Choosing the right nursing home is challenging. And chances are good you’ll someday face this decision for yourself or a loved one. More than half of older adults will eventually stay in a nursing home for at least one night, according to a September 2017 study. Of course, most residents stay much longer.
Obviously, you can’t just rely on facility tours or promotional brochures to make this crucial decision. First, get your ducks in a row. You can locate possible facilities and find inspection data by searching the U.S. News Best Nursing Homes rankings, as well as downloading a comprehensive checklist for visits.
When you’re ready to visit in person, turn to administrators, staff members and residents for answers to pivotal questions.
Is the location realistic? Lengthy drives, not to mention flights, will affect visits and add barriers to relationships with friends and family members, including spouses still living at home.
Many families face a tough conundrum. Sometimes it’s a matter of choosing between top-ranked but distant facilities versus more accessible locations for loved ones to visit regularly and monitor care, says Robyn Grant, director of public policy and advocacy at the National Consumer Voice for Quality Long-Term Care.
Choice and quality vary widely. Not surprisingly, a November 2017 study of nursing homes in 350 U.S. cities found facilities located in lower-income neighborhoods generally provided lower-quality care. In rural areas, a big issue is a lack of any nearby nursing homes.
Ask Administrators and Nursing Directors:
What are the staffing ratios? Bolster your question with research: You can see state-by-state staffing data for individual facilities, including average hours for registered nurses, licensed practical and certified nursing assistants, via the website of the nonprofit Long Term Care Community Coalition.
What is your staff turnover? Stable staffing is a good sign. In addition, consistent assignment – when the same caregivers are assigned to the same residents on a daily basis – is “critically important,” Grant says. That way, staff members really get to know residents, anticipate their needs and can recognize and address problems early.
How long do nurses and aides spend with residents each day? This is a critical component to getting the best care for your elderly or disabled loved one, says Mitzi McFatrich, executive director of Kansas Advocates for Better Care, a statewide nonprofit that works on long-term care and elder abuse issues.
Which services do you offer? If you’re undergoing rehab to recover from a hip fracture, you’ll need a higher level of care than some nursing homes can offer. With medical conditions like chronic obstructive pulmonary disease, or COPD, residents may need help managing supplemental oxygen.
What do nursing home surveys show? On an about-yearly basis, nursing facilities undergo inspections on behalf of the Centers for Medicare and Medicaid Services. Survey data, reports and ratings are available to the public. Annual survey reports should be posted in each facility – and if you don’t see that, ask. Good nursing homes should have lower-than-average deficiencies, McFatrich says, and none in the categories of mistreatment, actual harm or immediate jeopardy.
How do you prevent pressure sores? “If someone is bed bound or not very mobile, they have to be moved every two hours in order to avoid development of pressure sores,” McFatrich says. In addition to care protocols, ask about on-site equipment, such as special mattresses that can relieve pressure points.
How does your facility avoid infections? In 2016, the CMS mandated that nursing homes must improve their systems to prevent infections and detect outbreaks. However, infections like methicillin-resistant Staphylococcus aureus, or MRSA, remain a problem. Ask about infection-control practices for employees such as yearly flu shots and hand-washing.
What if I run out of money? McFatrich suggests asking: “If I come in as a private-pay [resident] and I run out of resources, are you certified to accept Medicaid? Am I going to have to move because I can’t live here if Medicaid is the entity that’s going to reimburse for my care?” Involuntary nursing home evictions have been reported across the country. Ask about resident safeguards and make sure contact information is clearly posted for your state’s long-term care ombudsman’s office.
Do you provide special care for people with dementia? Memory care means much more than just a locked unit to prevent residents from wandering. Staffing ratios should be no more than five residents per caregiver, including nurses and aides, around the clock, McFatrich says. Caregivers should have special training in dementia care, and the awareness and sensitivity to best address these needs.
How do you promote diversity so all residents feel comfortable? One approach is to ask what kind of diversity training staff members receive, Grant says. Without that, for instance, some LGBT seniors may find themselves withdrawing socially when they become nursing home residents, making isolation a risk.
What about mood-altering medication? Most facilities no longer use physical restraints. But so-called chemical restraint is another issue. McFatrich says she would ask, “How many of your residents currently receive antipsychotic, anti-anxiety or antidepressant medications as a means to control their dementia or related behaviors?” This speaks to whether drugs meant to treat certain mental illnesses are instead being used inappropriately, she says. According to Grant, antipsychotic medication should only be used as a last resort, if at all – and only with consent, for a limited time period and with residents closely monitored for side effects.
What kind of food do you serve? Residents rely entirely on nursing homes to meet their nutritional needs. Healthy, tasty food improves everyone’s quality of life.
How do you satisfy cultural and individual food preferences? People in nursing homes still want to enjoy meals that evoke family traditions and tastes they’ve developed over their lives.
Do you accommodate special diets?Residents come in with their own dietary preferences and restrictions. Some also may have medical orders for soft or puréed diets, for example.
Can residents eat when they want? Some people prefer to eat outside routine schedules. For these residents, Grant says, it’s worth asking “What if I like to get up late and I want to eat my breakfast at 10?”
After the formal tour, explain that you’d like a chance to speak with several residents. Drop in at the activities room or a lounge, introduce yourself, say you’re considering a move there and ask what it’s like for them, Grant suggests.
Are you happy here? “Do you enjoy living here?” “What do you like best about living here?” and “If you could change one thing, what would that be?” are positive ways to frame your questions and make residents more likely to respond.
Do you have freedom of choice? Does the facility offer resident-centered care? Are you able to get up when you want? Do you go to bed at the time you want?
When you ask for help, how long do you have to wait? If you always have to wait beyond five minutes for help, you’re likely to try doing things on your own, which could set you up for falls, McFatrich says.
Ask Activity Directors:
What about activities? How do you keep residents engaged? Ask to see monthly activity calendars. Offerings should be varied and appealing.
Does the facility have a resident or family council? These self-determined groups can provide a strong voice for quality care.
Is reliable transportation available? “Sometimes nursing homes only provide transportation for certain medical appointments – and they don’t provide transportation for social [purposes],” McFatrich says. “Is there staff to help residents get to a granddaughter’s play?”
Can residents easily spend time outdoors? Attractive courtyards are sometimes the first thing visitors notice. But how often can residents, particularly those with mobility issues, actually go outdoors? Does staff encourage and help them to do so?
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