. Brown said because of privacy laws, don’t assume you’ll have access to your loved ones medical records. “You need to find out form the facility what they’re going to require to make sure that you have all of the relevant medical information that you need to help make medical decisions,” said Brown.
Ask before you sign: Brown said also make sure you understand all the documents you will be asked to sign. Do not sign anything until your questions have been answered. “Failing to continue to ask those questions and make sure that your questions are answered and that you really understand what’s going on, is letting down your loved one and not doing your job,” said Brown.
7. You will be able to talk about the needs of the patient
How it works: Brown said once a person is admitted the nursing staff will have a planned care meeting to discuss specific patient needs. “Families are invited to that, and frankly should be, if you aren’t invited, you need to ask,” said Brown. “By being involved you will at least assure the conversation isn’t brief and that they don’t just skip over and say everything is, ‘ok,’” said Brown.
Visit often: Fredriksen also suggest picking a facility close to home so you can visit often. “Having friends and family visit that loved one is one of the best things for their care,” said Fredriksen. Fredriksen and Brown also suggest visiting at different times of the day and night, not just during regular business hours. Remember, your loved one lives there 24/7 so you want to know how a facility operates at all times.
You will know: Lastly, trust your gut. If you feel something is wrong, speak up and speak up often. Do not simply accept workers at a facility know best.