July 25, 2012

Nursing Homes: Finding the RIGHT One

On July 16, 2012, one of my favorite bloggers, Ronni Bennett, posted a piece about institutional elder abuse on her excellent "TimeGoesBy" site.

Among the grim stories she recounts are these three, reported in the Miami Herald’s four-part series Neglected to Death, which the paper ran last year:
  • "In Kendall, a 74-year-old woman was bound for more than six hours, the restraints pulled so tightly they ripped into her skin and killed her."
  • "In Hialeah, a 71-year-old man with mental illness died from burns after he was left in a bathtub filled with scalding water."
  • "In Clearwater, a 75-year-old Alzheimer’s patient was torn apart by an alligator after he wandered from his assisted-living facility for the fourth time.”
Please don't get me wrong: there are many superb facilities for seniors in America. But if this issue is important to you – it should be important to us all – I’d urge you to look at the Miami Herald series (link above).

While I hope my family never needs to initiate the process of finding senior housing for me (I started doing it for myself -- after my Parkinson’s diagnosis a few years ago -- before I “saw the light” and made the very correct decision to stay in my own home), I wondered what online resources were available to families facing that transition for loved ones -- from home to institution.

I did the classic Google search, and here’s what I found, from the top (most viewed) down.

The first couple links were ads… the price we pay for having such a remarkable search engine available to us. Find.nursinghomes.com and Care.com both required cranking in personal data before the site provided any useful information. A no brainer – commercial sites want to get our info. Needless to say, I didn’t give them what they wanted!

The first – apparently most used – non-commercial link was Medicare's nursing home compare site. It touted its quality measures based on new resident assessments, a measurement  that seemed helpful. It gave info in columns that included distance, overall rating, health inspections, staffing, and quality ratings. As you might expect, as a government site it seemed pretty comprehensive, with information about many other things, including hospitals, doctors, and home health care.

Next came the senior housing site from U.S. News and World Report. At the top of its homepage appeared this comment: “To check out a nursing home, you need information that is clear, meaningful, and reliable. What proportion of the residents have bedsores or are in pain? How does the facility do in health inspections? Is there enough nursing care? U.S. News has pulled together government data and ranked more than 15,000 nursing homes. An Honor Roll lists the best of the best.” 

The site appeared helpful, easy to use, and also provided information about hospitals by specialty, hospitals by city, best diets for you, and top health insurance companies.

Then came a site I liked, but it served California only.

After that came the link to senior housing options at About.com. I found the site thorough and useful. I especially liked its checklist, which I've copied in full at the bottom of this post (in italics).

Next in line was NBC's Today Show site, which offered a step-by-step process for finding the right facility. Interestingly, it features an interview with and article by U.S. News and World Reports' Sarah Baldauf. I thought the article was helpful.

Then came the Our Parents site, "assisting you and your aging parents." It struck me as a good resource for helping families find the right facility.

Next up was the U Compare Health Care site. It was easy to navigate, and provideed various ways to browse for information. It also seemed to offer more ratings than other sites.

OK, just one more... one that didn't appear in my Google list, but one I liked. It's the nursing home page from the Find the Best site. It was easy to use, color-coded (green = very good, etc.) and based on a single rating that combined different performance measures for each facility, along with Medicare health inspections, quality of care, and nurse staffing ratings. It also showed the number of beds (most sites do), occupancy, and daily costs, if that information is available.

So, that's a start. If you have particular resources you've found especially useful in your quest to find the right nursing home or senior facility, please feel free to leave a comment. Your recommendation might prove very helpful to others.

Here's that checklist from About.com I mentioned above. These are excellent questions to ask when that time comes:

Nursing Home and Staff Credentials
When you consider a nursing home, ask these important questions about the facility's licensing and staff credentials:

  • What are the nursing home licensing requirements in your state? 
  • Research the licensing requirements in your state for various types of facilities. Make sure the facilities on your list are licensed and that their licenses are prominently posted in the facility. 
  • Ask about the credentials of the staff. 
  • Does the nursing facility offer training? 
  • Are there staff dedicated to the different types of dementia? 
  • How many licensed RNs are on staff at all times? 
Nursing Home Care and Service
  • Ask to see the Resident's Bill of Rights. If you choose a facility, ask for a copy of the Bill of Rights and keep it on file. 
  • Some nursing homes have developed a "neighborhood" concept so residents can live and socialize with people who have similar needs and experiences. Are residents with dementia grouped together in one wing or are they spread out? 
  • Is there a Social Services Worker on staff in the facility? These workers can make the transition easier for older adults, and can help to make their stay more comfortable. 
  • What do the meals consist of? Can a special diet be implemented? What steps are taken to ensure the proper foods are given to the right residents? 
  • Look at the activity noise level and cleanliness of the facility. Is it clean? Is there a healthy amount of background noise? 
Nursing Home Safety and Accessibility
  • Are safety and accessibility top priorities for the facility? 
  • What precautionary steps are in place for emergencies? 
  • Are there smoke detectors, how many, are they all working? 
  • How often do they have the fire extinguishers checked and if they know where they are located? 
  • Are safety procedures adequate? Are stairways and exits clearly marked? 
  • Is it easy to move from one place to another? 
  • Are halls and toilets wide enough for wheelchairs? 
  • Are there any floor hazards like being too slippery or having a thick carpet? 
  • Is there an emphasis on allowing residents to be as independent as they can be? 
  • Are bathing devices available? Are handle rails provided in bathing areas? 
  • Are dining rooms and amenities well-spaced to keep walking distances short? 
What Types of Amenities and Comfort Does the Nursing Home Provide?
It's important that the nursing home feels comfortable and welcoming to residents. Before you choose one, ask these questions:
  • Does the facility have a “community” feel? 
  • Are the residents happy, alert, groomed, clean, well-fed, and healthy? 
  • Are the interactions between co-workers, and between workers and residents caring, friendly, and supportive? 
  • Does the staff know the residents by name? 
  • What services does the facility provide? 
  • A facility dedicated to resident comfort and service should provide laundry facilities on each floor, flat linen service, monthly housekeeping, maintenance and scheduled transportation. 
  • Other amenities may include a hair salon, bank, and gift shop. 
  • Each room should have individually controlled heat and air conditioning with an emergency response system.
A Good Nursing Home Provides Recreation
Quality of life is important at any age, so make sure the nursing homes you consider provide and adequate variety of recreational activities to keep the residents mentally and physically engaged.
  • What types of activities are provided? 
  • How are nursing activities supervised? How often are they held? 
  • Does the nursing home provide social, recreational, spiritual, fitness and wellness programs? 
  • What kinds of exercise regimes are included? 
  • Does the nursing home provide exercise equipment that is appropriate for residents and easy-to-use? 
  • Does the nursing home have a fitness instructor on staff? 
  • What types of social and individual activities are offered? 
  • Does the nursing home have a computer room, meditation room, library, craft room, game room or wood shop? 
  • Are religious services available, including visitation and worship? 
  • Does the nursing home property include nature areas, gardens and footpaths? 
Nursing Home Care: What Health Services Does the Nursing Home Provide?
  • Are different levels of nursing home care, from assisted living to health care to short term rehabilitation programs, available? 
  • Is there a focus on needs assessment to determine the appropriate level of care for each nursing home resident? 
  • Is there sufficient nursing and personal care, including medication management? 
  • Are in-home health services available? 
  • Are nurses always close at hand? 
  • If the facility offers short term rehabilitation programs, is there a private wing with private rooms and a dining area ? 
  • Does the nursing home facility offer care for residents with dementia? What kinds of programs are available for these residents? 
  • Does the nursing home provide personal care plans? Are these plans developed by an inter-disciplinary team?  
Financial Issues to Consider When Choosing a Nursing Home
  • Is there a guaranteed that the entrance fee is refundable? 
  • Do the assisted living and health care services come at no additional monthly fee? 
  • To what degree does the nursing home manage residents’ finances? 
  • Are Medicare and Medicaid plans accepted? 
A Good Nursing Home is Dedicated to Quality Improvements
  • When you research nursing homes, look for facilities that are dedicated to continually making quality improvements in the level of care they provide. 
  • Does the nursing home have programs in place to study processes, re-evaluate services and ask residents and families what might be done better? 
  • How often are the findings from these programs implemented into changes for the staff, residents, and administration? 
  • Is the center dedicated to the continuous training of its staff? How is training implemented? And how often? 
  • Does the dedication to improvements carry over into every facet of the facility?
By asking the right questions, you can be assured that you have found a nursing home or long-term care facility that will provide the best services and support for both the resident and his or her family.


apple said...

Regarding the financial issues concerning nursing homes, if residents have coverage from the best long term care insurance companies , then they will have lesser worries on paying for the rates and services

Liam Manning said...

I'm really glad that I found this. My friend has been looking into salt lake city nursing homes for a while and isn't sure what to do. I will have to share this with them, I think it will help.

Mario Lopez said...

This is very similar to the type of salt lake city nursing home that my wife wants to work at.

ottawa seniors residences said...

Choose the best retirement home that provides the all facilities to senors.

Tejal.joshi said...

Thanks for sharing the blog, seems to be interesting and informative too. Can you suggest some of the interesting places to visit for health care: Nursing facility at home