Finding a nursing home (-LTCF) for a loved one can be overwhelming. I was a nurse, charge nurse, and Assistant Director of Nurses at a nursing home up until I had my daughter. I have seen really good ones and places I wouldn't let keep a roach for five minutes. I hope to lay out a plan that will make it easier to find the right home for your loved one.
Take a tour of several facilities. If possible do not schedule this tour beforehand. Bring a notepad and pen with you. Nursing home are generally going to have a tinge smell of urine. With so many incontinent patients in one place it is inevitable. However, the aroma of urine and feces should not overpower you. If so, the nursing home is not properly changing the patients and/or cleaning the common areas. Take notes on the smell, the cleanliness, how many staff you see, if there is an abundance of call lights going off for a prolonged period of time, if there are activities going on, etc. Notice the other residents mood and behavior- if everyone in the place looks browbeat its not a good sign! Try to schedule your visit at a meal time and notice if the food is attractive, aromatic, and plentiful. Compare your notes to the answers from the questions bellow. Most of the time the Social Worker will be the one to guide your tour and answer your questions. However, sometimes it may be several people, but don't let that intimidate you. There are five key staff you want to know: Administrator, Social Worker, Director of Nurses (DON), Dietician, and Activity Director.
Ask these questions:
- Is the nursing home's state operating license current?
- Is the facility Medicaid and/or Medicare certified?
- Can I see a copy of your last state inspection? (this inspection report will tell you the things the nursing home received fines for not being compliant on,)
- What is the nurse to resident ratio? (if more than 30.…RUN AWAY)
- Is there a 24/7 on call physician? Who?
- What fees will the resident be billed for each month & what is the cost of the bed per month? Be sure to compare prices. Specialty care centers are generally more expensive. Some facilities will charge you for EVERY over the counter medication the patient takes. This can rack up a lot of cost when they charge $1.00 per Tylenol…etc.
- Who will be responsible for taking the resident to doctor appointments? (Some nursing homes make the family responsible for this and provide little warning when it is time for the appointment.)
- What is the visitation policy?
- Are the exterior doors locked at night? Are the doors coded during the day? (This is especially important if you have a confused wondering prone loved one. )
- Are the nursing stations manned at all times. (in other words is there someone at the desk to attend to residents needs while the medication nurses are passing medications.)
- Are the rooms private or semi-private? If semi-private can a resident change rooms if they do not get along with roommate?
- Is there a communal room(s), how often are activities planned, is there an activity director, how often are outings planned, and are there snacks provided during the day?
- Can the resident have input on meals or are there choices?
- Are there showers and whirlpools? (If your loved one is unable to sit up unassisted you will want to make sure there is a whirlpool AND lift. )
- Does the facility have a hair dresser or barber visit the facility? If so what are the charges and if not how are grooming needs met? Who trims the fingernails and toenails and how often? ( if your loved one is a diabetic you want to make sure a nurse or Podiatrist cuts toenails and nurse cuts fingernails. )
- If the resident goes up or down in ADL (-activities of daily living) ability can they still stay at the facility?
- Most likely you will be asking these questions to the social worker….if not ask if the facility has a social worker and if they are full time. (The social worker usually deals with resident complaints)
- Who is the Ombudsman (-patient rights advocate) and what is their phone number?
- Does the resident have access to a telephone and is it private?
- Is there a staff Physical, Occupational, and Speech therapist on site or available?
- Who is the DON, Social Worker, Administrator, Activity Director, and Dietician? Are these people readily available to family members and the resident?
