How to Choose a Nursing Facility

________________________________________________________________________

KEY POINTS

• Nursing facilities, also called nursing homes, provide a room; meals; nursing care; help with daily activities such as eating, bathing, and dressing; and supervision.
• When checking out nursing home options, you should ask lots of questions about the caregivers' background, what activities are offered, if care is offered in a safe place, what kind of meals are served, how health problems are handled, what to do in case of an emergency, finances, and other questions.
• Take the time to look at several options, ask lots of questions, and trust your instincts.

________________________________________________________________________

What is a nursing facility?

A nursing facility is a long-term care facility. Nursing facilities provide care for people with illnesses and disabilities that make it hard for them to stay in their own homes. Nursing facilities provide a room; meals; nursing care; help with daily activities such as eating, bathing, and dressing; and supervision. Nursing facilities are also called nursing homes or care centers. Because the facility is a home, people who live there are called residents.

The idea of living in a nursing facility does not appeal to most adults. It’s a hard decision for them and their families to make. Nursing facilities can, however, be a good choice for both the resident and the family.

What types of care do nursing facilities offer?

People live in nursing facilities for many different reasons. Nursing facilities provide:

• A place to stay for a short time to recover after surgery, stroke, or other illness
• Long-term care for people who are no longer able to live alone or who have serious medical problems
• A place to stay for a short time if the caregiver needs to be away
• Short-term comfort care for people who are near death

Nursing facilities offer several types of services:

• Nursing services. This may include giving medicines, caring for wounds, giving tube feedings, and keeping primary healthcare providers up to date on health concerns.
• Personal care. This includes help with walking, moving from bed to chair, eating, going to the bathroom, bathing, and dressing.
• Rehabilitation services. These services are provided by speech therapists, occupational therapists, and physical therapists. They may include help with speaking and thinking, regaining strength and flexibility, preventing injuries, reducing pain, using crutches or walkers, and relearning basic skills.
• Residential services. This includes a safe place to live, meals, and programs for social and spiritual needs.
• Medical care. A healthcare provider visits each resident routinely or as often as needed.

How do I choose a nursing facility?

Start by researching several facilities close to friends and family. You can get lists of nursing facilities from a hospital discharge planner, social worker, or the local Area Agency on Aging.

Call each nursing facility you are considering. Ask about waiting lists and admission requirements. Then visit each facility even if some do not have a bed currently available. Pay attention to how the facility treats your request for a visit and how much they allow you to see. This will tell you a lot about how they treat residents and their families.

Try to check out 3 or 4 nursing facilities. If possible, the family should visit each facility with the person who may live there.

Visit the facilities at different times of the day without calling first. Be there during meals and activities. Consider the size of residents' rooms and privacy. Look at the kitchen and laundry facilities, the recreation area, therapy rooms, and all other areas of the facility. Talk to other residents and their families to learn how satisfied they are with their care. Notice if the facility seems cheerful or depressing. Look at how staff members interact with residents. Ask the staff if they like working there and if so, why and how long they have worked there.

What should I look for during my visit?

A good nursing facility should:

• Be safe, comfortable, and clean and not have any strong odors. A heavy deodorizer scent may be masking the smell of urine.
• Provide services that help new residents adjust to the new setting.
• Encourage the residents to make choices and do things for themselves. It may be quicker and easier for the staff to do things for the residents. However, most adults are happier and healthier if they are allowed to do as much for themselves as they can--for example, walk and dress and feed themselves.
• Help with activities that the resident can no longer do by him or herself
• Offer special diets if needed, such as a diabetic diet or soft food
• Keep track of the health of residents
• Involve the family or usual caregiver when making plans for care or changes to plans for care.

When you visit a nursing facility, answer for yourself the following questions about the facility, staff, and services.

Facility:

• Are the building and grounds clean and in good shape? Does the facility have a bad smell?
• Are there possible safety problems, such as things blocking the hallways, poor lighting, or lack of warning signs on exits that should have alarms?
• Do they have safety equipment, such as fire doors, sprinklers, handrails in hallways, and grab bars in bath and toilet rooms?
• How big are the bedrooms? Is the furniture in good shape? Is there enough space for personal belongings? Are there privacy curtains?
• Is there good lighting, ventilation, heating, and cooling in the bedrooms?
• Do bathrooms have wheelchair-accessible showers and sinks?

Staff and services:

• Does the staff seem overworked? Are call lights answered promptly?
• Are residents treated and spoken to with respect?
• Are residents clean, well groomed, and dressed in clean clothing? Are they wearing their dentures, eyeglasses, and hearing aids?
• Do the residents seem content?
• Are any of the residents physically restrained? Do the residents seem to be over-medicated, have bruises, or act afraid?
• Are activities going on that would be of interest to the future resident?
• Is there enough food and is it appealing?

Ask the facility administrator:

• Does the medical staff have a lot of experience in long-term care?
• How are emergencies handled? Is a doctor always available by phone? Is there a registered nurse (RN) in the building at all times?
• How are complaints handled?
• Is equipment such as walkers, wheelchairs, and special beds or mattresses available? Is there an extra charge for it?
• Does the facility let residents bring some furniture from home? Are personal items safe from theft?
• Is the facility Medicaid certified? If not, the resident will have to move when he or she runs out of personal funds.
• Is the facility Medicare certified? Medicare certification is very important since those facilities can offer more services to a resident coming back from a hospital stay.

In addition:

• Ask to have all rates and charges fully explained. Ask for a written list of the services and supplies that are included in the basic rate and what costs extra.
• Ask for a copy of the admission contract. Ask for explanations of anything that you don’t understand. It’s a good idea to have a lawyer go over the contract with you so that you understand it completely. It should be possible to change the contract.
• Ask for a copy of the most recent state inspection report on the facility (also called the state survey). Nursing facilities are required by law to provide their latest inspection report to you. The family is entitled to take a copy home. This report may also be available on the Internet. If you cannot get a copy of the report, there may be a problem with the facility.

  Most inspections find some problems. Many of the problems are usually minor and may not affect the quality of care. You should be concerned if any major problems are listed. Find out if the problems have been corrected and what is being done to keep them from happening again.

You must feel confident that the facility administrator is qualified, competent, and responsive to residents, their families, and staff.

How is nursing facility care paid for?

Nursing facility care can be paid for with personal funds, long-term care insurance, Medicaid, or Medicare. Sometimes several of these payment methods are used.