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How To Choose A Nursing Home

Suggestions For A Site Visit Of A Nursing Home

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The following suggestions are based on a Consumer Reports article on Nursing Homes together with the recommendations of the New York State Department of Health. The list is extensive to provide questions to help you focus on things that will be important to you if you become a resident. Add whatever matters are of particular concern to you before you visit any sites so you do not overlook them. Photocopy the list with your additions. Take the list with you or give it to whomever will visit the site for you. Write down your observations for each home visited so you can make a better comparison later.  

Bottom LineForm your own impressions. After you have done all of your research, your final judgment should include your “gut feeling.”

 Inspection Report:

  • If you haven’t already received a copy of an inspection report, ask for one on site. 
  • Ask how any problems have been corrected. (If you ask to meet with the nursing home administrator, you will not only get answers to this question, but you can also ask about the philosophy behind the nursing home.)
  • Federal guidelines require nursing homes to make their latest inspection report available and readily accessible to residents and the public. Still, sometimes you have to be assertive to get a copy of the report. 

 Visits:

  • Tour each nursing home on your own rather than with a staff member. If the home won’t let you tour alone after the first guided visit, take it off your list.
  • Make unannounced visits. 
    • Ideally the visits should be at different times of the day and week to get a complete view of life in the home. 
    • One of the visits should be during the evening and/or on a weekend when there are usually fewer staff members on duty.

 Physical Appearance:

  • Does the nursing facility allow residents to personalize their rooms?
  • Does each resident have at least one comfortable chair?
  • Does each resident have his or her own dresser and closet space with a locked drawer or other secure compartment?
  • Is there an out-of-doors area where residents can walk and sit and is it used?
  • Does the equipment appear to be in good condition? For example, wheelchairs and assistive devices.
  • Is there a lounge or other area where residents can entertain visitors privately?

Safety:

  • Are the exits clearly marked and unobstructed?
  • Are there features geared toward accident prevention? For example, handrails in the hallways and grab bars in the bathrooms.
  • Are the hallways wide enough for two wheel chairs to pass? Can they pass freely everywhere or are there obstructions?
  • Are there safety hazards to people who walk unsteadily or with impaired eyesight?
  • Is there good lighting?
  • Telephones;
    • Are there any restrictions on mobile phones?
    • Are telephones placed so that wheelchair-bound residents can make use of them?
  • Are inside temperatures appropriate? Are residents dressed appropriately?
  • Are people assisted in walking for the purpose of exercise or retraining?

Cleanliness:

  • Check the kitchen for cleanliness.
  • Check for smells (particularly for urine and feces).
  • Look at the overall cleanliness of the public and activities areas.

 Residents:

  • You may be able to judge how successful a home is in caring for residents by observing residents without infringing on their privacy.
  • Look at the quality of the care and concern for residents.
  • Are residents allowed to set their own schedules?
  • Ask residents:
    • What they like like about the home.
    • What they don't like about the home.
    • What they do when they need something to be different. 
    • What they like about the staff. 
  • Ask visitors or volunteers the same questions you ask residents.
  • Do the residents appear to be content, enjoying the activities, interacting with each other? Are they well groomed?  If most residents are passive, it may be a sign that the home has no activity program or that residents are kept on medications.
  • Are any of the residents in restraints? If so, ask the staff why. 
    • Federal law states that nursing home residents have the right to be free from any restraints administered for purposes of discipline or convenience, unless required to treat medical conditions.  
    • In addition, federal law states residents have the right to be free from neglect and any type of abuse – verbal, sexual, physical and mental.
  • Do staff interact with residents in a warm, friendly manner?
  • Do staff address the residents by name?
  • Are residents allowed to participate in the planning of their own treatment?
  • If possible, speak with family members of the facility’s residents. There may even be a voluntary council of family members with which you can speak. 
  • Does the home give residents the freedom and privacy to attend to their personal needs?
  • Are there arrangements for residents to go home for holidays?

Staff:

  • Is a consistent team of doctors and nurses assigned to each resident? (Consistency increases staff familiarity with individual cases and needs, and reduces medical errors.)
  • How responsive is staff? Do staff respond to someone calling for help?
  • Visit the activities area when in session and notice how staff interacts with residents.  
  • Walk through the corridors and listen to what you hear.
  • Try to get a handle on staff turnover if you can. A high rate of turnover is not good.
  • Find out who to speak with if problems arise, and meet with that person.

Food:

  • Try to time a visit for meal time. Taste the food. Is food appetizing and of good quality?
  • What arrangements does the home have for special diets? 
    • Is there a dietitian? 
    • What effort is made to make special diets taste good?
  • Is there sufficient staff and equipment to help residents who canot easily feed themselves? 
  • Is sufficient time allotted for eating?
  • Is food delivered to residents who are unable or unwilling to eat in the dining room? 
  • Are snacks available?
  • Is the dining room clean and attractive?

Medical/Nursing Care:

  • Look at the medical services, since medical and nursing care is crucial. Generally, you choose your own doctor, even for emergency care. Nursing homes also have their own doctor. Find out:
    • Who the doctor is 
    • The doctor's qualifications
    • How often the doctor visits and reviews residents’ medical records.
  • What care is given by a registered nurse and what care is given by an aide?
  • How many residents is each nurse’s aide or direct care nurse assigned to care for? 
  • Are licensed nurses on duty around the clock?
  • Does the same nurse or aide care for the resident during each shift?
  • Will your attending doctor be able to care for you while you are in the facility?
  • How are medical emergencies handled?
  • If you need more than routine medical care, ask:
    • If a specialist can be called in.
    • If so, how is this done?.
  • In case a medical condition calls for it, with which hospital or hospitals is the nursing home affiliated?
  • If you may need special therapy:
    • Look in the therapy rooms to assess the physical quality.
    • Speak with the staff person in charge to find out if there is any rapport between the two of you.
    • How frequently will the therapy be offered? 
    • How much involvement is there from the doctor with respect to the establishment and oversight of the therapy?

Activities Programs:

  • Ideally, a program should be designed to fit the interests and skills of each person at a variety of times on a daily basis, including weekends.
  • Are residents taken out for events in the community?  
    • If so, how often? Where do they go?
  • Do people in wheelchairs get to participate?
  • How often are outside events brought in for the entertainment of residents?
  • What activities are provided for bed-bound residents?

Money Issues:

  • Find out what services the home provides and which ones cost extra.
  • How much does the nursing home charge for: 
    • A daily semi-private or private room if you need one.
    • The “extras”. For example, supplies such as diapers, catheter tubes and for special services like incontinence care. A daily rate seldom relates to the charges for the extras. Be prepared to supply the “extras” you need yourself.
  • Does the nursing home require that a resident sign over personal property or real estate in exchange for care? If so, how much?  

NOTE Prescriptions in nursing homes often cost double what they would at a local pharmacy. If the drug prices are gouging, demand the right to purchase drugs outside the nursing home.


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