How to Find and Evaluate the Best Nursing Home

Perhaps the hardest decision a family can make is to send a loved one to a nursing home. For many caregivers, it can feel like you're abandoning them, and the guilt is tremendous. In many cases, however, a nursing home is the best option for a person with a serious condition who needs constant care. Getting an early start, even months before your loved one needs to be in a nursing home, can help you find the best possible home for your relative. You can the spend that time researching how to pay for care, filling out applications, and finding the best facility.

Instructions

Difficulty: Moderately Challenging

1. Seek referrals from your family, friends, neighbors, co-workers and place of worship. Although telephone books can be a place to start, you'll gather better, first-hand information by asking around. Also, hospitals usually have continuing care or discharge departments that help families find nursing care. Even your personal physician may have a referral for you.
2. Look for a good track record. Reports of malnutrition and abuse are only a few reasons why many people shun the idea of placing a loved one in a nursing home. Unfortunately, they have reason to be concerned. The General Accounting Office of the federal government reported that of the nation's 17,000 nursing homes, 1 in 4 "continue to be cited for deficiencies" that either caused actual harm to residents or carried the potential for serious injury or death. Another 40 percent had "repeated serious deficiencies," and complaints that were not investigated. So, before committing to a particular facility check inspection reports and audits conducted by state and federal nursing home regulators. If a home isn't forthcoming or delays responding to your request, don't end your investigation there--keep digging. You can find information about reports, staffing and quality of care for Medicare and Medicaid certified nursing homes at the Medicare website (see Resources below).
3. Be prepared for devastating costs. The cost for a nursing home can be a huge financial commitment to a family, so check out Medicare and Medicaid applications in your state. Medicare often pays for the first 20 days at a skilled nursing home after you've been in a hospital, but longer stays have to be paid for partly by the residents and/or their families. State-funded Medicaid programs pay for long-term custodial care, but only if you can prove the bills have depleted most of your income.
4. Once you decide to start visiting facilities, make a list of at least 2 to 5 homes to visit and bring along your questions. Prepare to visit often--don't just stop at one visit per facility. It is recommended that a family visit a home at least 5 or 6 times before making a final decision.
5. Pay special attention to staffing and the way they treat patients. Things to make note of include: Do staff members call patients by name? Do they warehouse people in the hallway? Is the staff active? Are the residents well fed and groomed? If there is a lingering smell of urine, rotting food or unchanged linens, you should visit again to see if it's just a one-time problem or a sign that cleanups aren't regularly scheduled. Visit often and at different times before making a final decision.
6. Check the patient-to-staff ratio. Some homes have too few nursing assistants for too many patients, especially at night. Ideally, there should be at least one staff person for every 6 to 8 residents. Additionally, find out if the facility staffs mostly nurses who have a higher degree of health care training (registered nurses), or those with very little training such as certified nursing assistants.
7. Pay attention to safety precautions and guidelines. Bathrooms should have handrails and call buttons near toilets and showers. There should be some privacy for residents, fences to prevent wandering and areas where you can visit privately with your loved one.
8. Notice if the staff encourages residents to be dependent on them for care and other simple tasks. This can actually prevent a resident from getting better. You want to see a staff that is helpful but doesn't perform too many tasks for a resident if that resident is still capable of activity. For example, it might be faster for a staff member to use a wheelchair to take a resident to the cafeteria as opposed to helping that same resident walk (even slowly) themselves.

Tips & Warnings

• Once you get a nursing home contract, the AARP advises residents to make sure it includes information about basic services included in the daily rate, itemizes the lists of charges for services not included in the rate, and describes how decisions are made to move a resident to a different room.
• Visit your loved one at least 2 to 3 times a week. This is the best way to make sure they are doing well. Additionally, the staff will know that you'll check to see if special medication instructions are being followed and your family member is being well-cared for.
• Be wary of contracts that limit the home's liability if a resident is injured or has his or her property stolen.
• Residents should not be required to deposit all their income to the facility, or be required to pay up-front money when they are eligible for Medicaid.
• Reputable nursing homes also don't require residents to consent to medical procedures or to have a living will or health-care power of attorney in advance.