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what's happening in our world

3 Strikes, You're Out

Modesett Williams - Monday, February 16, 2015

For years now, Texas has consistently ranked among the worst states when it comes to nursing home quality. Recognizing this deficiency, Texas lawmakers have proposed a "3 strikes rule" that would revoke the license of and shut down any nursing home cited with three federal-deficiencies. The conditions of the legislation are that the offenses would have to take place on separate dates, and that the offenses would have to occur within a 24 month period. 

Proponents of the legislation argue that the 3 strike rule would make nursing homes more conscious about their conditions and encourage managers to appropriately handle their staff. However, there are oppositions to the legislation. It has been argued that if a nursing home's license were to be revoked, the individuals living in the home could face difficulties finding a facility to accept them. Regardless of the arguments against the legislation, the lawmakers have spurred and welcomed a much-needed discussion on what Texas can do to improve the quality of care in nursing homes.

To view the full article, visit: http://www.nytimes.com/2014/09/07/us/nursing-facilities-blast-three-strikes-proposal.html?_r=0

The Most Disturbing Elderly Abuse Cases: Sexual Assault

Modesett Williams - Thursday, February 12, 2015

In 2012, Mary Rivera was placed in a nursing home after being diagnosed with dementia. She was the beloved mother of 8 who spent her life cleaning nursing homes to support her family. Her daughter went to visit her mother one weekend to find that she was behaving very strangely and appeared injured. Her daughter took her into a hospital that same day where exams concluded that she had been sexually assaulted. 


As disturbing as this case is, it is unfortunately not uncommon. KVUE reports that since September of 2009, over 494 sexual assaults claims have been filed in Texas alone to the Department of Aging and Disabilities Services, otherwise known as DAADS. Of those 494 claims (yes, that many) only 8 have been substantiated as legitimate by the department. Although Mary Rivera's rape kit has not yet been tested by the Austin Police Department, DAADS has already closed her case. It is unacceptable that this many claims have been submitted to DAADS, an organization that should be protecting the elderly, not ignoring claims that ultimately subject them to abuse.


Our own Jack Modesett successfully represented Miss Rivera’s lawsuit. With dedication and perseverance, it is possible that we will end eradicated these disturbing elderly abuse cases.



To view the full article, visit the KVUE website: http://www.kvue.com/story/news/investigations/defenders/2015/02/09/these-are-the-perfect-victims/23144269/

Death of Austin Nursing Home Resident Spurs Investigation, KVUE Discovers Widespread Neglect

Patricia Small - Friday, July 25, 2014

In 2010, Kathy Lee placed her mother in Austin Retirement and Nursing Center, KVUE reports. A few months ago, she received a call from an ICU nurse. Her mom was in the hospital. Within hours, 86-year-old Sadie Brasch was dead. 

According to the KVUE article, the Department of Aging and Disability Services launched an investigation after receiving a complaint lodged after Brasch's death. In February, DADS released a report that found Austin Retirement and Nursing Center put as many as 86 residents with dementia at risk. In addition, the nursing home has been cited more than 100 times over the past few years for multiple reasons. 

KVUE reports that the nursing home did not consult a physician despite a worsening in Brasch's condition, and did not even know Brasch had died until Lee told them. The DADS report determined that many more patients were also put at risk of illness and death due to delays in notifying a physician. According to KVUE, Ben Marks, the administrator for Austin Retirement and Nursing Home, the center does not agree with the state's findings and is appealing the claim that their facility is out of compliance.

Although the nursing home has been fined $16,500 since 2008, only about half of that has been paid, KVUE reports. In fact, KVUE discovered that Texas nursing homes rarely pay initial state fines because state law allows DADS to reduce fines if nursing facilities pay early and promise to correct violations. 

This is a loophole that state Senator Charles Schwertner of Georgetown hopes to correct. 

"That needs to be closed, and those penalties need to be serious penalties and not just seen as the cost of doing business," Schwertner tells KVUE. 

For more information, see the full KVUE report

Nursing Homes Abuse Antipsychotics to Control Patients

Patricia Small - Tuesday, July 22, 2014

A recent article by AARP sheds light on a widespread problem in nursing homes that is putting elderly patients at risk. According to the article, thousands of nursing homes across the country are using unnecessary antipsychotic drugs as chemical restraints to control residents. 

The article quotes Toby Edelman, an attorney at the Center for Medicare Advocacy in Washington, D.C., who points to inadequate training, understaffing, and aggressive marketing tactics by big pharmaceutical companies as the driving force behind this long-standing practice. These large companies target nursing homes as the main distributor of their drugs because these facilities are often highly medicalized but typically have very few doctors on site. Less than a year ago, Johnson & Johnson and its subsidiaries were forced to shell out over $2.2 billion for criminal and civil charges after marketing non-FDA approved drugs to nursing homes, the article reports. 

"When nursing facilities divert funds from the care of residents to corporate overhead and profits, the human toll is enormous," Edelman said.

And indeed, the bottom line is often the most important factor when considering the quality of care received by patients in nursing homes. Nursing homes can cut costs by keeping less full-time staff members, or employing CNAs over full-time physicians. The CNAs working in nursing homes are often underpaid and overworked, a problem that is compounded by residents who require a high level of care, the article reports.

Although by law, nursing homes require informed consent by a patient, or family member if consent by the resident is not possible, before receiving drugs like antipsychotics, many nursing homes administer these medications without authorization, pointing to "bad behavior" as justification for doling out antipsychotics to patients. According to the article, these drugs are not meant for elderly patients or those with Alzheimer's or dementia, but rather for patients with extreme schizophrenia or bipolar disorder. 

"They can dull a patient's memory, sap their personalities and crush their spirits," states a report from the California Advocates for Nursing Home Reform. 

Not only can these drugs make patients agitated, anxious, confused and disoriented, they can also double the risk of death in the elderly, the article reports. Despite knowing the risks associated with antipsychotics, pharmaceutical companies continue to market their products to nursing homes, claiming these drugs work as an effective way to control difficult patients. 

The article details a specific case of overmedication in a nursing home resident, reporting that Patricia Thomas, a 79-year-old nursing home resident, went into a nursing home with a broken pelvis, and died within weeks of being discharged after an 18-day stay. 

According to the article, Thomas's daughter, Kathi Levine, 57, said she "wasn't my mother anymore. She was withdrawn, slumped in a wheelchair with her head down, chewing on her hand, her speech garbled."

The article reports that her short stint in the nursing home exposed her to so many heavy-duty medications, including illegally administered antipsychotics, that she was no longer able to function. For each drug she was given, she was given another drug to counter the side-effects of the first. 

"My mother went into Ventura for physical therapy. Instead, she was drugged up to make her submissive. I believe that my mother died because profit and greed were more important than people," Levine said.

Levine took her case to a Ventura County Superior Court judge, and attorneys from Johnson Moore joined by lawyers from AARP Foundation settled a class-action lawsuit against the nursing home for illegally administering dangerous drugs, the article reports. 

Attorney Kelly Bagby, senior counsel fro AARP Foundation litigation, said, "It is the first case of its kind in the country, and hopefully we can replicate this nationwide."

For more information, see the full article by AARP

The Good Guys are out There

Patricia Small - Friday, June 13, 2014

Texas Elder Abuse and Mistreatment Institute Works to Mitigate the Growing Tide of Elder Abuse

In Harris County, a coalition of clinicians, APS (Adult Protective Services) workers, prosecutors, attorneys, community groups, researchers, academics, business entities, social service agencies and others have formed a clinical and research arm to help stop elder abuse in Texas. The group was formed to educate health professionals, community service workers and the public about the growing problem of elder abuse. 

TEAM takes clients referred by APS who have suffered substantial abuse or neglect, may have complicated medical issues and often have a questionable capacity, and provides a comprehensive geriatric assessment. After this medical assessment, a plan of care is determined by an interdisciplinary team made up of the APS case worker, a social worker, and the TEAM Institute medical team. 

TEAM is also the umbrella organization for H-FAST and EFFORT, which also have a role in protecting the elderly and providing justice for abuse and neglect cases that result in tragedies. H-FAST, the Houston Financial Abuse Specialist Team, works specifically to fight against financial exploitation of the elderly, which is the third most common form of abuse against our elderly. EFFORT, or the Harris County Elder Abuse Fatality Review Team, reviews specific cases of unexpected adult deaths and reports its findings and recommendations to the Harris County Commissioner's Office every two years. 

For more information on TEAM and how you can get involved, visit these sites:





It's Not a Myth

Patricia Small - Tuesday, June 03, 2014

Elder Abuse is Happening in Our Own Backyard

Recent statistics by the National Center on Elder Abuse state that 9.5% of the elderly population suffered some form of abuse in 2010. That is roughly one out of of every ten people over 60 years of age. Despite how shocking those numbers may be, it is difficult to see them as anything other than numbers. Connecting real names and faces to the individuals who experience abuse and neglect can be challenging. We write them off, dismiss these incidents as anomalies or freak accidents.

Unfortunately, these cases hit closer to home than we may want to believe. A recent article by the Houston Chronicle reported the death of two residents in a northwest Houston nursing home after both were beaten to death by another resident with a wheelchair armrest.

According to the article, Antonio Acosta, one of the victims, warned his family about the dangers of his new roommate, even begging them to find somewhere else for him to go. The roommate, 56-year-old Guillermo Correa, was charged with capital murder for the death of Acosta and another roommate, Primitivo Lopez, the article reports. 

This tragic murder sheds some light on a problem that is often not thought about when we talk about abuse in nursing homes. Often we assume that nursing home abuse refers to blatant abuse between a staff member and a resident. However, as was the case in Houston, abuse can also occur between residents. The Houston facility, Lexington Place, refused to comment, the article states. 

These incidents are often yet another result of understaffed nursing homes. More supervision, more time for resident concerns and more careful monitoring of arguments between residents can go a long way in preventing these tragedies. 

Let's Talk Stats

Patricia Small - Tuesday, June 03, 2014

Nursing Home Abuse and Neglect Incidents in Numbers

Long term care facilities are meant to be safe havens for our country's elderly. Families place their loved ones in these homes with the intention of giving them the best life possible and ultimately place their trust in staff members who promise to provide the care and attention each resident deserves. Unfortunately, recent studies reveal there is more to these facilities than meets the eye. 

According to recent studies by the National Center on Elder Abuse, reports of abuse and neglect are on the rise in nursing homes. For many reasons, the elderly are one of the most at-risk populations in the U.S. for verbal, physical and sexual abuse. Many nursing home residents suffer from dementia, Alzheimer's, or an overall decrease in mental acuity. They have trouble recalling events, communicating incidents of abuse effectively and run the risk of not being taken seriously. 

In 2010, the NCEA cited close to six million cases of elder abuse and neglect. Of those six million individuals, 67.3% were women, 18.7% were African American, 10.4% were Hispanic and 66.4% were white. The median age in these cases was about 78 years old. Almost 60% of the cases were reported as neglect, while 15.7% were reported as physical abuse. 

Even more shocking, that same study reported that 91% of nursing homes lack adequate staff to provide residents with the expected quality of care. This might mean that the facility is understaffed, or that the required medical personnel are not on staff, or that staff members are under-qualified or not given proper training. Understaffing is almost always linked to abuse and neglect cases in nursing homes. 

The study also reports that 36% of nursing homes are in violation of elderly abuse laws. In Texas, the Department of Aging and Disability Services investigates claims of elderly abuse and neglect, and while they often recommend that state licensing be terminated, facilities are rarely actually shut down by the state. Penalties for facilities in violation of state laws are often little more than a slap on the wrist.

The NCEA predicts that by 2020, the number of elderly in need of nursing home care will far exceed the available beds in U.S. nursing homes. If changes are not made, and fast, incidents of elderly abuse will continue to rise. 

Texas Nursing Home Abuse and Neglect on the Rise

Patricia Small - Thursday, May 29, 2014

KVUE, ABC's news broadcast channel in Austin, recently did an in depth investigation into a nursing home neglect case. The story reported that the state failed to follow the appropriate procedures in response to a possible sexual abuse case. 

Another recent article by KVUE cited that incidents of abuse and neglect are increasing in Texas. According to the article, DADS is hesitant to terminate contracts with nursing homes despite clear violations of state policies. 

KVUE spoke to a family that uncovered blatant elderly abuse by nursing home staff members by placing a hidden camera in their grandmother's room. Although those staff members recorded abusing the resident were fired, the facility's contract with the state was not terminated. 

See the full story here

Disclaimer of Reliance

Walter Williams - Thursday, May 22, 2014

In commercial real estate sales contracts, particularly for income producing properties like apartment complexes and office buildings, the buyer will frequently rely on the seller’s disclosures regarding historic operations, such as income, expenses and occupancy. Sometimes, though, the seller fills the building with less than desirable tenants or fudges the income numbers to justify a higher sales price. Relying on a seller’s information can cause problems for all sides of the transaction. That’s because the sales contract may have a merger clause, an As-Is clause and/or a disclaimer of reliance provision. Each of these provisions could limit or exclude a buyer’s right to rely on the accuracy of the seller’s information and seek damages for those misrepresentations. In particular, these provisions could have the effect of cutting off a fraudulent inducement claim. 

A fraud claim is particularly important in a real estate sales context because the seller is usually a single purpose entity that distributes  the sales proceeds after the close of the sale and has no other assets, making collection on a judgment that much more difficult.

A.   The Evolution of Fraudulent Inducement and As-Is, Merger and Disclaimer of Reliance Clauses

Until the end of the 1990’s, there was no more absolute rule under Texas jurisprudence than fraud vitiates whatever it touches.  Stonecipher v. Butts, 591 S.W.2d 806, 809 (Tex. 1979); Gulf, Colorado & Santa Fe Ry. v. Jones, 17 S.W. 534, 536 (Tex. 1891) (“Fraud, of course, would vitiate any transaction, however solemnly it may have been executed.”)  The Texas Supreme Court made the point in Dallas Farm Machinery Co. v. Reeves, 307 S.W.2d 233, 239 (Tex. 1957), that as a matter of principle it is necessary to weigh the advantages of certainty in contractual relations against the harm and injustice that result from fraud.  The Court went on to hold “The same public policy that in general sanctions the avoidance of a promise obtained by deceit strikes down all attempts to circumvent that policy by means of contractual devices.” Dallas Farm Machinery Co., 307 S.W.2d at 239.

As recently as 1995, in Prudential Ins. V. Jefferson Assoc., Ltd. 896 S.W.2d 156 (Tex.1995), Justice Hecht wrote for the court that an as-is clause in a contract negotiated at arms-length by sophisticated parties can establish the absence of reliance unless the seller made fraudulent representations or concealed information.   

That changed with Schlumberger Tech. Corp. v. Swanson, 959 S.W.2d 171, 177 (Tex. 1997), which for the first time held that a merger clause in a post-dispute settlement agreement sufficiently negated reliance so as to preclude a claim that the settlement was induced by fraud, where it specified that no party was relying on any statement or representation of any other party.

Thirteen years later, again in the settlement agreement context, in Forest Oil Corp. v. McAllen, 268 S.W.3d 51 (Tex.2008), the Court expanded the scope of earlier decisions, abrogated the Dallas Farm Machinery ruling and held the following facts were most relevant in determining whether a disclaimer of reliance provision was enforceable at all:  (1) the terms of the contract were negotiated, rather than boilerplate, and during negotiations the parties specifically discussed the issue which has become the topic of the subsequent dispute; (2) the complaining party was represented by counsel; (3) the parties dealt with each other in an arm’s length transaction; (4) the parties were knowledgeable in business matters; and (5) the release language was clear. 

The court held out some hope for plaintiffs by noting that a disclaimer of reliance “will not always bar a fraudulent inducement claim,” because situations exist where the disclaimer provision lacks “the requisite clear and unequivocal expression of intent necessary to disclaim reliance” on the “specific representations at issue.”  Id. at 60.

Left open by the Texas Supreme Court was the application of Forest Oil and Schlumberger to pre-dispute agreements containing merger, As-Is or disclaimer of reliance clauses.  Although several appellate courts had applied these cases to pre-dispute agreements, in 2011, the Texas Supreme Court visited the issue again in Italian Cowboy Partners, Ltd. v. Prudential Ins. Co. of America, 341 S.W.3d 323 (Tex. 2011). The Court held that a lease provision did not cut off a fraudulent inducement claim because the language was boiler-plate and the language was not “clear and unequivocal”—the standard set in Schlumberger. Italian Cowboy Partners, Ltd., 341 S.W.3d at 336.  Italian Cowboy is significant, because it did not hold that disclaimer of reliance is only effective in settlement agreements, where the parties wish to finally resolve their disputes and end their dealings.

In 2012, the San Antonio court of Appeals applied the Schlumberger, Forest Oil and Italian Cowboy cases to affirm summary judgment against five tenants alleging a landlord had mislead them to get them to sign leases in a commercial development.  In that case, the court held that a properly worded merger clause barred the fraudulent inducement claims arising out of a pre-dispute agreement. Dragon Fish LLC v. Santikos Legacy Ltd., 383 S.W.3d 175, (Tex. App. --San Antonio 2012, no pet. h.). The Court found the following clause in the lease negated reliance and barred the claim:

Landlord and Tenant hereby acknowledge that they are not relying upon any brochure, rendering, information, representation or promise of the other, or an agent or broker, if any, except as may be expressly set forth in this lease.Dragon Fish LLC, 383 S.W.3d at 179.

Months earlier, in Allen v. Devon Energy Holdings, LLC, 367 S.W.3d 355  (Tex. App. –Houston [1st Dist.] 2012,  pet. granted, judgm't vacated w.r.m.), one owner sold his interest in a company to the other owner, who later sold the whole company for 20 times the amount purchased from his former partner.  The Houston Court of Appeals reversed the summary judgment and remanded the case because, the release language in the contract did not (1) "clearly express[es] the parties' intent to waive fraudulent inducement claims" or (2) "disclaims reliance on representations about specific matters in dispute."  Indeed, the defendant relied on a general release, which is typically insufficient to bar fraud claims. Allen, 367 S.W.3d at 368. 

B.  Additional Arguments When Faced with Merger, As-Is and Disclaimer Provisions

1.  “As-Is” Provisions Limited to Physical Condition of the Property


As-Is contractual provisions typically apply only to the physical condition of the property.  Gym N-I Playground v. Snider, 158 S. W. 3d 78, 85 (Tex. App. –Austin 2005, pet. filed)(As-is clause relates to claims associated with the physical condition of the property); Wellwood v. Cypress Creek, 205 S. W. 3d 722, 726  (Tex. App. –Dallas 2006, no pet.). 

The court in Coldwell Banker Whiteside Assoc. v. Ryan Equity Partners, Ltd., 181 S. W. 3d 879, 886-86 (Tex. App. –Dallas 2005, no pet.) helpfully interpreted the legal import of the term “defect” in a real estate sales contract and limited that definition to “some irregularity in “a surface or a structure” of the Property that mars its appearance or causes some aspect of the Property to weaken or fail. “ 

2.  Fraudulent Representations Contained In Contract

In IKON Office Solutions, Inc. v. Eifert, 125 S.W.3d 113, 128 (Tex. App. – Houston [14th Dist.] 2003, pet. denied), the court distinguished between fraud claims based on extra contractual statements, which it held were barred by the merger doctrine (related to As-Is and disclaimer of reliance provisions) and claims based on representations that were ultimately included in the contract.

3. Interpretation of Agreement Would Render Contractual Representations Meaningless

Similar to situations where the misrepresentation is in the agreement itself, sometimes, the As-Is or disclaimer of reliance language would render earlier and more specific contract language meaningless, making a narrow interpretation of these provisions more consistent with the parties’ intent when they signed the contract.  In that instance, the plaintiff may want to argue that the As-Is or disclaimer language should be limited, depending on the structure of the agreement. 

In construing parties’ obligations under a contract, the court’s primary concern is to ascertain and give effect to the intentions of the parties as expressed in their agreement. Kelley-Coppedge, Inc. v. Highlands Ins. Co., 980 S.W.2d 462, 464 (Tex.1998). To ascertain the parties' true intentions, courts must examine the entire agreement in an effort to harmonize and give effect to all of the provisions of the contract so that none will be rendered meaningless. MCI Telecomms. Corp. v. Tex. Utils. Elec. Co., 995 S.W.2d 647, 652 (Tex.1999).

In the commercial real estate sales context, as-is, merger and disclaimer of reliance provisions could be as important as having good title.  If you are relying on the seller’s disclosures and they turn out to be wrong, your options may be limited. 

Selecting a Nursing Home: What to Look For

Patricia Small - Thursday, May 22, 2014

Choosing the Right Long-Term Care Facility for Your Loved One

The decision to place a loved one in a nursing home can be difficult for everyone involved. It requires careful thought, detailed planning and willingness to turn the care of your loved one over to another person. Inevitably, there may be anxiety over whether the nursing home is providing proper care and treatment to the residents. When choosing a long-term care facility, there are several factors you will want to consider to ensure that your loved one gets the best care possible and continues living a comfortable, happy life.

There is no one-size-fits all nursing home. It is important to find a facility that meets the unique needs of your loved one. You want to find a place where your entire family feels comfortable and at home. Don't be afraid to take time making the decision, and make multiple visits to the facility if you feel it is necessary. Choosing a home can feel daunting. Here is a list of tips and questions you want to consider when deciding on a nursing home.

Overall Impression

Before you even decide to visit a nursing home, think about the location in terms of proximity to you, a hospital and your loved one's personal physician. Make sure the location is convenient for friends and family to visit. On your visit, ask to see documentation that the facility is licensed to operate by the state. 

Some things to notice on your visit:

-Are the building and grounds well cared for?
-Does everything look clean and attractive?
-Is there a receptionist desk when you walk in with someone who can assist you?
-Does the interaction between staff and patients seem warm and respectful?
-Are there any unpleasant or overwhelming odors?
-Are hallways clear of clutter and well lit?
-Is the overall atmosphere pleasant and homey?
-Do any other residents have conditions similar to your loved one?
-Are the residents clean, appropriately dressed and well groomed?
-Are the other residents willing to talk about how they like the residence and staff?
-Do the residents seem to be appropriate housemates for your loved one?
-Does the staff seem to genuinely enjoy working with the residents?
-Does the staff appear to care about and respect the residents?
-Does the staff treat the residents as individuals?
-Are staff members that you pass during your tour friendly to you?
-Are your questions answers clearly, frankly, and in sufficient depth?
-Is the community designed for resident's needs?
-Is the floor plan easy to follow?

Health and Safety

Your loved one's health and safety is of the utmost importance in a nursing home. The facility should be able to provide more than adequate accommodations for the successful care of your elderly family member. Ask to see the most recent State inspection report. If there were any deficiencies, ask to make sure they have since been corrected by the facility. 

Other things to pay attention to in relation to health and safety:

-Does the home have arrangements for emergency situations with a nearby hospital?

-Are there handrails in the hallways an support bars in bathrooms?

-Are exits clearly marked, and are there visible emergency plans?

-Are there smoke detectors and sprinklers?

-Are fire extinguishers easy to locate?

-Are doorways wheelchair accessible? 

-Are there safety precautions to prevent residents from falling during moves or down the stairs?

-Are spills and other accidents cleaned up quickly?

-Is there a written care plan for each resident?

-How long after admission is the care plan written?

-Are the family and resident involved in writing the care plan?

-What is the procedure for assessing a potential resident's need for special care of services?

-Are those needs reassessed periodically?

-Is there a doctor/physician on site? How often?

-How is medication administered? Who administers it? Are there circumstances where a resident has control over their own medication?

-Is staff available to provide 24-hour assistance with activities of daily living (ADL) if needed? Including:




-Hygiene and Grooming




-Using the Phone


-Housekeeping in Unit

-Transportation to doctor, hairdresser, activities, etc.


-Walking/caring for pets

Nutrition is a large part of your loved one's care in a nursing home. This is an area you may want to ask many questions, and perhaps even observe mealtimes during your visit. Some things to consider in terms of food:

-Does the residence provide three nutritionally balanced meals a day, seven days a week?
-Are meals provided at a time chosen by the resident, or are there set times for meals?
-Can the resident choose what they want to eat? Are options provided?
-Do the meals look appetizing, cooked properly, and nutritional?
-Do residents participate in meal planning?
-Are options available for residents with special dietary needs, ie. diabetes?
-Can residents request special foods?
-Are snacks provided?
-Are common dining areas available?
-Can residents eat meals in their units?
-Are residents rushed through meals? Or do they have time to finish eating and socialize?
-Are residents allowed to choose whom they eat meals with?
-If residents need help eating, do care plans specify the type of assistance they will receive?
-Will the staff make accommodations for residents whose medication affects what they can eat?
-Is water always available and easily accessible to residents?

Administration and Management

It is important to understand how the nursing home is organized in terms of management. You might ask if the facility is non profit or for profit, who it is owned by, and what the hierarchy of management is. Ask to review the latest state survey and/or monitoring report. This should be in a public place where anyone can see it. Some other questions to keep in mind:

-Is the facility in good standing with the state inspectors?
-Are family and resident councils independent from the nursing home's management?
-Do the charge nurses, social workers, department heads, and top-level administrators have geriatric experience and/or education?
-Are care plan meetings held at times that are independent from the nursing home's management?
-Are visiting hours reasonable?
-What is the policy on insurance and personal property?


The staff members at a nursing home are one of the most important factors in your loved one's life in a nursing home. They are the ones performing day-to-day care-taking tasks, responding to resident emergency calls, and spending time with residents. You want to feel comfortable with staff members. They should be warm and friendly and treat residents with respect and care. You also want to ensure that there are always enough staff members present to give residents adequate care.

Some other things you want to look for in nursing home staff:

-Do nursing home staff respond quickly to requests for help?
-Do administrators and staff seem comfortable with each other and with the residents?
-Do residents have the same care givers on a daily basis?
-Are there enough staff members at night, on week-ends and during holidays to care for the resident?
-Are there enough staff members to help move residents quickly in an emergency?
-Are other residents comfortable with the staff?
-Can you ask residents how they feel about the staff members?
-Are there regular training sessions for staff members?
-Are staff members taught to recognize, prevent or stop physical or sexual abuse among residents?

Contracts, Services and Fees

You want to understand what kind of contract you are entering into when you decide on a nursing home. Be sure to ask any questions you have, and also be sure that the questions are answered clearly and in depth. 

Some questions you might want to ask:

-When may a contract be terminated?
-Under what conditions would a resident be asked to leave a nursing home?
-Are there any government, private, or corporate programs available to help cover the cost of services?
-These might include Medicare, Medicaid, private insurance, VA benefits, etc.
-What is the cost per day? Per month?
-What services are included in that cost?
-Can the contractual agreements include accommodations, personal care, health care and supportive services?
-Are additional services available if the resident's needs change?
-Are there different costs for various levels or categories of service?
-What are the billing, payment and credit policies?
-How often are rates increased?
-Can a resident handle their own finances with staff assistance if capable, or should a family member be designated to do so?
-What services are available without leaving the building? How are these services paid for?
-Dental care, vision care, podiatry services, hearing services, hair/beauty salon.

Quality of Life

Placing a family member in a nursing home means giving him or her the best chance to maintain a high quality of life. You want to make sure your loved one still has some control over how free time is spent, personal appearance, and living quarters. 

These are some questions you may want to ask in regard to your loved one's quality of life at the nursing home?

-Can residents make choices about their daily routine? When to get up, go to bed, bathe, and eat. 
-Does the nursing home meet your cultural, religious, or language needs?
-Does the home maintain comfortable temperatures?
-Are the residents allowed to have personal articles and furniture in their units?
-Do the public spaces and resident rooms have comfortable furniture?
-Is the nursing home and public spaces generally quiet?
-Are there outdoor areas for resident use? Are staff members available to assist residents outside?
-Do faucets, call buttons, phones and TV sets work?
-How often will residents get a shower? Can residents take baths instead of showers if they prefer?
-If a resident needs help with hygiene tasks, such as teeth brushing/denture cleaning, is that help available? How often?
-Are residents able to dress in the clothing of their choice? Or do they need to dress in sweats or gowns?
-Is transportation provided to medical appointments, haircuts, grocery stores, etc.?

Your loved one's personal unit is a very important aspect of their life in a nursing home. It is a resident's personal space and their home, potentially for the rest of their life. Do your best to make this space as comfortable as possible for your resident.

-Do residents have their own lockable doors?
-Is a 24-hour emergency response system accessible from the unit?
-Are rooms private or shared?
-Are bathrooms private with handicap accommodations?
-Are residents able to bring their own furnishings for their unit?
-What are residents allowed to bring with them?
-Do all units have a phone and cable TV? How is billing handled?
-Is a kitchen area/unit provided in units?
-Are residents allowed to keep food in their units?
-What are the smoking policies in rooms and shared spaces?
-Are pets allowed, either by residents or visitors?
-What is the policy on insurance and personal property?

Social Events and Activities

The transition from living at home to living in a nursing home can often be jarring. One of the ways to minimize some of the stress and unpleasantness that can come up as a result of a move to a nursing home is to get involved in social events and activities. Residents should be able to choose from a variety of interesting and relevant activities that allow them to socialize and match their level of mental acuity and mobility.

These are some questions you may want to ask regarding resident activities:

-Are planned, posted and varied recreational and social activities available?
-Are residents able to choose from a variety of activities they like?
-Do the activities seem interesting and appropriate?
-How many activity staff does the facility employ?
-Is there a recreational therapist on staff?
-Do residents have a voice in planning activities?
-Do residents seem interested in participating in activities?
-Are there special activities for people with dementia?
-Are activities provided for residents that are unwilling or unable to leave their rooms?


Inevitably there are some bits and bobs that need to get worked out when choosing a nursing home.

Here are some additional things you may want to ask:

-What types of behavioral issues are you able to handle?
-Do you keep documentation of all the behavior interventions you use?
-Will the family be informed of any incidents, major or minor, suggested medication changes, etc.?
-Under what circumstances would a resident be asked to move or transfer? How long would you have to make other arrangements? Will the facility help with those arrangements?
-Can your loved one continue seeing their personal physician?
-What are all of the visitation policies?
-How is laundry handled? Do residents have the option of doing laundry themselves, or can the family do laundry, if the facility sends it out?

The transition to a nursing home can be difficult, both for the resident and the rest of the family. It is crucial that you support your loved one making this transition. Plan to spend a few hours with your love one on the day of the move to help him or her get settled. Understand your loved one may be hurt or angry and do not take it personally. Remember you are doing the best thing for the entire family. 

It is important to visit regularly and to pay attention to the care your loved one is receiving at their new home. Encourage other family and friends to do the same. If anything sets off red flags, feels off, or is downright wrong, don't hesitate to ask questions, demand to speak to management, file a report with the the home's administration or management or go directly the State and file a complaint. You can visit the DADS site for information on how to do this. 

Getting involved with the nursing home is another great way to remain connected to your loved on and become a part of the community. It also keeps you informed about the nursing home. You can volunteer, join a committee, or become part of a council. 

All of these steps will help ensure that your loved one receives the best care possible and continues living a high quality, happy life and will help protect your loved one from neglectful or abusive facilities. 

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