Choosing A Nursing Home for your Loved One
Choosing a nursing home for a loved one is about as much fun as a root canal. The process usually starts late in the day, maybe on a Friday, when you get a call from the hospital telling you that your parent/grandparent is going to be discharged over the weekend. “Which nursing home do you want?” A mad dash to the phone book or Google ensues. How can you tell which ones are good? The newspapers would have you believe that they are all terrible. First stop may be the web site the federal government provides: http://www.medicare.gov
This site purports to provide the information you will need to make a rational choice and even rates nursing homes on a “Five Star” basis- five stars equals good and one star not so much. After a little digging, however, you are probably totally confused. The site doesn’t really rate the quality of nursing homes but rather rates the homes on how well they performed on federal and state Medicare inspections (called “Surveys”) The results are confusing and the surveys are much too paper oriented, rather than people oriented.
Choosing A Nursing Home by Their Policies
For example, nursing homes are required to have written policies for nearly everything. Failing to have a policy may appear to be equal to actually failing to do something: a lack of a written policy or even the presence of one policy while the practice is to follow something else, will result in a “deficiency”. A lack of a policy that requires the nursing home to conduct criminal background checks on employees will appear to be the same as hiring someone with a history of resident abuse.
A policy that certain food surfaces must be cleansed with a particular cleaning product while the actual cleaning is done with something else will result in a food sanitation citation- as will failing to clean the surface at all!! As a result, the medicare site is not of much help to anyone “not in the know.” It is, however, a place to start when choosing a nursing home.
Using Your Common Sense when Choosing a Nursing Home
So the question remains, “How can you tell if the home is a good one?” first of all, there is absolutely no way better than actually going to the home and seeing for yourself. Your common sense, when choosing a nursing home, will guide you better than any web site. Is the place clean? Is there an odor? Do the residents look comfortable and relaxed? Realize that an odor may result anytime that a resident has a “problem” but there is a distinct difference between a fresh odor and a stale, nasty odor that has been around a long time.
There is a movement for something called “culture change” in nursing homes. Simply put, this movement strives to put the residents and families in charge of the residents’ care. It is often confused with various “progressive” care strategies but really has at its core a full and complete understanding of Residents’ Rights. Those rights start with the premise that a person who is admitted to a nursing home gains rights, not loses rights. For your purposes of choosing a home, those homes that truly respect each and every resident’s rights (or the person legally exercising those rights) will be the best choice.
Be Proactive for Your Loved One When Choosing A Nursing Home
A simple test question: “My mother likes to have a small glass of brandy in the evening before bedtime. Is that permitted?” If the answer is no or “sure, your mother can come to the nurses’ station and we will provide a sip of her brandy in a medicine cup- providing we can get a doctor’s order for it” then that facility does not understand the concept of resident rights. If your mother could have a glass of brandy at home without a doctor’s order, what happened to her rights once admitted to a nursing home?
While brandy may not apply to your relative, the example does. Ask the question anyway. If the attitude of the nursing home is that they are in total charge of your relative’s life and they will make the decisions, look elsewhere.
When you tour the nursing home, try to go at different times of day. When choosing a nursing home go early in the morning after breakfast and right after supper which are tough times for nursing home staff and residents alike. This is the time of the most work and, at least in the evening, the least staff for the amount of work to be done. Are the people- staff and residents- friendly and busy but not stressed? Is there an odor? Noise?
Ask to meet with the Administrator and head nurse (usually called the Director of Nursing). Where are these offices located? If they are inaccessible to the residents, that is a warning sign. If the offices are near the resident’s rooms and residents feel comfortable visiting the offices, that is a good sign. Does the Administrator seem to know the residents or is the Administrator simply paying lip service. Do the residents know him/her?
Ask to see the Activities schedule. If there is an activity scheduled while you are there, go to it. Are you welcomed? Is the activity well attended? Age appropriate and appropriate for the level of care or are residents bored and listless?
If you are there at meal time (always a good idea), visit the dining area. The food service should be judged no differently than you would judge a restaurant. Does the food being served match the posted menu? The menu is posted, is it not? Is the meal served on reasonable dining plates, cups, etc or is it served on trays with institutional dishware?
If your relative requires a special diet, are special diets prepared and served in the same manner as the “house diet” or is the special diet something left over? What about diets that require pureed foods? There are methods of preparing pureed foods so that the food looks just like the regular meal and is, in fact, the regular meal pureed and reconstituted to look similar.
You probably will not find the perfect place; the perfect place is at home. You can however, choose the better or best facility. Unfortunately, the very best will probably, but not necessarily, be the most expensive and difficult to gain admission.
Do not get too hung up on extraneous matters such as size or whether the home is operated by a not-for-profit. I have seen wonderful small facilities that had the feel of home and that gave great care; I have seen small facilities that were simply lost in time and culture and no concept of modern methods of treating nursing home residents. I have also seen large homes that did a great job and some that did not. Not-for-profit homes usually have good intentions but sometimes their good intentions do not translate into good care. Some for- profit homes, put short term profit before care. The only way to judge is to see for yourself.
Posted by Dwight Sowerby , Sowerby Law Office, PLLC
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