Tuesday, February 17, 2009

Investigating Nursing Home Options

Since my early years in senior care, many different options have emerged. I will address these in future blogs, but here I would like to educate you on choosing a nursing home. I have worked in "poor" nursing homes, and in the "rich" ones, and the only real difference was the decor.

To choose a nursing home it is imperative to investigate. There are several ways to do this. You should never make an appointment to tour. Show up unannounced, and ask to tour the facility. Facilities that are proud of the care, will not hesitate. I believe it is a huge red flag if they want to schedule an appointment for a tour.When you tour take note of the patients and staff. Are the patients clean, and interacting with staff? Are the staff professional looking, and appear to like their jobs, or do they look miserable? How does the staff talk to patients? Do you see an adequate number of staff available? Take note of the facility. Is it clean in all areas? I know from experience that many people are looking for smells. Smells can emerge and dissipate in even the best facilities, so understand that as you tour.If you like what you've seen, ask for their latest survey, if you don't, cross it off your list, and move on to the next.

Surveys are a great indication of the care and conditions. You need to know that every facility will have infractions. Surveyors do not leave a facility without citing the facility for something. Once the survey is complete, the facility is given a specific time frame to respond with their action plans. Typically if the infractions are serious enough, a subsequent survey will be scheduled, so note the next survey date. Reading the survey citations, and facility responses will take some common sense on your part. Red flags are multiple decubitis ulcers, or bed sores, high amounts, and frequent injuries, and cases of abuse or neglect. All facilities will have illnesses and injuries. These things cannot be 100% prevented even if there were a 1:1 ratio of staff to patient.

Try and find if there has been or is any pending litigation on the facility. We all know in the day and age of suing someone, just to sue, there could be a case. It's the multiples that should really draw attention.

Ask what kind of background checks are performed on employees. Don't just settle for we do them. Ask where does the information come from? Database, state, and national checks are NOT enough. County checks are the most accurate and up to date. I will address this further in a future blog.

If you are satisfied with the investigation thus far, end this part of the visit. Return in the evening at dinner time or on the weekend. One reason is nursing homes are very busy places weekdays. All the administrative staff, therapy, social workers, physicians, clerical, kitchen and maintenance staff is there during the day. Nursing homes become much quieter places in the evening and weekends. I say to visit at dinner, because most likely you will find family members of patients either visiting, or feeding their loved ones at dinner. Most family members will be more than willing to give you their opinion about the care, so ask them. Ask about the care, the food, the cleanliness, the response time when a patient needs something, and how their family member has done since they came there. Some will decline due to health conditions, but if they're all declining because they're miserable, that's another story. You will want to ask more than one family because you can't please all of the people all of the time, and my experience has shown that patients who have family members that visit daily to very frequent will have better or more prompt care than those who don't. The last thing the staff wants is multiple complaints from family members. This is also a great time to see how the staff interacts with the patients. Are they kind, patient, respectful? Or are they treating the patients in an undignified, disrespectful, rushed manner? Are they socializing with the patients or with each other? It is important you know that the labor pool for nursing homes is very limited. These are back breaking, high stress jobs that pay very little. The worst nursing homes can have employees that are kind, and caring, and the best homes can have less than good employees. It really comes down to the administration. Bad administrators will not keep good employees because the frustration and stress levels are too high for caring employees. The good administrators will terminate bad employees when they know they have one. So I recommend looking at the whole picture in your investigation. Ask how patients spend their time? What activities are available and what is the percentage of participation? Patients have rights, and can refuse. Some homes are better at getting their patients to participate than others.

Finally, if your loved one is receiving any type of care, whether it's a nursing home, assisted living, hospital, home health, private duty homecare, or hospice, and you feel there is a problem, please bring it to the attention of someone who can resolve it. Employees are not constantly supervised in any setting. There may be problems that supervisors or administration are unaware of. Many companies want to resolve problems, and maintain a good level of care, and improve their services, but if they do not know about a problem, they cannot resolve it. You will learn more about a company by the way they handle issues than anything else.

I hope this blog has left you with a little more information and knowledge to use for yourself or pass on to someone in need. The more empowered we all become, the less we will tolerate substandard care for our society's seniors.

Please leave any comments or helpful tips for other readers.
You can reach Angil Tarach-Ritchey by email at Angil@behiundtheoldface.com

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