What You Should Know Before Assessing a Nursing Home
Although comparatively few Americans will become nursing home residents, on any given day, there are 1.5 million people living in 16,000 nursing home throughout the nation. Within a calendar year, there are typically over three million Americans who will spend at least some portion of the year in a nursing home facility. This means that many families are in the process of, or will be seeking, good care for their loved ones. However, the process of finding quality nursing home care can be confusing, difficult and stressful and is often done under duress, when a loved one has had a stroke or has broken a hip and requires rehabilitative care. Families must be armed with resources to make an informed decision about where to place their loved one. If at all possible, the family should make a commitment to conduct an in-depth assessment of a nursing home that is being considered.
It is important to remember, as you are assessing a nursing home, that nursing homes are a big business with revenues of over $50 billion per year. As many as 25% of nursing home beds are owned by as few as 10 publicly traded companies who may own subsidiaries that provide management, dietary or medical services to the facilities they own. Other nursing homes may be privately owned or owned by non-profit organizations, but these homes may be managed by for-profit companies. Recognize that the corporation’s bottom line may take precedent over the care and treatment of a resident. Nursing home care is expensive, and there can be additional charges for patients with dementia or Alzheimer’s.
Beware of Special Focus Facilities. There is nothing positive about the word “special”: consider it a red flag. A Special Focus Facility is typically one with a history of abuse or neglect and substandard health inspection ratings. Such a facility is subject to extra scrutiny and inspections by the Centers for Medicare and Medicaid and by the state where it operates.
Before you consider placing your loved-one in any nursing home, visit the Centers for Medicare and Medicaid Services at Medicare.com/NHCompare to check the overall rating of the facility. Under the current rating system of one to five stars, Medicare allows only ten percent of nursing homes within a state to be designated as five star facilities. A four star facility may be equally as good but fell below the cutoff. If a facility has less than a three stars, you may want to consider other facilities first. Medicare regulations require that each nursing home has the latest State survey of the facility readily available for review at the facility. Read it and see if there are concerns regarding nursing and medical care.
Two major considerations in selecting a nursing home is whether the facility provides “person-centered” care and consistent assignment. “Person-centered” care means residents set their own schedules, wake up and eat when they want to. Traditional nursing homes require residents to awake, eat, bathe and go to bed at the same time. Consistent assignment means that the same staff members will treat the same patients throughout the day and evening, providing continuity of care that reduces errors and allows residents and staff members to form meaningful relationships that promote emotional and physical well-being.
Lastly, contact your state ombudsman, a federally funded employee who advocates for nursing home patients. This person can tell you about any state inspections, surveys or rankings of nursing homes and how many complaints the office has collected about a specific nursing home and the nature of those complaints. The ombudsman will know about any recent significant changes at nursing homes, such as a change in management. Your ombudsman may be found online at the Elder Law Answers. In Michigan, you will find the state ombudsman as well as your regional and local ombudsmen contact information at http://www.ltcombudsman.org/ombudsman/michigan.
The 6 Tips
1. Investigate the company or operator of the nursing home before placing your loved one in their care. When visiting the nursing home, here are some factors to evaluate:
- Who owns or operates the facility? What are the admission requirements and cost of care?
- Is the facility and the nursing home administrator properly licensed by the State? Is the facility certified by Medicare and Medicaid, and if so, how long has it been certified?
- Does the home perform background checks on all employees?
- Do employees receive training to identify and prevent nursing home abuse as well as learn the skills to cope with caring for the needs of many residents?
- Are there clear, formal procedures in place to identify circumstances that may lead to abuse or neglect? How would a family report or investigate a complaint arising from abuse and neglect?
- How are a resident’s personal possessions safeguarded?
- Are there special unit services such as rehabilitation, Alzheimer’s or hospice available to residents? Is the Alzheimer’s unit separate from the other areas of the facility? there a waiting period or facility guideline for when a resident should be moved in or out of the facility?
- Is the nursing home conveniently located to family members and friends?
- Are transportation services available to residents?
- What diagnostic medical treatment is available at the facility?
- Will a resident share a room and/or bathroom with one or more other residents?
- How are roommates initially selected or changed if a problem arises? Can a resident bring some of her own furniture?
2. Speak with the residents at the nursing home, and if possible, visit those who are bedridden. Consider the following:
- Do the residents appear to be well-groomed, well-dressed, with good skin, hair, nail and oral hygiene?
- Are residents alert and content, or do they seem confused or depressed?
- Are you directed only to residents who are willing to talk with you? If the answer is yes, there may be reason for concern.
3. Ask the administration and senior staff, including the director, lead physician and head nurse about the number of staff on duty during the morning, evening and night shifts. Evaluate the following:
- How many nurses and certified nursing assistants (CNA’s) are on duty each shift? What is the turnover rate for skilled employees as well as that of the support staff?
- Are there comparatively more bedridden residents or those in wheelchairs who will require total care in daily activities? If so, the large number of these residents will require a higher CNA staff to resident ratio.
- Do the nursing home residents seem to get along with staff? Do staff members know each resident by name?
- Does the staff allow family participation in the resident’s care plan?
- What are the qualifications of the lead physician? How often is the physician on the premises?
4. Visit the nursing home at different times of the day. If possible, eat a meal there to assess the quality and assortment of the food. Note the following:
- Is the home adequately staffed on weekends and weekday evenings?
- At meal times, how much time does staff spend feeding residents? How much food is eaten? Are there a number of thin-looking residents?
- Are bedridden residents receiving adequate assistance at meal times, or are food trays sitting in front of residents while the food gets cold and aides run from room to room to feed residents?
- Is fresh water available and within reach of residents in their rooms? Do aides offer water to those who are unable to get it by themselves?
5. Observe the cleanliness and orderliness of the facility. Attempt to assess the following:
- Do the halls, rooms or residents smell of feces, urine or other strange odors?
- Are the residents being changed frequently to avoid life-threatening illnesses such as bedsores or urinary tract infections? If not, the facility may have an unpleasant odor.
- Is the facility well-lighted, welcoming and safe? Safety and close monitoring of residents is particularly significant if your loved one is living in an Alzheimer’s unit.
6. Assess the type and frequency of activities for residents.
- Does the facility offer different activities for residents that appeal to different interests?
- Does the home incorporate the community into activities or services within the facility? Are residents (who are able) taken to community and cultural events?
- Do staff members actively evaluate each resident’s interest and tailor programs to residents with specific needs?
- Is there a library available to residents with large print or audio books?
- Is there a safe place for residents to enjoy the outdoors?
Federal law requires that information and services be provided to each nursing home resident, including an initial assessment of the resident’s functional capacity and a personalized health and care plan in which each resident is reassessed on a regular basis. Nursing homes are required to maintain a resident’s basic rights and prevent and treat bedsores and pressure ulcers. If you or a loved one are a victim of nursing home neglect or abuse, contact The Law Office of Henry Hanflik at (800) 720-4000, Toll Free (800) 905-4632 or by email at firstname.lastname@example.org.
- Michigan Department of Community Mental Health-Health Facility Complaints and Investigations Link 1 | Link 2
- Elder Law Answers
- National Center on Elder Abuse
- Michigan Campaign for Quality Care – Citizens Advocacy Group
- National Long-Term Care Ombudsman Resource Center
- National Consumer Voice of Quality Long-Term Care
- Citizens for Better Care – Citizens Advocacy Group
- Michigan Seniors
- Elder Law Answers