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.
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:
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:
-Hygiene and Grooming
-Using the Phone
-Housekeeping in Unit
-Transportation to doctor, hairdresser, activities, etc.
-Walking/caring for pets
Administration and Management
-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?
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?
-What is the cost per day? Per month?
-These might include Medicare, Medicaid, private insurance, VA benefits, etc.
-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:
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.
-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?
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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