Choosing Care

Choosing a nursing home is one of the most important decisions you will have to make for a loved one. Here are some guidelines to follow when making your decision.

Visit the facility and observe several different meals. Ask to taste the food.

Talk with others

Get a recommendation from someone who has a friend or relative in a nursing home and ask them about their experience. If they have had problems, chances are you will have the same problems with that particular facility.

Visit at different times of  the day

Visit the facility at different times of day, ie; morning, afternoon, evening, weekends. Nursing homes tend to have more staff on duty in the morning, therefore, if you only visit at that time, you will get a sense that there is better staffing than might otherwise be the case. This is very important because one of the biggest problems in the nursing home industry is adequate staffing. This is due to: a shortage of qualified nurses and assistants, low pay, and cost cutting to minimize overhead and maximize income. Since nursing homes are in business to make money, it pays to keep staffing to a minimum regardless if the facility is owned by a large conglomerate or whether it is owned by a single owner.

The Staff

Pay close attention to the staff. Do they seem to be in a hurry, scurrying about with no time for the residents? Do they take the time to talk with the residents, answer questions, watch a few minutes of a tv show with them, or ask how they are doing? A nursing home is only as good as the people working there. If they don’t seem to be interested in the residents and only want to put their time in and go home, look for a different facility.

The Residents

Observe the residents. Do they seem to be uptight, not talkative, glum? Or are they singing, humming, talking to each other, interacting with each other and, overall, happy? It will be difficult for the residents to be happy and upbeat if they are in a facility where they are ignored, talked down to and neglected. Talk to the residents. They might be reluctant to tell you if they are experiencing problems, but you should be able to get a sense of whether they are happy.

Look past the sales pitch

Don’t be swayed by the guided tour. The tour guide is a salesperson and has been carefully taught what to say and what to show you. Look past the fancy plants, wood on the walls and pretty furniture and pay attention to the residents and the staff.

Keep an eye out for cleanliness

Do the hallways seem to be cluttered and smell like urine, feces or mildew? Examine the nurse’s station. Is it cluttered and disorganized? Sit and observe the nursing staff. Do they sit at the station, eat, talk, and complain or do they seem to be helping the residents?

Food and dining

At mealtime, do the residents seem to interact while they eat or do they sit by themselves? Ask to taste the food. Do the residents seem to eat all of the food or do a large number of people leave most of the food on the tray? Do the residents appear to be well nourished or do they all look thin? Visit the facility and observe several different meals. Do they all seem to be the same or is their some variety? For those residents who are bedridden, are their trays collected promptly or are dirty trays still sitting in the room several hours after the meal was served?

Further Questions

  • Do the residents smell and look clean? Look in some of the rooms.
  • Do the residents have soap, shampoo, toothpaste? Is their hair brushed?
  • Is the facility warm enough in the winter and cool enough in the summer?
  • Can the windows be opened to let in fresh air?
  • Does every room have pitchers of water?
  • Does the staff offer water to those residents who are bedridden or who are confined to wheelchairs?

Ask how long the various members of the staff have worked at the nursing home.

It’s a good situation if there are many long term employees. On the other hand, it’s a bad sign if most people have been employed there for less than a year. A high turnover rate usually means that staff members are overworked, underpaid or are under a good deal of stress. This is not the type of environment in which you want to leave your loved one. If the nursing home seems to be a good one but there are no long term employees, ask the administrator about the situation.

Ask whether the nurses are members of the Service Employees International Union(SEIU).

Members of this union are well trained and can offer better quality health care.

Ask to see the latest survey by the state.

Medicare requires that nursing homes make the latest state survey available for review. If you are told that there is nothing significant in the report or that the report is misplaced, warning bells should sound. Don’t take “no” for an answer; insist on your right to review the report or remove the facility from consideration if you continue to be refused.

The bottom line: keep your eyes, ears, and nose open

What you observe in the facility should give you a “gut” feeling as to what its like to live there. These observations are much more important than the guided tour by the salesperson whose job it is to get you to commit to the facility.