The Complete Guide to Choosing the Best Nursing Home for Your Loved One

Finding the right nursing home for a loved one can be difficult under the best of circumstances. Most people don’t think about elder care until the need is urgent, leaving little time to make an informed and careful decision. There are some resources to assist family members in making this transition for their parents or elderly relatives.

Tips for Assessing the Quality of a Nursing Home

There are normally several choices for nursing homes in any given community. Deciding which one has the highest level of care is not readily apparent. The first and easiest step for evaluating a local nursing home is through the Medicare website, at their Nursing Home Compare page. On this page individuals can search by zip code or community, specifying the distance from home to come up with a list of nursing homes. The nursing facilities are ranked by health inspection, quality measures, and nursing home staff, using a five-star rating. The chart allows for closer comparison of three homes and the viewer can see which have Medicare and Medicaid coverage, the number of beds and type of ownership.

Another dimension for assessment is individualized care. Make sure that a care plan, one that is individual and specific to your family member, is addressed and discussed. Also, make sure that assessments are conducted. They are often done by the staff such as one’s family physician, family, social services and a dietary assessment. These assessments should be reviewed now and then to ensure that the resident is receiving the necessary help that he or she needs.

From here a selection can be made for facilities to visit. A visit is crucial for determining the type of atmosphere, the friendliness of the staff and other patients as well as compatibility for the family member.

Visiting the Nursing Facility

There are certain things to be looking for when visiting nursing homes. Making an appointment to talk with administrators is important, but an unannounced visit allows for a glimpse of normal operations. Make a list of questions to ask beforehand, and carry the list along. Being prepared lets the administration know that this is a serious visit and ensures that crucial questions are addressed. Notice the willingness of staff to talk with visitors and answer questions.

While visiting, look at the following:

  • Dining facilities: Ask to see the dining room during a meal. Are patients being assisted with eating? Is there a menu which allows for individual choices? How are individuals seating, in groups, or large tables?
  • Living areas: How many available attendants are visible on the floor? Is there a call button ringing and if so does it seem to be answered promptly?
  • Hallways: Look at the residents, are they sitting in the halls alone, or in groups talking? Do they seem well groomed and clean?
  • Nursing staff: How many registered nurses work for the facility? Is there a nursing administrator? Qualifications are extremely important, especially if your loved one has dementia. If the staff is not familiar with a dementing illness, it will be difficult for them to communicate with your loved one. I suggest finding a nursing home that is geared towards dementia persons. Many homes have a separate wing for dementia residents. However, please be careful. You want to make sure that your loved one will receive quality care. Do not be afraid to ask the qualifications of the staff.
  • Family Support: Ask the administrator if there are family councils, groups set up to work with other families. Get the name and information of the contact person.
  • Family Intervention: Family is crucial for your loved ones well being. Some homes do not contact family members if a problem occurs, such as if your loved one is wandering or if your loved one had to go to the emergency room. As a caregiver, you have the right to be informed if something should happen to your loved one.
  • Activity: Residents need social interaction. Be sure that your loved one receives the appropriate activity throughout the day. Your loved one has the right to activity and should receive it. Some homes may use the excuse that your loved one is unable to do certain activities. This is NOT an excuse. Your loved one should not lie in bed all day. A worker can walk with your loved one or if they are in a wheelchair, the worker can push your loved one for a ride. Being cooped up in a room is not healthy. Just because a person has dementia, does not mean that they cannot join in on social gatherings and activities. If the loved one does not wish to participate in activities and has challenging behaviors, the staff should be able to come up with alternatives such as sitting in a chair by the window.
  • Safety: How safe is the facility? If your loved one wanders, how do they handle the situation? I have heard of residents being restrained in the evening to stop wandering. Quality homes will have safety measures inside the facility. Many facilities have security systems where the only way to get out of the building is to press in a password number. Does your loved one keep falling? If you answer yes, then you may wish to find out why. There may not be adequate handrails in the washroom or along the walls of the facility.
  • The Odor of Rooms: Notice the odor as you walk in the home. Remember that these facilities handle incontinence, so a slight urine smell is not always bad. However, you do not want it to be overpowering. You will be able to tell the difference as soon as you walk in the door.

Here are some sample questions to ask the nursing home administrator:

  • Is this nursing home Medicare or Medicaid certified?
  • Does this nursing home have the quality of care needed?
  • Is a full-time registered nurse on duty in the nursing home all the time?
  • Is there a choice of food at every meal? Are the residents able to receive their favorite food items?
  • What are the daily activities available for all of the residents and are these activities posted so that everyone knows about them? Are announcements made that help those who can’t read?
  • Is there a volunteer program that is active and used often?
  • If there is an emergency, what are the plans that will be implemented?
  • Speak to the social services worker. Find out what she/he is there for. Many social services workers ensure that your loved one is being treated well

Choosing the Best Nursing Home

After visiting at least two nursing homes or assisted living residences, it’s time to make some decisions. One way to assess the loved one’s comfort with a particular facility is to arrange for a weekend stay. Many facilities have respite care; a short visit allows the family member to test it out and meet other residents. Family has a chance to interact with staff as well and can see how agreeable the nursing staff is to family requests and concerns.

Review billing procedures and ask for the list of additional costs. Nursing home costs can be higher than expected and are based on a number of different criteria.

Carefully look at room rates, proposed increases in rates and whether there are assessments based on the level of care required. Ask specifically how many of the daily living chores are performed by the nursing home staff. Be clear on what the expectation is for family participation.

Making the choice to place a loved one in a nursing home or assisted living facility can be stressful for all members of the family. Using guidelines and checklists to assess available facilities can assure loved ones are safe and well cared for.