Volume 1, Number 2
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Practical Considerations in Choosing a Nursing Home
As elder law attorneys, we often advise our clients about the care that they are entitled to receive in a nursing home. We routinely answer questions about state and federal regulations relating to quality of care, involuntary transfers and discharges, restraint use, bed hold policies, admission contracts, and the other legal aspects of a stay in a nursing home. However, sometimes even the best elder law practitioner can be stymied by the simple question of how to choose a nursing home.
Practically speaking, choosing a nursing home may be one of the first watershed decisions for children who are now taking care of aging or disabled parents. Choosing a nursing home is the decision that is made after the heart-rending decision to place a loved one in a nursing home has been made. In order to make an informed decision about nursing home care, many questions need to be asked of a facility under consideration. 1
Some information is basic. Is the nursing home Medicare or Medicaid certified? Does it provide the level of care that your loved one needs? Does the nursing home have special units for special services; for example, an Alzheimer’s or dementia unit, or a rehabilitation unit? Even if the nursing home has the appropriate levels of care and special services, is a bed available? Is the last state inspection report readily available for inspection upon request? Has the n ursing home corrected all deficiencies (failure to meet one or more Federal or State regulatory requirements) on its last state inspection report?
It is also important to conduct research that goes beyond that glossy marketing brochures provided by many for-profit nursing homes. If possible, a visit to the nursing home that is beyond the guided admissions tour and that allows an opportunity to speak to residents is suggested. When observing the nursing home, the decision makers should make note of whether the nursing home is free from overpowering unpleasant odors (food or otherwise). The facility should appear clean and well-kept and should be well lit. Furnishings should be sturdy (to allow for residents to use them for support when needed) and comfortable. Residents should appear clean, well-groomed, and appropriately dressed for the season. The temperature in the nursing home should be appropriate for the season. Are there a variety of activities for resident participation and are there activities or enrichment opportunities for residents who are unable to leave their rooms. Residents should appear happy, alert, and free from bruises and interactions between residents and staff should be pleasant.
Safety is a paramount consideration. Fire and evacuation plans for nursing homes have gained nationwide attention since fires in Hartford, Connecticut and Nashville, Tennessee claimed the lives of 31 residents in 2003. The United States Government Accountability Office prepared a report in July 2004 regarding Nursing Home Fire Safety ( www.gao.gov/new.items/d04660.pdf). Some simple questions include: Are emergency e xits clearly marked? Does the nursing home have an emergency evacuation plan and hold regular fire drills? Smoke detectors and sprinkler systems are a must. If the facility is older and does not have modern sprinkler systems, a comprehensive evacuation plan should be requested. Other safety questions to ask include whether the whole nursing home is wheelchair accessible, and whether there are handrails in the hallways and in resident rooms. Also, there should be grab bars in the bathrooms.
Questions concerning staffing and the health care that a resident receives at a nursing home are often the most frequently asked questions. Regarding staffing, it is critical to ensure that nursing home residents are treated respectfully and with dignity. Where needed, staff members should politely and patiently help residents with activities of daily living (eating, toileting, showering, etc.)? Do staff members wear name tags? Are criminal background checks performed on all nursing home employees? Does the nursing home offer training and continuing education for its employees? Is there a full time registered nurse on staff (other than the Director of Nursing or the Administrator)? Is the staff doctor at the nursing home daily and can the doctor be reached at all times? Do nursing assistants work with a reasonable number of residents and with the same residents throughout the week? Are nursing assistants, who are truly invested in resident care, part of the care plan meeting for each resident? Regarding health care, does the nursing home have an arrangement with a nearby hospital for emergency situations? Residents should be permitted to see the same personal physicians that he or she saw prior to nursing home admission. Residents should also get preventative care to help keep them healthy, such as eye exams, dental exams, and a yearly flu shot.
Other considerations concern the comfort of a loved one’s stay in a nursing home. Remember that a nursing facility is the resident’s home, not merely a hotel, and a resident must be able to feel welcome and secure. Residents should be able to have personal belongings and/or small pieces of furniture in their rooms. Each resident should have secure storage space and the nursing home should have a policy for dealing with lost, misplaced, or stolen items. Water pitchers should be filled with fresh, cold water, and should be within resident reach. Staff should frequently offer water to residents who may be unable to pour water for themselves. Residents should have access to a personal telephone and a television. Residents should have a choice of food items at each meal and special meals (e.g. Kosher meals or vegetarian options) should be available upon request. Nutritious snacks should be available to the residents outside of normal dining room hours.
Choosing a nursing home is a difficult decision. As elder law attorneys, we should be prepared to practically guide our client through this decision and offer them meaningful ways in which to choose a facility that will best meet the needs and expectations of our clients and their loved ones.
1. Many of the questions presented in this essay come from the U.S. Government’s Medicare Website ( http://www.medicare.gov/Nursing/Overview.asp). This site contains a nursing home checklist that I often find useful when discussing choosing a nursing home with a client.