You are looking for an excellent nursing home placement for yourself or your loved one. These 10 points will help you determine which placement will provide the best care and the most dignity.
1. Ask About Care Plans
Care plans outline the care provided to the resident and should be updated at least every three months and immediately on any change in a resident’s condition. Care plans should be specific and individualized, listing what staff will be involved and what each staff member will do, and should include the resident, family members, and staff. Care conferences to discuss the medical care, activities, and therapies the resident receives should be held regularly and should involve the staff, the resident, and the family. Ask these questions of the residents and their families too. Find out how nonemergency medical concerns are handled. Ideally, a medical director will respond to questions and concerns within 24 hours.
2. Check Last Three Inspections
Nursing homes must be inspected at least every 15 months. Inspection reports are available from Medicare at medicare.gov. Read the most recent inspections. If there are deficiencies, ask about those deficiencies and find out what is being done to correct the problems. Pay attention to the size and scope of the deficiencies; some deficiencies are more serious than others. If the facility has had any major penalties, find out why the penalties were imposed and if the underlying problems have been resolved. The following penalties should raise a red flag: government sanctions, decertification from Medicare or Medicaid, partial or total bans on admissions, state appointed monitors, or temporary managers fines.
3. Ensure Minimal Use of Restraints
Restraints are anything used to keep a resident from moving freely, including, but not limited to, cloth ties, bed rails, chair trays, and hand mitts. Restraints can contribute to agitation and depression, development of bed sores, increased likelihood of injury in case of a fall, broken bones, and strangulation. Safer alternatives include pillows to help a person sit straight, reclining chairs, chair alarms, bed alarms, lowered beds, and floor padding. Ask staff and residents or residents’ families about restraints. Look around. Do you see evidence that restraints are commonly used?
4. Take a Tour
Tour the facility. Pay attention to what you see, hear, and smell. Do not be limited to public areas, but ask to tour the residential areas too. Check out the food being served. Look at the activities chart. Pay attention to how the staff treats the residents. Try to tour on a weekday and on a weekend and look for any differences.
5. Talk to the Residents
Find out what the current residents or their families think about their care. Talk to them, their family members, and caregivers. Talk to the staff. Get a feel for what they think about their jobs and how they feel about the residents. Ask about coworkers and try to find out if staff turnover is a problem. Lower turnover could mean higher job satisfaction, which results in better care for the residents. Lower turnover also means that the residents can develop relationships with the staff and receive more consistent care.
6. Inquire About Staffing
Facilities are requires to post the number of licensed and unlicensed direct care staff for each shift. Check it out on weekdays and weekends. Homes with more licensed staff tend to provide better care. Do they use temporary agencies? Are staff members permanently assigned to residents? The better the staff know the resident and the more comfortable they are, the better the care should be.
7. Check the Resident or Family Council
Resident and family councils, made up of residents and their families and friends, help protect against abuse and neglect, tell a facility when culture change is necessary, assist the activity director in increasing resident participation, and provide ongoing appreciation for staff. Resident and family councils benefit residents by providing education about residents’ rights and a means to express concerns and solve problems. They also provide orientation, support, and information for new residents and families.
8. Request Information About Changes in Source of Payment
Federal law prohibits Medicaid certified homes from seeking written promises to pay privately. Most nursing home applications still require financial information and many have written policies stating that someone is more likely to be admitted if that person has a certain level of assets, which ensures his or her ability to pay privately. State law requires that if a nursing home is certified for Medicare, it must be certified for Medicaid. Medicare beds are, however, more profitable to the nursing home and the Michigan Department of Community Health (MDCH) does not actively enforce this law. In 2004, the MDCH issued a policy stating that any newly certified Medicaid beds (after August 1, 2004) must also be Medicaid certified. Dual certification benefits residents when their source of payment changes.
9. Find Out How Much Control the Residents Have
Find out how much choice the resident has in his or her daily schedule and the care received. For example, can the resident participate in social, recreational, religious, or cultural activities that are important to him or her? Can he or she decide when to participate? Does he or she get to choose what time to get up, go to sleep, or bathe? Can he or she get food and drinks at any time? What if he or she doesn’t like the food that is served? Is transportation provided to community activities? Does he or she get a separate television? Can he or she decorate the living space the way he or she wants?
10. Ask About Visitation
Ideally, the nursing home should be located conveniently for family and friends and should provide a welcoming atmosphere for visitors. Find out what the restrictions are for visiting. Visitors are beneficial to the resident in that they can alert staff to changes in the resident’s behavior or mood, raise concerns with staff members, and ensure that a resident is receiving appropriate and adequate care. Not only do visitors brighten the resident’s day, but residents who have lots of visitors generally receive better care.
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