How to Choose a Nursing Home
Introduction
Placing a loved one in a nursing home or assisted living residence is a difficult decision. As our loved one's physical and/or mental conditions decline, we are often faced with no alternative but to consider long-term care placement. The reality is that many of these facilities lack the staffing necessary to meet the needs of their residents. The following is a list of guidelines which can be used in determining whether a particular nursing home or assisted living facility is appropriate for your loved one. It is not intended as, and should not be used by you as legal advice, but rather as a way to approach this important decision..
(1) Assess your loved one's needs.
Does your loved one require skilled care at a nursing home, or can they live in a semi-independent environment of an assisted living facility? Assisted living facilities cannot provide skilled care, but many of them now have special Alzheimer's units for cognitively impaired patients that provide for many of the daily needs of their residents. Talk with your doctor about what type of facility is best suited for your loved one. While nursing homes and assisted living residence are required to evaluate potential residents to determine if they can meet the residents’ needs, this evaluation is not always done properly, and sometimes residents are admitted even where their needs cannot be met by the nursing home or assisted living residence.
(2) Start with nursing homes and assisted living residences in your community.
Link here to get a listing of nursing homes and assisted living residence in Rhode Island and Massachusetts. The Rhode Island and Massachusetts Departments of Health regulate nursing homes and assisted living residence and can also provide you with a list of facilities.
When choosing nursing homes and assisted living residence it is important to try and select a facility that is close to the friends and relatives who will be visiting your loved one. The nursing home and assisted living residence needs also to be accessible to those persons who will be visiting your loved one the mos. Frequent visits will encourage the nursing staff to provide your loved one with the proper care as well as improve your loved one's mental health.
(3) Visit the facility.
Visiting the nursing home or assisted living residence gives you the opportunity to see, hear and smell the facility. Be aware of cleanliness, appropriate safety precautions, and staff presence. Although visits are usually scheduled in advance with the admissions director, you may want to try visiting the nursing home or assisted living residence without an appointment to get a more realistic impression.
A.Speak to staff members and determine whether they seem friendly, open and honest. Ask them if they have family members in the nursing home or assisted living residence. For the most candid answers speak to the nursing staff when their supervisors are not present.
B. Attend a meal, and taste the food. Watch the nursing staff as they assist residents in the dining room. Mealtime is usually a good reflection of the staffing patterns in the facility. Are there enough nursing home personnel to help the residents? Does the menu seem to accommodate the specific dietary and/or ethnic needs of the residents? Are there many choices on the menu? Is the food served hot?
C. Ask for a list of activities provided that week. Most nursing homes and assisted living residence provide activities in an effort to keep their residents stimulated. This is important for purposes of maintaining good physical and mental health. See if they have a bulletin board with a list of activities. Do they have outside activities or field trips?
D. Ask about the staffing at the facility. What is the ratio of staff members to residents? What do they do when a staff member calls in sick? Do they have a procedure in place to assure that a replacement is available? Have the staff members received any specialized training for dementia or Alzheimer's care? What type of rapport do you observe between the staff and the residents?
E. If your loved one has suffered an injury or disability that requires physical therapy, does the nursing home or assisted living residence have a rehabilitative program to meet those needs? If so, does the facility have the equipment on site? Is the rehabilitative staff at the facility, full or part-time? How often does the regular staff provide exercise activities to compliment the rehabilitation?
F. Nursing homes are inspected and surveyed annually by the Department of Health, and if their care is found to be deficient, they are cited. By law they are required to post these deficiency citations in a public place. Ask to see the surveys going back 3 years to determine if any pattern of poor care exists.
G. Ask if the nursing home or assisted living residence is a for-profit or a not-for-profit facility? Generally, a non-profit facility will have less incentive to sacrifice patient care for added corporate profit. This doesn't mean that all for-profit nursing homes or assisted living residences provide poor quality care, or that all non-profit facilities provide top quality care. But as a general rule, you may be better off with a non-profit nursing home or assisted living residence because they do not have a margin of profit to conflict with the expense of providing quality of care.
(4) Search the Internet
If a nursing home or assisted living residence is part of a large chain, it may have an Internet website. Expect the site to reveal only good things about their nursing homes or assisted living residence. Run searches on the nursing home or assisted living residence on the Providence Journal, Warwick Beacon, Cranston Herald, and other local newspapers. Google the name of the facility. You may be surprised (pleasantly or otherwise) at what you learn. Medicare offers a Nursing Home Compare resource at www.medicare.gov/nhcompare/home.asp that provides information on every nursing home that accepts Medicare and Medicaid. Also see the Consumer Reports Nursing Home Quality Monitor at www.consumerreports.org/nursinghomes. This free resource identifies nursing homes that are likely to provide better-quality care and those you should avoid. You can also purchase detailed nursing home reports through companies like www.healthgrades.com and www.carescout.com.
(5) Inquire About Financing.
Ask about the financing of your loved one's stay. Will they be entitled to receive Medicare? Most nursing homes accept Medicare if they meet the eligibility requirements, however some nursing homes do not. Assisted living residence will not accept Medicare. Under limited circumstances they may accept Medicaid, under a process called Medicaid waivers.
In most situations Medicare will only pay for nursing homes for the first 100 days of a stay. Thereafter, you will have to arrange for alternative funding. If your loved one has assets of any kind, they may have to "spend down" to show that they meet the eligibility requirements for Medicaid.
(6) Look Closely at the Admission Agreement or Contract.
This agreement or contract will control your loved one's legal rights while in the facility. In a nursing home your admission agreement usually references the patient's bill of rights, which can also be found under the federal regulations, 42 C.F.R. § 483.10. Because those regulations do not apply to assisted living facilities, your contract is even more important because it specifically determines the level of care your loved one is entitled to receive. Be sure to inquire into any additional costs not explicitly stated in the contract and identify those amenities that you feel your loved one needs for a comfortable living environment. Many facilities include provisions requiring the arbitration of all claims, and waiving your right to a jury trial. You should insist that any arbitration clause waiving your legal rights be taken out of the agreement.
Conclusion
Nobody can guarantee that your loved one will receive the proper care he/she deserves in a nursing home or assisted living residence. However, doing your homework in researching the proper facility will certainly improve your odds. Remember, once your loved one enters the nursing home or assisted living residence you will need to visit as frequently as possible to assure that good quality care is being provided. Those visits and a good relationship with the staff in the facility will create a support system that helps insure your loved one's well-being is a top priority of the nursing home or assisted living residence. Do not be afraid to move your loved one if the care is not satisfactory.