Nursing Home: Knowing When They Need It and Choosing the Right One

Nursing Home: Knowing When They Need It and Choosing the Right One

There comes a point in time for many family caregivers when we have to start thinking about finding a nursing home with and for our senior loved ones.

A nursing home is probably not your first choice, but if you have been providing care for years and find they currently need more care than you can provide, now that need may be a reality.

Nursing homes, compared to assisted living facilities, provide 24 hour care by professionals who are trained to deliver that care.

Facilities are as different as the people who own, operate and work there. It is important to do your homework when looking at facility placement for your senior. But what should you consider?

When is Nursing Home Care Needed?

It can be a real struggle for caregivers to finally decide that it is time for their loved ones to make the move to a facility, which they may have promised to never do, and they may fear making the wrong decision.

Today’s nursing home is not the place of our grandparents — for the better. Most are homelike and have staff that are loving and caring toward the people for whom they care daily.

Your senior loved one will likely display some signs that will alert you to begin thinking about a change.

  • Frequent falls, which could result in life changing injury
  • Inability to live at home safely alone, either with paid caregivers or you to help
  • Display aggressive behavior that could harm someone
  • Refusal to accept care
  • You have injured yourself caring for them
  • They are wandering and may get lost leaving the home alone
  • You are financially unable to continue to provide in-home care or meet their needs, you may need to return to work

The best plan is to begin looking for a care facility before you need it because you may not have time to get the information you need to make the best decision once your senior loved one is in a crisis situation. Many facilities have waiting lists, which may mean you will not have access to your first choice. Put your senior’s name on a few waiting lists just to be assured of a bed.

If your senior requires a memory care unit, it might be more difficult to find a place, since there are fewer available beds for this type of care and the number of people needing it is rising.

Information to Help You Decide

There are several ways for you to gather information about the facilities you are considering for your senior loved one. There are government documents to review, facilities to visit and networking with those living there already.

You should try to do all these things.

  1. Ask your senior’s doctor for recommendations.
  2. Visit several facilities in person. Visit more than once going at different times of the day and maybe once on the weekend to get a realistic look at the facility. There are no reports or testimonials that can replace the feeling you get when you talk to the personnel and walk the halls yourself.
  3. Talk to people you know in the area with family members in a facility. They can help you learn more about a particular facility in a way you can’t find in a written report.
  4. Check out the facilities business philosophy. Some long term care facilities are owned by corporations. You can investigate the corporation as well by reviewing their philosophy and see how they perform across the chain. You may even want to check the Better Business Bureau in your area to see if any complaints have been filed.
  5. Find out if it is licensed and thereby held to standards.
  6. Review the latest inspection survey. This will tell you what was deficient on the last state survey conducted by the government. In most long term care facilities, Medicare and Medicare pay at least some of the bills so they inspect at least yearly to be sure that the claims are validated and our seniors are cared for properly. The report should be available to you on your visit as it is required to be posted or in the lobby for anyone to read.
  7. Check out the quality report at Nursing Home Compare, which is provided by and compares facilities’ quality using a five star rating system.

What To Ask and Things To Review On Your Visit

When you visit a facility, there are many important questions to ask and things to see.

First on the agenda is talk to the staff — administrator, a nurse, an aid, a housekeeper, a kitchen worker or an activity assistant. They will each give you a different perspective about the facility. Front line staff, not just executives, will have good details to share.

If you can speak with a family member of one of the current residents you may gain insights nobody on staff can provide.

Things to review/determine on your visit:

  • Has the staff been there for a period of time for stability and dedication?
  • Check out the menu to see if your senior will enjoy the meals and if substitutions are available for menu items they may not like.
  • Read the activity calendar to see if your senior will engage with others and not be bored. Are there faith services for your senior if that is important to them?
  • Is there an unpleasant odor, does the facility appear clean and are the rooms comfortable?
  • Can residents bring items from home? Can they smoke? Can they have a pet or get a pet visit?
  • Discuss the financial arrangements. What isn’t covered, such as laundry, beauty shop, phone, cable, transportation? Do they accept Medicaid?
  • Do the residents look clean, well-kept and happy?
  • Is the facility close so that family and friends can visit frequently?

Nursing Home Compare 3.0

The federal government compares nursing home facilities using several different criteria to come up with a one to five star rating. The higher the number of stars, supposedly the better the facility.

Unfortunately, as those in the industry will tell you, the numbers aren’t always an accurate indication of quality.

Apparently the government agrees, as they have recently decided to change the way the stars are earned. Facilities receive points for good inspection surveys and self-reported data, among other things.

The government now will add other metrics to their scoring, including the use of psychotropic drugs. Many fear that the number of falls data is skewed when facilities overmedicate residents. Facilities that limit drug use could be penalized by a lower rating due to increased falls when they are not using chemical restraints such as these drugs.

The evaluation process will also use a different algorithm for calculating staffing levels than was used in the past. The changes are expected to raise the bar on performance so that stars must be earned, leading to improved care for residents.

People Make the Difference

Yes, the quality of nursing homes’ physical facilities is important, but the quality of care your senior loved one receives is most likely to be determined by the people providing that care.

I have worked in nursing homes for over twenty years (I started very young). I came to love those for whom I cared as if they were my own grandparents. When they passed on, I missed them and the family members who had became my friends.

I worked with many dedicated individuals whose goal was to make the final years of our seniors the highest quality possible. We went above and beyond to keep the facility clean, friendly and homelike.

I don’t think the facilities in which I worked were unusual, rather they were representative of the state of the industry today. Naturally there are going to be some that cut corners and don’t have as caring a staff as possible, but those are exceptions.

When you have visited and completed your investigation, rest assured your senior will be given the care they need.

Your role as family caregiver will not end, but transition, as you will continue to be involved and be an advocate for their health, safety and happiness.

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