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By Sharon Johnson, March 25th, 2009

What to look for in a Nursing Home

As I mentioned in a previous article, helping a family member choose the nursing home in which he'll spend the rest of his life is one of the most important things you can ever do for him. It's easier on the patient to find the right place the first time - even though it's possible to transfer to another facility later on, a move is harder on the patient after he has become familiar with the environment and staff members.

If the patient is currently in the hospital, the discharge planners or social workers can provide you with a list of local facilities. They might recommend a certain facility -- but that doesn't necessarily mean that's the best one to meet the patient's and family's needs. Their job is to discharge the patient as soon as possible, and often they'll send the patient to the first nursing home willing to accept the patient. Sometimes the "best" patients (those with the best insurance, or the ability to pay privately for long-term care) are sent to a facility with which the discharge planner has a relationship -- such as a part-time job, or a family member who works at that nursing home. It's not supposed to happen that way, but sometimes it does. Most of the time the patient has the right to choose which facility to which he'll be discharged.

So, what are the signs that a nursing home provides good care? Visit the facility and ask for a tour - a marketing person will walk you through the facility, and this first impression is extremely important. Take your tour during mealtime and notice the staff and patient interactions - if there are smiles all around and the atmosphere is relaxed, that's a good sign. Staff and residents who appear stressed and uncomfortable can be an indication of a poorly run facility. Return to the facility on a weekend to see how patients are treated when Administration isn't usually around -- there shouldn't be a great deal of difference in care on the weekend vs. the weekday.

Many nursing homes will tout their non-profit status as an indicator of excellence, but these facilities are required to follow the same rules as those that are for-profit. My experience has been that non-profits are no better or worse than any other facility; all of them have to break even on expenses or they won't be in business long. Here are some things to look for when choosing a facility:

  • Are you able to reach a staff member to set up a facility tour? If they are too busy to give a tour, they might be too busy to provide personalized services to each patient.
  • Is there enough parking available? If there aren't enough parking places, family members may not visit as often.
  • Is the activity calendar posted in a public place? Do the activities look interesting for an elderly person?
  • Do they take patients on trips outside the facility? Does the facility have a wheelchair equipped van for transportation to appointments?
  • Do staff members call patients by their names in a respectful manner?
  • Do patients have personal items in their rooms, or does that appear to be discouraged by the management?
  • How does the facility smell? If it smells strongly of urine, there's a problem. But if it smells strongly of cleaners while you're there, go back at a later time and see if it was to cover up unpleasant smells.
  • Are the patients lined up in the hallways, looking bored? If this is happening at all hours, it's possible the activity program is lacking.
  • Does the staff look frazzled and disorganized, with paperwork everywhere?
  • Are there medications sitting out unattended? This is a health hazard.
  • Are telephones answered in a reasonable amount of time?
  • Are there outside areas available that are easily accessible to the patients, with enough shade?
  • Are the most recent survey results available, including the 2567 Form from the site visit? Is the Ombudsman's phone number posted?
  • Is the facility well known for having a high staff turnover? If a facility can't keep its staff, that's an indication of problems.
  • Look on the Medicare site (www.Medicare.gov) and review the information listed under Nursing Home Compare.
If the nursing home's admissions are currently being 'held' but they'll place you on a list -- why are they being held? The facility might not have any beds available, which is an indication of a desirable facility. On the other hand, the Centers for Medicare & Medicaid Services might have placed a hold on admissions due to care concerns, which is an indication of a poorly run facility. Ask friends, neighbors, or anyone else if they've had any experiences with the nursing home; if one has had a bad experience that's to be expected, but if several people have -- consider another facility. Use the Internet to help:
  • Search information about the parent corporation of the facility if it's a chain of nursing homes.
  • Search consumer sites to see if there are problems with the nursing home or parent company, including the Better Business Bureau.
  • Is the nursing home a member of the local Chamber of Commerce? Are they an active force in the community?

Remember that you don't have to send the patient to the first facility that will accept him -- doing your homework can help to make a positive change in the patient's life. Patients often have choices, no matter what their payment source may be -- and the closest facility might not be the best choice. Do your homework and you won't be sorry.

Sharon Johnson, BSW, is a Social Worker with over18 years of direct experience working with the elderly. She is the author of several books on senior care issues and Executive Director of Case Management Solutions, LLC.