Answering my office phone late one Friday afternoon, I heard a concerned woman say, “My mom needs a nursing home, but there are so many distressing stories about them. How do I find the right one?”
“How did you hear about us?” I asked.
She replied, “Several years ago, you took care of my best friend’s mother, and she said you would help me.”
How do you find a quality nursing home or an assisted-living facility for your parent? The following are eight suggestions I’ve shared with families to help them begin their search:
1. Word-of-mouth recommendations are an excellent place to start; there is no source more reliable than someone you know and trust. In the past, women of my generation had lunch and discussed how to locate the right orthodontist for their children. Today, the same women are networking to locate the best long-term-care facility for their parents. If the name of a particular facility is mentioned again and again, be sure to file it away for future reference.
2. The local senior center in your area can provide a list of nursing homes within a comfortable radius of your neighborhood. Ask to speak with the social service specialist.
3. Religious social service organizations, such as Jewish Family Services or Catholic Charities, can also serve as a good point of reference.
4. Your family doctor, hospital social worker, and clergy may provide you with good leads as well. Be sure to ask if they have personally visited the nursing home, or if they are sharing someone else’s experience with you. Recommendations from firsthand knowledge will be the most dependable.
5. Organizations such as Alzheimer’s Association, Parkinson’s Association, or National Stroke Association will have a list of facilities in your area. Each of these illnesses has special requirements, and it is important to admit your parent to a facility equipped to meet his type and level of care.
6. Geriatric-care managers play a new role in the field in geriatrics. As licensed social workers or registered nurses, they come to your home, assess the situation, and recommend appropriate in-home services or a more advanced level of care, if necessary. Contact the National Association of Professional Geriatric Care Managers.
7. Your local Area Agency on Aging will give you a list of licensed facilities in your area as well as the phone number for the nearest location of the Office of the Long-Term Care Ombudsman. As state advocates for elderly residents, ombudsmen routinely visit assisted living facilities and nursing homes; consequently, they are knowledgeable about the features and the quality of care each facility offers. Contact Eldercare Locator at 800-677-1116.
8. The Internet can be a useful tool. However, facility websites may be no more than advertisements, and government-posted inspection reports are frequently out-of-date, difficult to understand, and open to misinterpretation. Consider the Internet for general information only.
Nolan. A gentleman I didn’t recognize was walking up and down the hall of our care facility. “Can I help you?” I asked.
Introducing himself as Nolan, he showed me his book on how to choose a nursing home. “This author recommends that I come in unannounced,” he said, “but now that I’m here, I’m not sure what to do next. Just looking into people’s rooms isn’t getting me anywhere.”
On the way to my office, Nolan explained that his ninety-two-year-old mother had been self-sufficient until the previous week, when she had fallen and hit her head. Admitted to the hospital for tests, she was still quite weak. “They say she’ll be discharged the day after tomorrow and that she needs nursing home care,” he continued. “Even though my brother has visited three nursing homes already, I’d like to have an informed conversation with him, so I’m doing some research of my own. This book says to be sure to ask about staffing ratios and inspection reports.” He paused. “I have no idea what they’re talking about.”
Can You Rely on Inspection Reports?
Inspection reports for every nursing home in the United States are available on the Internet. Go to medicare.gov and click on “Nursing Home Compare.” In these reports you will find survey results, deficiency patterns, staffing information, number of beds, type of ownership, and whether the facility participates in Medicare, Medicaid, or both.
Staffing Reports. Since facilities are generally surveyed by the Department of Healthcare Services every twelve to fifteen months, information you find can be out-of-date. Although data posted on the Internet may prove valuable, you cannot assess resident care and quality-of-life issues from a government graph. More important is how long the current administrator and director of nurses have been responsible for the facility—frequent turnover of these positions will have a great impact on quality of care. A personal visit continues to be your best bet in finding a quality care facility because it allows you to observe the staff, and the staff is the most important element in the success of a nursing home.
Staff-to-resident ratio is one indicator of the quality of care your parent will receive. An acceptable ratio of nurse’s aides to residents would be as follows:
|
Day Shift |
one nurse’s aide to six residents | ||
|
Evening Shift |
one nurse’s aide to ten residents | ||
|
Night Shift |
one nurse’s aide to fourteen residents |
This ratio should be maintained seven days a week.
Ask if the licensed nurses and nurse’s aides are full-time employees or if the facility works with nursing registries (temporary agencies). If the facility is staffed with registry nurses, it will be unable to offer the same level of care as one that hires, monitors, and educates its own staff.
The Inspection Report
Pamphlets advising consumers how to choose a nursing home often give state inspection reports a lot of credibility. However, these reports do not necessarily portray the facilities accurately. When I look up nursing homes in Los Angeles on the Internet, it makes me uneasy to see respectable ratings for facilities that I personally know are undergoing difficulties. Although survey findings may be useful to establish a record of repeated violations, they do not begin to tell the full story. Facilities that look good on paper may not be delivering quality care. The inspectors’ interpretation of regulations can be subjective and inconsistent. Survey teams, short staffed due to poor government funding, are responsible for completing a sea of paperwork when their time could be better spent evaluating actual hands-on care given to patients.
Certainly, government inspections have helped to improve long-term care, for example, by exposing high incidences of bedsores, frequent falls, and overuse of physical and chemical restraints. Over time, however, the surveys have become more of a punitive instrument, imposing stiff monetary fines for violating regulations, but doing little to improve patient care. Often, facilities simply add more staff whose sole responsibility is to improve the paperwork, not the quality of care.
If you like what you’ve learned about a facility, but you have read a survey report and feel uncomfortable about certain deficiencies, ask the administrator for an explanation. If she is open and able to explain your findings, this may still be a desirable facility.
Making the Phone Calls. Once you have developed a list of facilities, use the phone to request information regarding facility size and location. The cost should be established before visiting the premises. Are there additional fees? Is there a bed available? If your parent has special needs, can the facility accommodate him? If it is a nursing home, is it certified for Medicare and Medicaid funds? Is there a religious affiliation?
From the first hello, whether you notice it or not, the facility is already making an impression on you. Ask yourself these questions: How did you feel about the call? Was the staff member you spoke to friendly and attentive? If she couldn’t answer your questions, did she transfer you to someone who could? Did you feel as if you wanted to know more about the facility? If not, proceed down your list.
When you have narrowed your choices to three or four facilities, plan to visit each one, preferably during the lunch hour. Although visiting during lunch will limit you to one facility per day, it will provide you with useful information. For example, by noon, residents should be up and dressed, and their rooms neat and orderly. The meal being served should look fresh, appetizing, and nutritious. This is a good opportunity to observe the staff. Are they interacting with the residents, or are they speaking mainly to each other?
The Walk-Through and the Inquiry Process. Two things are essential in determining if the care facility is best for your parent:
1. A physical walk-through with a professional staff member.
2. A formal, in-depth meeting, which I call the “inquiry process” (see Chapter 15). I strongly recommend that you meet with the administrator or with the director of nurses.
You will find questionnaires in books and on the Internet to help choose a facility. Most of them consist of items to be checked yes or no to keep track of and narrow your choices. If you take one of these checklists with you on your visit, do not let it distract you from the two essentials above. Remember, your parent’s individual needs and personality are not on the checklist.
Making Your Decision. Rank the facilities you have visited in the order of your preference. If time permits, revisit your first and second choices, this time choosing another time of day, perhaps during activities, to give you a more complete “feel” for the surroundings. Observe the staff one more time, bearing in mind it is the staff, the hands-on caregivers, who will determine your parent’s well-being in her new home.