One of the hardest decisions a family will ever face is that of moving an elderly loved one into a nursing home. It’s an admission that the individual cannot take care of him or herself, and that the family is unable to provide the necessary care themselves at home, which is a painful conclusion to reach.
But if it has to be done, then at the very least it is important to choose the most appropriate facility. Here are a few points to keep in mind in selecting a nursing home:
1. Plan ahead
Try not to succumb to the temptation of denial. Most of the time, you know in advance that this is a decision that will eventually have to be made. If you do your homework early, it’s a lot better than scrambling around at the last minute.
If you do end up waiting, something to keep in mind is that you can buy a little extra time when your loved one is scheduled to be discharged from the hospital. About half of all nursing home admissions are from a hospital, and the hospital often gives almost no notice that a patient needs to be discharged. You may find yourself with only a matter of hours or a day or so to find some place that provides the level of care that will be necessary.
In that case, if you inform the hospital administration that you wish to appeal the discharge decision, this will give you at least an additional 48 hours.
2. Determine the type of facility that’s needed
Nursing homes are divided into three broad categories, for residents needing different levels of assistance. These are:
* Personal care: Also called custodial care, this is for residents who are closest to being able to live on their own, though they may need a certain amount of assistance with such activities as bathing, dressing, and eating.
* Intermediate care: This is for residents who need a higher level of care, perhaps including rehabilitative therapy or help with their medications, where the staff includes a higher proportion of licensed therapists and nurses.
* Skilled nursing care: This is for residents needing the highest level of care, where the resident is least able to care for him or herself, and perhaps is bedridden. These facilities have the highest proportion of health professionals on staff.
Within these categories, there are facilities that specialize in a certain type of resident, such as those with Alzheimer’s or dementia.
You need to do an honest assessment of which level of facility is most appropriate for your loved one.
3. Use Eldercare
A good starting place to find out your available choices is the Eldercare Locator at 800-677-1116. This is a program of the Department of Health and Human Services that will tell you about the nursing homes in your area.
4. Seek recommendations
If you have friends or family who have moved loved ones into a nursing home, no doubt they have had good and bad experiences. Talk to them. Doctors, seniors groups, clergy-these are all people who have likely had experience with nursing homes in the area. Get feedback from them on your options.
5. Consider distance
All else being equal, you want a facility close to those who intend to visit.
6. Consider cost
In an ideal world, money would not be a factor and you’d just want the best possible care. But unfortunately in the real world, you have to factor cost into your decision.
Acquaint yourself with what Medicare or other government programs, private insurance, etc. will and will not pay, and what you will have to pay. Make sure you understand what is covered in the nursing home’s basic rate and what is charged extra, and whether they bill on a daily or monthly basis or have different options.
7. Check accreditation and history
If your elder loved one is receiving, or may become eligible for, Medicare or Medicaid, understand that only some nursing homes are certified by these programs. You also want to make sure any nursing home you are considering is licensed by your state.
Check with the relevant state regulatory agency to see the history of the nursing home. The nursing home itself must provide you on request a copy of their most recent state inspection. Look carefully at whatever violations and problems it mentions.
8. Visit unannounced
Instead of making an appointment and telling them you’re coming, drop in during business hours to check out a nursing home you’re considering. Ask to be shown around by the person in charge or someone who can answer any questions you might have.
9. Observe the residents
What can you pick up of the mood of the place from watching the residents? Is it happy or gloomy? Are the residents active? Are the residents interacting with staff and each other, or mostly looking lonely? Is the privacy of residents being respected, or are residents being dressed or toileted within sight? Are restraints used only in emergencies, or are restraining and restricting devices being used in a routine manner?
10. Check the kitchen
Ask to see the kitchen to make sure it is clean. See if you can have a meal with the residents to sample the food. Make sure there is a licensed dietician on staff, and that the nursing home is meticulous about special diets that may be necessary for some residents. Check if fresh drinking water is always readily available to residents, as dehydration is an unfortunate problem at some nursing homes.
11. Check for hot water
Larger and older nursing homes often have a problem with hot water. Run the water in the bathroom or anywhere you have access on your visit and make sure there is hot water.
12. Be conscious of safety issues
Check for smoke detectors, a sprinkler system, wheelchair ramps, emergency exits, call buttons, guardrails in the bathrooms, and so on.
13. Inquire about services
Different nursing homes provide different types and levels of services, from laundry, to television, to speech therapy, to recreational activities, to religious services. Find out about these and make sure they fit your needs.
14. Inquire about staff
Find out such things as how frequently the residents see a doctor, how many nurses are on staff, whether there is a pharmacist on staff, how much turnover there is among the staff, and the ratio of staff to patients.
15. Attend a resident council meeting
Most nursing homes have groups of residents and family that meet with each other and with staff to communicate their needs, complaints, and suggestions. Ask to sit in on one or more such meetings. (And join the group and continue to attend if you do indeed choose this nursing home.)
16. Consider a trial period
Depending in part on your budget, if possible it’s a good idea to have your loved one actually live in each of the “finalist” nursing homes for a short period so that they and you can get more of a feel for it from the inside and see where he or she would fit best.
Never be hesitant to ask questions and raise concerns. Also, continue to monitor the situation with frequent visits even after the decision is made.
This is a very emotional process, but that doesn’t mean it can’t also be handled intelligently and responsibly.
Karen Westerberg Reyes, “Choosing a Nursing Home.” AARP.
“Choosing a Nursing Home: A Caregiver’s Guide.” National Family Caregivers Association.
“How to Choose a Nursing Home.” Nursing Home Guide.