There are now more than 16,100 nursing homes in the United States with over 1.5 million residents. As the baby boomer generation begins to reach the senior years, these numbers will certainly rise.
Choosing the right facility is one of the most important decisions older people and families can make. Unfortunately, this decision is often made during times of great stress or illness, and there is a lot of emotion behind the decision.
Whether the move to a facility will be temporary during a recovery or permanent, it’s important to investigate the home thoroughly to make sure it provides the lifestyle and quality of care that will enhance your loved one’s life.
Making the decision to move a loved one to a nursing home is certainly never easy, but arming yourself with the right information and researching suitable facilities can allow your loved one to continue their vibrant life. The perfect home should be safe, comfortable, secure, and happy. If you are considering a move to a nursing home, use this checklist to make sure you find the best nursing facility available.
Credentials The first place to start is checking the nursing home’s credentials and those of its staff. You should find the answers to these questions: • What are the nursing home licensing requirements in the state? Keep in mind different types of facilities have different licensing requirements. Any facility that makes your list should be licensed. • What are the credentials of the staff? • Does the facility offer training? • Are there staff members dedicated to forms of dementia? • How many licensed RNs will be on staff at all times?
You can also check if the facility has been certified by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). JACHO is a not-for-profit organization that inspects, accredits and certifies nursing homes and other facilities across the country. If the nursing home has been accredited by JCAHO, it means it has satisfied strict sets of quality control and safety guidelines.
You will also want to find out if the facility is certified by Medicare if you expect to receive financial assistance from the organization.
Care and Service Ask to see a copy of the nursing home’s Resident’s Bill of Rights. Find out if the facility has developed a community concept that allows residents to live and socialize with others of similar needs, and find out if residents with dementia are kept in a separate wing.
For many older adults, the hardest part about moving to a nursing home is giving up their independence. Some independence and privacy will diminish in a nursing home setting, so it’s vital that you find out how much freedom is afforded to residents. Will your loved one be able to choose when they want to eat, and what they want? Can they arrange the room as they like and decorate with personal items? Are they free to go outside, and are there designated quiet times? The more freedom given to residents, the more likely residents will be happy with their living situation.
Learn about the meals that are offered and whether special diets can be implemented. Some nursing homes employ nutritionists; find out what steps are taken to make sure the right meals reach the right residents.
You should also visit the facility and observe the cleanliness and noise level.
Consider the nursing home’s long-term plan, as you will want a nursing home dedicated to making improvements in the quality of care it provides. Find out if there are programs in place to re-evaluate services and whether the facility offers continuous training to staff, for example.
Official Policy Do not assume anything when evaluating nursing homes. While the first facility you visited may have had an open door policy to visitors, not all will. Most facilities will provide their policies in writing.
If they do not, ask the following questions:
• Is smoking allowed inside the facility? • Are there restricted hours for visiting? • Do all residents have access to a television and phone? • Are residents allowed to choose their roommates? • Do residents see their own doctors? • Are pets allowed? • How does the facility treat behavioral problems?
Safety and Accessibility Safety is a serious concern in a nursing home. There should be no hazards and adequate staff to avoid accidents. • Has the facility made accessibility and safety a top priority? • What precautions does the facility have in place for emergencies? • How many smoke detectors are there in the facility and are they all functioning? • Are fire extinguishers inspected regularly? • Are there adequate safety procedures with clearly marked exits? • Is it easy for residents to move around? • Are all areas of the facility wheelchair accessible? • Are there any floor hazards, such as thick carpet or slippery floors? • Are bathing devices provided?
Amenities The facility should be comfortable to residents and provide amenities that will make them feel at home. This also includes amenities that will limit the need for them to use scheduled transportation if they have mobility issues. • Is there a community feel to the nursing home to allow residents to make friends and socialize? • Do residents seem happy, well-groomed, well-fed, and healthy? • Are the interactions between staff and residents caring and friendly? • Do staff members know residents by name? • What services are provided by the facility? • Does each room have individually controlled air conditioning and heat with an emergency response system?
Amenities vary by nursing home. The facility should at least provide laundry facilities on the floor, flat linen service, monthly housekeeping, room maintenance services, and scheduled transportation for residents.
Additional amenities you may find include religious services, banking, a hair salon and barber, a gift shop, a crafts center, and more.
Recreation Quality of life is a very important concern. Any nursing home you consider should offer a variety of recreational activities for residents. Questions to ask include: • What activities are provided? • Are these activities supervised? • How often are nursing home activities provided? • Are there social, recreational, spiritual and fitness programs offered? • What sort of exercise programs are included? • Is appropriate exercise equipment provided? • Is there an on-staff fitness instructor? • What sort of social and individual recreational activities are offered? • Is there a library, craft room, game room, computer room or relaxation room? • Are religious services offered? • Are there nature areas on the property?
Health Services Not every nursing home will provide the level of care your loved one requires. There are various levels of care at nursing homes, from assisted living and short-term rehabilitation programs to long-term care and dementia care.
Each level of care should have a strong focus on needs assessment for each patient, and there should be sufficient nursing and personal care to keep your loved one safe, happy, and healthy.
If your loved one has Alzheimer’s or dementia, you will want to carefully examine the memory care services provided. Nursing homes with memory care units offer specially designed living spaces and a supportive environment for residents with cognitive challenges. This includes flooring that avoids problematic patterns and wall colors that help residents find their way. There should also be special “wander guards,” which prevent residents from leaving the property unattended.
Preventative care should be a high priority. The facility should take active steps to not only care for your loved one’s current condition but do their best to keep their health from declining. Preventative care programs include special diets, exercise regiments and flu and pneumonia vaccinations.
Financial Considerations Cost is usually the second-biggest factor in choosing a nursing home after quality of care. You should have a very good understanding of what is, and what is not, included in the nursing home’s fee structure.
Nursing homes are required to spell out their fees, and you should get a copy of this fee schedule in writing to make sure you can compare it easily to all other facilities. Never assume that physical therapy visits or meal choice, for example, is included in the monthly cost.
You will also want to know if Medicare and Medicaid plans are accepted, if you will be going this route.
On the subject of financial issues, make sure you understand the degree to which the nursing home manages the finances of its residents. You will want to make sure your loved one will not be taken advantage of financially.
How it Compares Finally, while nothing can beat actually visiting each facility you are considering, it is a good idea to check the Nursing Home Compare service online to narrow down your list before you start your tours.
Nursing homes certified by Medicare or Medicaid are listed by this service, which allows you to find a nursing home based on its name or geographic location. These results may then be sorted by criteria.
Medicare gives nursing homes star ratings for: • Health inspections, including results from on-site examinations of resident care • Staffing, which looks at the staff hours per patient per day • Other quality measures, such as safety measures.
