How to Select a Quality Nursing Home

Many of us in todays world are having to make some tough decisions with regard to caring for our parents.  In fact, we are known as the sandwich generation.  Many of us are still caring for our children and now have to care for our parents who are ill.  Making a decision to put our parent in a nursing home can be overwhelming. It causes a grief all of its own.  Robert W. White, former President of Prebysbeterian Church Homes and Consultant for homes for the aging, provides a good tool to help you determine if a nursing home is the right choice for your family member

by Robert W. White

Many of you will be called upon to make a major decision regarding a parent or spouse regarding their health and long term care. This may be due to a death in the family or just because of the illness of a family member when care can no longer be provided at home.

In either care, choosing a nursing home can present a lot of stress for family members and making a decision about which nursing home is right for the needs of the patient and the family can seem overwhelming. Here are a few very simple guidelines to assist you in this process.

Should you consider a nursing home?
Do you have a family member or relative who can no longer live independently? Do they need twenty-four hour nursing care and supervision? Does your loved one need help with most daily living activities such as, eating, bathing, dressing, using the bathroom and getting in and out of bed? Is the person chronically ill, or in need of intensive rehab care? If you answered “yes” to most of these questions, then you and your family may have reached the point at which you should consider choosing a nursing home.

What Kinds of service can a nursing home offer?
A quality nursing home offers a full array of personal, dietary, therapeutic, social, recreational and nursing services. Meals, laundry, housekeeping and medical services are provided. In addition, most nursing homes, offer religious services and counseling programs.

The nursing home staff consists of the following:

Administrative Staff to provide over all administration through the Nursing Home Administrator, admissions coordinator and secretarial support.
Nursing Staff that provide hands on care to the residents. These would include registered nurses (RN’s), licensed practical nurses (LPN’s), certified medical technicians (CMT’s), certified nursing assistants (CNA’s) and medical records technicians.
The food service director oversees a nursing home’s daily meal program. Most homes also employ a consulting dietitian to ensure that meals are appetizing and varied and meet the individual dietary requirements of residents.
The activities coordinator who is a trained therapist or someone designated to assess resident’s individual needs can create and provide recreation, entertainment and therapy for residents.
The social service staff consists of social workers and perhaps psychologists and counselors who assist residents in coping with the emotional and psychological aspects of aging.
Pastoral care staff consists of ordained professional or lay persons trained to meet the spiritual needs of residents through worship, study, meditation and counseling.
The activities coordinator who is a trained therapist or someone designated to assess resident’s individual needs and create provide recreation, entertainment and therapy for residents.
Pastoral care staff consists of ordained professional or lay persons trained to meet the spiritual needs of residents through worship, study, meditation and counseling.
Volunteers are members of the community who assist staff by spending many hours interacting with residents and helping them perform their daily activities.

Who pays for nursing home care?
Nursing home care, like all good health care is costly. Before you agree to pay for services, understand completely all the financial arrangements of the home you have selected. Nursing homes charge a basic daily or monthly rate. Many residents or their families pay for nursing home care out of their own private funds. One way to help defray nursing home expenses is to purchase private Long Term Care Insurance. If you do not have Long Term Care Insurance, and your money has been depleted then you can apply for Medicaid. However, some nursing homes do not accept Medicaid patients.

Be sure to check with the nursing home of your choice to determine if they will accept Medicaid after the patient’s assets have been depleted. If they do not, you must be prepared to find a place in another nursing home. It is easier for the family and the patient if you deal with this issue up front so you do not have to move the patient to another location when funds become depleted.

Be sure to ask the admissions staff at the nursing home of your choice what the basic monthly fee covers, what is included and what is not. Ask if the facility charges extra for physician’s fees, medications, laundry, special feeding, frequent linen changes or special supplies such as wheelchairs and walkers. Are therapies included in the basic charge? Is a deposit required?

To find out whether a resident is financially eligible for Medicaid, call the Department of Social Services in your area. Contact your Social Security office about Medicare, but be aware that Medicare pays for very little nursing home care, and never for a long-term stay. In addition, if your relative is a veteran of the U.S. armed forces, it will be to your advantage to investigate services available through the Veterans Administration. The nursing home may ask for financial disclosure to determine the appropriate payment mechanism. Admissions personnel will assist you in determining what information is necessary and what forms need to be filed to expedite placement. Because some nursing homes have waiting lists, you might want to have paperwork done in advance in the event an emergency placement needs to be made.

One of the most difficult tasks in helping loved ones, when they need twenty-four a day nursing care, is choosing to use a nursing home and then finding the right one to use. For this reason, we have created the following “check list” to be used when selecting a nursing home.


CHECK LIST FOR SELECTING A QUALITY NURSING HOME

______Does the Nursing Home have a current operating license?

______Does the Administrator have an up-to-date license and is a member of the American College of Health Care Administrators?

______Ask to see the most recent survey by the Division of Licensure and Regulation of the State. This survey will let you know the number and type of deficiencies this nursing home had in its last inspection. (A deficiency is a condition found on inspection that was not acceptable to the state inspectors)

______Ask if the nursing home is certified for Medicare and Medicaid. If the resident’s money will be spent down in two to three years of residing in the nursing home and Medicaid is not certified in that nursing home, you will have to move the resident to another nursing home. If a resident receives Skilled nursing care and the nursing home is not Medicare certified, the resident will not receive Medicare benefits for this care.

______Does the location of the nursing home suit the resident, family members and even friends who would all make regular visits?

______Are there handrails, grab bars in the bathrooms and other features aimed at accident prevention?

______Are exits clearly marked and unobstructed paths to these exits? All nursing homes must comply with state and/or federal fire safety codes.

______Do bedrooms open onto a corridor and have windows, as required by law?

______Is a physician available for emergencies?

______Are there any heavy odors, whether pleasant or offensive? A good nursing home will not use highly scented sprays to mask odors.

______Are hallways wide enough to permit two wheelchairs to pass with ease and wheelchair ramps for easy access into and out of the facility?

______Does the kitchen separate food preparation from garbage and dish washing areas and are they keeping perishable food refrigerated?

______Are toilet facilities designed to accommodate wheelchair residents?

______Is there an attractive resident dining room with tables convenient for wheelchairs and food that looks appetizing? Notice, too, whether residents who need help are receiving it?

______Do residents look clean and dressed appropriately for a full day of activity and social interaction.

______Is there a policy that encourages residents to go outside? Even city nursing homes should have a lawn or garden area for residents to get fresh air.

______Is there a commitment to a philosophy of care in which physical and chemical restraints are used minimally or not at all?

______Is there an activity room or designated space for residents who are able to be involved in reading, crafts and social activities?

______Is there a friendly and available staff who appear pleasant, caring and accommodating to residents and visitors?

______Is there a volunteer program? People who volunteer their time and talents to bring special attention and activities to residents.

______Is there an active resident council or some type of resident participation program that enables residents to recommend changes with the nursing home?

______Is there a stated policy that identifies and respects residents’ individual rights? Ask to see the facilities “Patient Bill of Rights”.

______Will the nursing home contact you and ask you to participate in resident care meetings where the staff and you talk about the resident’s care and needs on a regular basis?

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